ANXIETY DISORDERS

Course Title: Mental health and psychopathalogy-1

SUBMITTED BY:
Misbah Shabeer
Alveena Fatima Malik
Javeria
Iqra Fatima
Ayesha Waseem
Fatima Hassan
Sahiba Shabeer
SUBMITTED TO: Mam Kehkashan

Date: December 19, 2022

Department of Psychology
Faculty of Social Sciences
International Islamic University, Islamabad
Contents
Anxiety.......................................................................................................................................................... 4
General symptoms of Anxiety ................................................................................................................... 4
Anxiety is different From Fear .................................................................................................................. 5
Case for Anxiety Disorder ......................................................................................................................... 5
SPECIFIC PHOBIA...................................................................................................................................... 5
Definition .................................................................................................................................................. 6
Types of Specific Phobias .......................................................................................................................... 6
Symptoms ................................................................................................................................................. 7
DSM-5 Criteria for a Specific Phobia Diagnosis......................................................................................... 8
Causes/Etiology of specific phobia: .......................................................................................................... 8
Treatment ................................................................................................................................................. 9
SOCIAL ANXIETY DISORDER .............................................................................................................. 10
What is social anxiety disorder? ............................................................................................................. 10
Symptoms ............................................................................................................................................... 10
Causes ..................................................................................................................................................... 11
Diagnosing social anxiety disorder:......................................................................................................... 11
Treatment ............................................................................................................................................... 12
PANIC DISORDER.................................................................................................................................... 13
What is a panic attack? ........................................................................................................................... 14
How common are panic attacks? ........................................................................................................ 14
Who might have panic attacks? .......................................................................................................... 14
Symptoms ............................................................................................................................................... 14
Causes ..................................................................................................................................................... 16
Risk factors .............................................................................................................................................. 16
Complications.......................................................................................................................................... 17
Prevention ............................................................................................................................................... 17
Diagnosis ................................................................................................................................................. 18
Management and treatment .................................................................................................................. 18
How are panic attacks managed or treated? ........................................................................................ 18
AGORAPHOBIA ....................................................................................................................................... 19
Causes ..................................................................................................................................................... 19
Symptoms ............................................................................................................................................... 20
 Risk factor ............................................................................................................................................... 20
Diagnosis ................................................................................................................................................. 20
Treatment ............................................................................................................................................... 21
GENERALIZED ANXIETY DISORDER ................................................................................................. 23
Difference between GAD and normal anxiety? ...................................................................................... 24
Does GAD lead to panic attacks? ............................................................................................................ 24
SYMPTOMS ............................................................................................................................................. 24
DIAGNOSTIC CRITERIA ............................................................................................................................ 25
CAUSES .................................................................................................................................................... 26
TREATMENT ............................................................................................................................................ 27
What assessments are used for generalized anxiety disorder? ............................................................. 29
SUMMARY ............................................................................................................................................... 29
ETIOLOGY OF ANXIETY DISORDERS ................................................................................................ 29
Genetic Causes: ....................................................................................................................................... 31
Neurobiological Factors .......................................................................................................................... 32
Personality Factors.................................................................................................................................. 32
Gender; ................................................................................................................................................... 34
Culture: ................................................................................................................................................... 35
REFERENCES ........................................................................................................................................... 36
Misbah Shabeer 1516

Anxiety
It is an unpleasant type of feeling. An emotion characterized by feelings of tension, worried
thoughts and physical changes like increased blood pressure. People with anxiety disorders
usually have recurring intrusive thoughts or concerns.

General symptoms of Anxiety

Physical symptoms
• Cold or sweaty hands.
• Dry mouth.
• Heart palpitations.
• Nausea.
• Numbness.
• Muscle tension.
Mental Symptoms
• Feeling panic.
• Fear.
• Nightmares.
• Repeated thoughts.
• Uncontrollable, obsessive thoughts.
Behavioral symptoms
• Washing hands repeatedly.
 • Trouble in sleeping.
• Inability to be still and calm.
How Anxiety is different from Fear?

Anxiety is different From Fear

➢ Anxiety is defined as a prediction over an anticipated problem whereas fear is a reaction to
immediate danger. Psychologist focus on the ‘immediate aspect of fear versus the
‘anticipated aspect of anxiety fear tends to be about a threat happening now, whereas
anxiety tends to be about future threat. Thus, a person facing a snake experiences fear,
whereas a college student concerned about the possibility of unemployment after
graduation experiences anxiety.
➢ Both Anxiety and fear can involve arousal.it means both evokes alert about any danger or
threat. Anxiety involve moderate arousal and fear involves higher arousal. A person
experiencing anxiety may feel no more than restless and physiological tension. Whereas
person experiencing fear may sweat profusely, breathe rapidly. And feel an overpowering
urge to run.
➢ Anxiety and fear are not necessarily “bad”-in fact, both are adaptive. Fear creates fight and
flight reactions. That it brings changes in our sympathetic nervous system and prepares
body to run away from danger or fight with it. In some circumstances fear saves life.
Imagine a person who faces a snake or bear and experiences no impulse flee, no surge in
energy to run away, the situation will be harmful for that person. Fear is high alarming
where there is death causing threat present. For example, lion, earthquake. Similarly,
anxiety is helpful when it is normal. It helps to avoid dangerous situations, helps us notice
and plans for future threats, increases our preparedness and enhances our performance.

Case for Anxiety Disorder

Girl name, Jenny 23-year old student of medical school. She is going through hard time due to
long hours, academic challenges of medical school and also her mother had developed cancer. One
day while attending rounds, she found herself feeling lightheaded and dizzy. The attending
physician asked the students to diagnose and explain the given case, on that day Jenny became
extremely worried these questions when her turn came. As she brought about this, her heart began
to pound and palm began to sweat. Due to fear of something that happens wrong she left the room
without explaining the departure. After departure at night she could not sleep and thinking of how
to explain the reason of her departure and wondering what will happen if it happens again. One
week later, while driving to school she experiences the same previous attacks and took off from
school. After this she avoided public situations, group study and friends gathering. Despite her
withdrawal, she experienced three more attacks each in unexpected situations. She consults
psychologist and confirmed that she is experiencing panic disorder and they started cognitive
behavioral therapy.
Javeria 1475
 SPECIFIC PHOBIA
Definition
The term "phobia" refers to a group of anxiety symptoms brought on by certain objects or situations.
Specific phobia is an intense, irrational fear of something that poses little or no actual danger.
Although adults with phobias may realize that these fears are irrational, even thinking about
facing the feared object or situation brings on severe anxiety symptoms.

Types of Specific Phobias

There are five types of specific phobias:

1. Natural/environment type: These are phobias of nature, weather, and environmental events
or situations. These can include the fear of thunder and lightning (astraphobia)
or water (aquaphobia).
2. Injury type: This type of fear is related to a fear of physical harm or injury. These include a
fear of the dentist (dentophobia) or injections (trypanophobia).
3. Animal type: These fears are centered on animals or insects. This can include the fear
of dogs (cynophobia), snakes (ophidiophobia), and insects (entomophobia).
4. Situational type: This type of phobia centers on fears triggered by specific situations. These
include the fear of washing (ablutophobia) and enclosed spaces (claustrophobia).
5. Other types: Fears that don't fit into the other four types are included in this category. This
can include things such as a fear of dolls, vomiting, or loud sounds.

The most common specific phobias include:

• Claustrophobia: Fear of being in constricted, confined spaces

• Aerophobia: Fear of flying
• Arachnophobia: Fear of spiders
• Driving phobia: Fear of driving a car
• Emetophobia: Fear of vomiting
• Erythrophobia: Fear of blushing
• Hypochondria: Fear of becoming ill
• Zoophobia: Fear of animals
• Aquaphobia: Fear of water
• Acrophobia: Fear of heights
 • Blood, injury, and injection (BII) phobia: Fear of injuries involving blood Trusted
Source
• Escalaphobia: Fear of escalators
• Tunnel phobia: Fear of tunnels

These are far from the only specific phobias. People can develop a phobia of almost anything.
Also, as society changes, the list of potential phobias changes. For instance, nomophobia is the
fear of being without a cell phone or computer. A person can have more than one specific phobia.

Symptoms

A person with a phobia will experience the following symptoms. They are common across the
majority of phobias:

• a sensation of uncontrollable anxiety when exposed to the source of fear

• a feeling that the source of that fear must be avoided at all costs
• not being able to function properly when exposed to the trigger
• acknowledgment that the fear is irrational, unreasonable, and exaggerated, combined with
an inability to control the feelings
• A person is likely to experience feelings of panic and intense anxiety when exposed to the
object of their phobia.
• The physical effects of these sensations can include sweating, abnormal breathing,
accelerated heartbeat, trembling, hot flushes or chills, a choking sensation, chest pains or
tightness, butterflies in the stomach, pins and needles, dry mouth, confusion and
disorientation, nausea, dizziness, headache.
• A feeling of anxiety can be produced simply by thinking about the object of the phobia. In
younger children, parents may observe that they cry, become very clingy, or attempt to
hide behind the legs of a parent or an object. They may also throw tantrums to show their
distress.
When to see a doctor

• An unreasonable fear can be an annoyance having to take the stairs instead of an elevator or
driving the long way to work instead of taking the freeway, for instance but it isn't considered
a specific phobia unless it seriously disrupts your life. If anxiety negatively affects functioning
in work, school or social situations, talk with your doctor or a mental health professional.
• Childhood fears, such as fear of the dark, of monsters or of being left alone, are common, and
most children outgrow them. But if your child has a persistent, excessive fear that interferes
with daily functioning at home or school, talk to your child's doctor.

• Most people can be helped with the right therapy. And therapy tends to be easier when the
phobia is addressed right away rather than waiting.

DSM-5 Criteria for a Specific Phobia Diagnosis

A fear and a phobia are not the same, so it's important to know the difference. Many people
experience fears or aversions to objects or situations, but this does not necessarily mean that they
would be diagnosed with a specific phobia.

Therapists cannot use a lab test to make this diagnosis, so they and other mental health
professionals consult the DSM-5 (Diagnostic and Statistical Manual, 5th Edition). This guide
provides diagnostic criteria for specific phobia from the American Psychiatric Association:

• Unreasonable, excessive fear: The person exhibits excessive or unreasonable, persistent

and intense fear triggered by a specific object or situation.
• Immediate anxiety response: The fear reaction must be out of proportion to the actual
danger and appears almost instantaneously when presented with the object or situation.
• Avoidance or extreme distress: The individual goes out of their way to avoid the object or
situation or endures it with extreme distress.
• Life-limiting: The phobia significantly impacts the individual’s school, work, or personal
life.
• Six months duration: In children and adults, the duration of symptoms must last for at least
six months.
• Not caused by another disorder: Many anxiety disorders have similar symptoms. A doctor
or therapist would first have to rule out similar conditions such
as agoraphobia, obsessional-compulsive disorder (OCD), and separation anxiety disorder
before diagnosing a specific phobia.

In previous DSM editions, adults with specific phobias had to recognize that their fears are out of
proportion to reality, but children did not. The 2013 edition now says the adults no longer have to
recognize the irrationality of their behavior to receive a diagnosis.

Causes/Etiology of specific phobia:

There are a number of different factors that can contribute to the development of specific phobias.
These include:
 • Temperament: Research suggests that people who exhibit more behavioral inhibition have
a higher risk for a variety of anxiety disorders, including specific phobias.
• Genetics: People who have a family member with an anxiety disorder or phobia are more
likely to also develop some type of phobia.
• Traumatic Experiences: Stressful or traumatic experiences can also play a role in the
formation of a phobia. A single incidence of being bitten by a dog, for example, can play
a role in the development of a fear of dogs.
• Fear can be learned from others, as well. A child whose parents react with fear and anxiety to
certain objects or situations is likely to also respond to those objects with fear.

• Phobias that start during childhood can also be caused by witnessing the phobia of a family
member. A child whose mother has arachnophobia, for example, is much more likely to
develop the same phobia.
• Classical conditioning:

The process of classical conditioning can explain how we acquire phobias. For example, we learn
to associate something we do not fear, such as a dog (neutral stimulus), with something that triggers
a fear response, such as being bitten (unconditioned stimulus). After an association has formed,
the dog (now a conditioned stimulus) causes a response of fear (conditioned response) and
consequently, we develop a phobia.

• Operant conditioning:

According to operant conditioning, phobias can be negatively reinforced. This is where a behavior
is strengthened because an unpleasant consequence is removed. For example, if a person with a
phobia of dogs sees a dog whilst out walking, they might try to avoid the dog by crossing over the
road. This avoidance reduces the person’s feelings of anxiety and negatively reinforces their
behavior, making the person more likely to repeat this behavior (avoidance) in the future.

Treatment
While specific phobias can be serious and debilitating, effective treatments are available. These
can help reduce or even eliminate symptoms. They include:

1.Medication

While medication is not usually used on its own to treat phobias, it may sometimes be prescribed
to help people manage physical and emotional reactions associated with phobias.
Such medications are usually most effective when paired with psychotherapy.

2.Psychotherapy

There are a number of psychotherapy techniques that may be used to treat phobias, but exposure
therapy and cognitive-behavioral therapy (CBT) are the two that are more commonly used.
 • Exposure therapy involves gradual and progressive exposure to the feared object or
situation. Such exposure is paired with relaxation strategies until the fear reaction is
reduced or extinguished. For example, picture of spider, touch picture, look at spider in
a glass case, spider in someone else's hand, spider in your hand, etc.

• Cognitive-behavioral therapy involves helping people learn to identify and then

change the automatic negative thoughts that contribute to phobic reactions. Cognitive
behavioral therapy (CBT) is the most commonly used therapeutic treatment for phobias.
It involves exposure to the source of the fear in a controlled setting. This treatment can
decondition people and reduce anxiety. The therapy focuses on identifying and changing
negative thoughts, dysfunctional beliefs, and negative reactions to the phobic situation.
New CBT techniques use virtual reality technology to expose people to the sources of
their phobias safely.

Iqra Fatima 1510

SOCIAL ANXIETY DISORDER

What is social anxiety disorder?
Social anxiety disorder, which is sometimes known as social phobia is a type of anxiety disorder
that causes anxiety or fear in social settings. Someone person with this disorder has trouble to talk
with people, meeting new people, and attending social gatherings. They feel anxious about others
judging or scrutinizing them. They may understand their fears are irrational but feel powerless to
overcome them. Social anxiety is different from shyness. Shyness can make socializing, school,
and work difficult, but it doesn’t disrupt life to the same extent as social anxiety. Social anxiety is
persistent and overwhelming and may affect everyday activities, such as shopping for groceries
etc.

Symptoms

Some symptoms of social anxiety disorder are following

• Blushing
• Sweating
• Trembling or shaking
• Nausea
• Difficulty in speaking
• Rapid heartbeat
• A rigid body stance
 • Intense worry before, during, and after a social situation
• Concern that others will notice you are stressed or nervous
• Missing school or work because of anxiety

People with social anxiety disorder have constant fear that other people are judging them. They
may avoid all situations, including;
• Asking a question
• Job interviews
• Shopping
• Talking on phone
• Eating in public
• Using public restrooms

Causes
The exact cause of social anxiety disorder is unknown, but it may result from a combination of
factors .Physical, biological, and genetic factors likely play a role, according to scientists.
Problems with neurotransmitter systems may lead to imbalances in the hormones serotonin,
dopamine, and glutamate. These brain chemicals help regulate mood. Environmental factors may
contribute, but only as part of a complex interaction that also involves biological and genetic
features, some experts say. Negative experiences may lead to a type of post-traumatic stress
disorder (PTSD), where social anxiety is a symptom. Anxiety disorders can run in families, but
it’s unclear whether this is due to genetic or environmental factors.

Diagnosing social anxiety disorder:

There is no medical test to check for social anxiety disorder, but a doctor will use criteria from
Diagnostic and Statistical Manual of Disorders Fifth Edition (DSM-5).

They will likely ask about;

• your symptoms
• your family history
• other health conditions

• The criteria for assessing social anxiety disorder according to the DSM-5 are: a fear of one
or more social situations that could involve scrutiny from others
 • having a fear of acting in a way that will lead to a negative evaluation by others, or upset
or offend others
• a specific situation nearly always provokes fear or anxiety
• the person either avoids the situation or attends with intense anxiety or fear
• fear is out of proportion to the threat
• fear or anxiety is persistent, usually lasting 6 months or more
• fear and anxiety disrupt daily living
• other symptoms or health conditions cannot explain the fear and anxiety the person feels

Treatment

Treatment depends on how much social anxiety disorder affects your ability to function in daily
life.

Psychotherapy:

The most common treatment for social anxiety disorder includes psychotherapy (also called
psychological counseling or talk therapy) or medications or both. Psychotherapy improves
symptoms in most people with social anxiety disorder. In therapy, you learn how to recognize and
change negative thoughts about yourself and develop skills to help you gain confidence in social
situations. Cognitive behavioral therapy (CBT) is the most effective type of psychotherapy for
anxiety, and it can be equally effective when conducted individually or in groups. In exposure-
based CBT, you gradually work up to facing the situations you fear most. This can improve your
coping skills and help you develop the confidence to deal with anxiety-inducing situations. You
may also participate in skills training or role-playing to practice your social skills and gain comfort
and confidence relating to others. Practicing exposures to social situations is particularly helpful
to challenge your worries.

First choice Meditation:

Though several types of medications are available, selective serotonin reuptake inhibitors (SSRIs)
are often the first type of drug tried for persistent symptoms of social anxiety. Your health care
provider may prescribe paroxetine (Paxil) or sertraline (Zoloft). The serotonin and norepinephrine
reuptake inhibitor (SNRI) venlafaxine (Effexor XR) also may be an option for social anxiety
disorder. To reduce the risk of side effects, your health care provider may start you at a low dose
of medication and gradually increase your prescription to a full dose. It may take several weeks to
several months of treatment for your symptoms to noticeably improve.

Other Meditations:

Your health care may provide medicines like,

• Other antidepressants. You may have to try several different antidepressants to find the
one that's most effective for you with the fewest side effects.

• Anti-anxiety medications. Benzodiazepines may reduce your level of anxiety. Although

they often work quickly, they can be habit-forming and sedating, so they're typically
prescribed for only short-term use.

• Beta blockers. These medications work by blocking the stimulating effect of epinephrine
(adrenaline). They may reduce heart rate, blood pressure, pounding of the heart, and shaking
voice and limbs. Because of that, they may work best when used infrequently to control
symptoms for a particular situation, such as giving a speech. They're not recommended for
general treatment of social anxiety disorder.

Stick with it…

Don't give up if treatment doesn't work quickly. You can continue to make strides in psychotherapy
over several weeks or months. Learning new skills to help manage your anxiety takes time. And
finding the right medication for your situation can take some trial and error.

For some people, the symptoms of social anxiety disorder may fade over time, and medication can
be discontinued. Others may need to take medication for years to prevent a relapse. To make the
most of treatment, keep your medical or therapy appointments, challenge yourself by setting goals
to approach social situations that cause you anxiety, take medications as directed, and talk to your
health care provider about any changes in your condition.

Ayesha Waseem 1559

PANIC DISORDER
A panic attack is a sudden episode of intense fear that triggers severe physical reactions when there
is no real danger or apparent cause. Panic attacks can be very frightening. When panic attacks
occur, you might think you're losing control, having a heart attack or even dying.

Many people have just one or two panic attacks in their lifetimes, and the problem goes away,
perhaps when a stressful situation ends. But if you've had recurrent, unexpected panic attacks and
spent long periods in constant fear of another attack, you may have a condition called panic
disorder.

Although panic attacks themselves aren't life-threatening, they can be frightening and significantly
affect your quality of life.

What is a panic attack?

A panic attack causes sudden, brief feelings of fear and strong physical reactions in response to
ordinary, nonthreatening situations. When you’re having a panic attack, you may sweat a lot, have
difficulty breathing and feel like your heart is racing. It may feel as if you’re having a heart attack.

Panic disorder can develop when you worry too much about having another panic attack or change
behaviors to avoid having a panic attack.

How common are panic attacks?

Every year, up to 11% of Americans experience a panic attack. Approximately 2% to 3% of them

go on to develop panic disorder.

Who might have panic attacks?

Anyone can experience a panic attack. These factors play a role:

• Age: Panic attacks typically first occur during the teen or early adult years. But people of
all ages, including children, can have panic attacks.
• Gender: Women are twice as likely as men to develop panic disorder

Symptoms

Panic attacks typically begin suddenly, without warning. They can strike at any time — when
you're driving a car, at the mall, sound asleep or in the middle of a business meeting. You may
have occasional panic attacks, or they may occur frequently.

Panic attacks have many variations, but symptoms usually peak within minutes. You may feel
fatigued and worn out after a panic attack subsides.
Panic attacks typically include some of these signs or symptoms:

One of the worst things about panic attacks is the intense fear that you'll have another one. You
may fear having panic attacks so much that you avoid certain situations where they may occur

Panic attacks occur suddenly and without warning. There’s no way to stop a panic attack after it
starts. Symptoms usually peak within 10 minutes after an attack starts. They disappear soon after.
Signs of a panic attack include:

• Chest pain.
• Chills.
• Choking or smothering sensation.
• Difficulty breathing.
• Fear of losing control.
• Feeling like you’re going to die.
• Intense feeling of terror.
• Nausea.
• Racing heart.
• Sweating.
• Tingling or numbness in fingers or toes.
• Trembling or shaking

Panic attacks typically begin suddenly, without warning. They can strike at any time — when
you're driving a car, at the mall, sound asleep or in the middle of a business meeting. You may
have occasional panic attacks, or they may occur frequently.

Panic attacks have many variations, but symptoms usually peak within minutes. You may feel
fatigued and worn out after a panic attack subsides.

Panic attacks typically include some of these signs or symptoms:

• Sense of impending doom or danger

• Fear of loss of control or death
• Rapid, pounding heart rate
• Sweating, Trembling or shaking
• Shortness of breath or tightness in your throat, Chills
• Hot flashes, Nausea
• Abdominal cramping, Chest pain
 • Headache, Dizziness, lightheadedness or faintness
• Numbness or tingling sensation
• Feeling of unreality or detachment

One of the worst things about panic attacks is the intense fear that you'll have another one. You
may fear having panic attacks so much that you avoid certain situations where they may occur.

Causes

It's not known what causes panic attacks or panic disorder, but these factors may play a role:

• Genetics
• Major stress
• Temperament that is more sensitive to stress or prone to negative emotions
• Certain changes in the way parts of your brain function

Panic attacks may come on suddenly and without warning at first, but over time, they're usually
triggered by certain situations.

Some research suggests that your body's natural fight-or-flight response to danger is involved in
panic attacks. For example, if a grizzly bear came after you, your body would react instinctively.
Your heart rate and breathing would speed up as your body prepared for a life-threatening situation.
Many of the same reactions occur in a panic attack. But it's unknown why a panic attack occurs
when there's no obvious danger present.

Risk factors

Symptoms of panic disorder often start in the late teens or early adulthood and affect more women
than men.

Factors that may increase the risk of developing panic attacks or panic disorder include:

• Family history of panic attacks or panic disorder

• Major life stress, such as the death or serious illness of a loved one

• A traumatic event, such as sexual assault or a serious accident

 • Major changes in your life, such as a divorce or the addition of a baby

• Smoking or excessive caffeine intake

• History of childhood physical or sexual abuse

Complications

Left untreated, panic attacks and panic disorder can affect almost every area of your life. You may
be so afraid of having more panic attacks that you live in a constant state of fear, ruining your
quality of life.

Complications that panic attacks may cause or be linked to include:

• Development of specific phobias, such as fear of driving or leaving your home

• Frequent medical care for health concerns and other medical conditions

• Avoidance of social situations

• Problems at work or school

• Depression, anxiety disorders and other psychiatric disorders

• Increased risk of suicide or suicidal thoughts

• Alcohol or other substance misuse

• Financial problems

For some people, panic disorder may include agoraphobia — avoiding places or situations that
cause you anxiety because you fear being unable to escape or get help if you have a panic attack.
Or you may become reliant on others to be with you in order to leave your home.

Prevention

There's no sure way to prevent panic attacks or panic disorder. However, these recommendations
may help.

• Get treatment for panic attacks as soon as possible to help stop them from getting
worse or becoming more frequent.
 • Stick with your treatment plan to help prevent relapses or worsening of panic attack
symptoms.

• Get regular physical activity, which may play a role in protecting against anxiety

Diagnosis
Serious health problems, such as heart disease, thyroid disease and respiratory problems, cause
symptoms similar to panic attacks. Your healthcare provider may run tests to rule out a physical
problem. If there’s no physical cause, your provider may make a diagnosis based on your
symptoms and risk factors.

Medical or mental health providers can diagnose panic disorder. Your provider may diagnose
panic disorder when you have repeated panic attacks and you:

• Persistently worry about having more panic attacks or their consequences.

• Obsess about losing control during a panic attack.
• Change your behaviors to avoid situations that may trigger a panic attack.

Management and treatment

How are panic attacks managed or treated?

Psychotherapy, medications or a combination are very effective at stopping panic attacks. How
long you’ll need treatment depends on the severity of your problem and how well you respond to
treatment. Options include:

• Psychotherapy: Cognitive behavioral therapy (CBT) is a type of psychotherapy, or talk

therapy. You discuss your thoughts and emotions with a mental health professional, such
as a licensed counselor or psychologist. This specialist helps identify panic attack triggers
so you can change your thinking, behaviors and reactions. As you start to respond
differently to triggers, the attacks decrease and ultimately stop.
• Antidepressants: Certain antidepressant medications can make panic attacks less frequent
or less severe. Providers may prescribe serotonin selective reuptake inhibitors (SSRIs),
serotonin-norepinephrine reuptake inhibitors (SNRIs) or tricyclic antidepressants (TCAs).
SSRIs include fluoxetine (Prozac®) and paroxetine (Paxil®). SNRIs include duloxetine
(Cymbalta®) and venlafaxine (Effexor®). TCAs include amitriptyline (Elavil®) and
doxepin (Sinequan®).
• Anti-anxiety medications: Benzodiazepines are the most commonly prescribed anti-
anxiety medication to treat and prevent panic attacks. They help with anxiety but have risks
of addiction or dependence. These medications include alprazolam (Xanax®) and
lorazepam (Ativan®).

Fatima Hassan 1465

 AGORAPHOBIA

Agoraphobia is a mental health disorder in which a person fears going out in public places where
he or she may feel helpless, trapped, or embarrassed in the event of a panic attack. People with this
condition have a fear of losing control during a panic attack, and they often start to avoid the
situations that they fear or insist on having another person go with them. Agoraphobia may
interfere with normal daily activities and personal relationships. People with severe agoraphobia
may become completely homebound and dependent on others for daily tasks, such as grocery
shopping and taking care of errands. Agoraphobia is a type of anxiety. It usually begins before age
35, but it can start in older adult years. People with agoraphobia are at risk for other anxiety
disorders, depression, and substance abuse
The dictionary definition of agoraphobia depends on the literal significance of its parts; that is,
agoraphobia is defined as the fear of open spaces: from the Greek agora, meaning “an assembly;
hence, the place of assembly, especially the marketplace”; and, phobia, meaning “fear”
(“Agoraphobia” 2014). However, the theoretical understanding of both elements of the
psychological disorder “agoraphobia” – agora and phobia – is contentious. It is evident from
agoraphobia’s theoretical and conceptual history that the nature of the disorder still eludes our
understanding this distinction illuminates the nature of the disorder and clarifies both its profound
disabling effect on sufferers and its chronicity (that is, resistance to long-term efficacious
treatment). The use of the term “phobia” to describe the disorder is contentious in part because the
fear is not, as originally described (and the psychiatric definition notwithstanding), of an object (or
space) that can be avoided, but, following Weiss, a “mental registration of structural
disorganization” (Compton 1992, p. 409). The term agoraphobia was first coined in 18717 by
Westphal, a neurologist and psychiatrist, to describe three male patients for whom the experience,
or contemplation, of walking through certain streets was accompanied by a “dread of anxiety” (p.
12; ltd. in Snaith 1968, p. 673). Westphal reports that his patients indicated “that they might be
laughed at or considered to be insane due to the peculiarity of the matter” and that they had “no
idea what cause[d] the fear, as if it were a fear of fear” (Westphal 1871/1988, p. 59; p. 62; my
emphasis). Their “fear of fear” seemed to be accentuated by the fear of being perceived as insane,
or otherwise embarrassed.

Causes
The specific reasons why agoraphobia develops remain unclear, but changes in the areas of the
brain that control the fear response may play a role.
The DSM-5 lists three types of risks:

• Environmental factors: Agoraphobia may develop after experiencing a crime, abuse, or a

traumatic event.

• Genetic factors: There are signs that people can inherit it.
 • Temperamental factors: Some people appear to be more prone to anxiety-related
disorders.

Symptoms
You may have agoraphobia if you have any of the following symptoms for 6 months or longer:
Intense fear arising from two or more of the following:
• Using public transportation, such as cars, buses, planes, trains, or ships.
• Being in open spaces, such as parking lots, shopping malls, or bridges
• Being in enclosed spaces, such as shops, theaters, or elevators.
• Standing in line or being in a crowd.
• Being outside the home alone.

Fear of being unable to escape or get help if feared events occur. These events include:
• Panic attack
• Loss of bowel control in older adults

Reacting to feared situations by:

• Avoiding them
• Requiring the presence of a companion.
• Enduring them with intense fear or anxiety

Fear or anxiety that is out of proportion to the actual danger that is posed by the event and the
situation

Risk factor
People with a genetic predisposition to anxiety may be at high risk of developing a phobia. Age,
socioeconomic status, and gender seem to be risk factors only for certain phobias. For example,
women are more likely to have animal phobias. Children or people with a low socioeconomic
status are more likely to have social phobias. Men make up the majority of those with dentist and
doctor phobias.

Diagnosis
The physical symptoms of anxiety disorders may be similar to other medical conditions, like heart
disease or hyperthyroidism, according to NAMI. This means a doctor will need to rule out these
conditions during a diagnosis.
When diagnosing an anxiety disorder, a doctor may carry out:
 • a physical examination
• an interview
• a number of lab tests
o Mental health professionals may base the diagnosis on certain guidelines and
diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental
Disorders (DSM-5)
o The DSM-5 lists the following diagnostic criteria Trusted Source for a specific
phobia:
• A person experiences significant anxiety or fear about a specific object or situation, which
almost always provokes these feelings.
• The fear or anxiety is out of proportion to the actual risk.
• A person avoids the object or situation or endures it with intense fear or anxiety.
• The fear, anxiety, or avoidance provokes clinically significant distress or impairment in
day-to-day functioning.
• The anxiety, fear, or avoidance is persistent and may last for 6 months or more.
• A medical professional cannot better explain the person’s symptoms as those of another
mental disorder.

Treatment
The Anxiety and Depression Association of America (ADAA) states those weekly sessions
of cognitive behavioral therapy (CBT) alongside homework assignments can be effective for
treating phobias.

• Person typically has 12–16 sessions of CBT. During the sessions, the therapist may
help a person understand the incorrect assumptions they have about insects.
• The therapist may help a person identify mistaken beliefs and help them avoid
immediately jumping to the worst-case scenarios. They may help a person realize that
they are making these mistakes and help them understand realistic risks.
• Once a person better understands their phobia, the therapist may then gradually expose
them to insects in order to help them overcome the phobia.
Exposure therapy
During exposure therapy, a psychologist will create a safe environment where they will gradually
expose a person to insects, the ADAA explains. This may help reduce a person’s fear and
avoidance of insects.
A psychologist may use several methods of exposure therapy. Some common approaches include:
 • In vivo exposure: During this approach, a person will directly face their object of fear.
This may involve holding an insect in their hand.
• Imaginal exposure: During this approach, a person will imagine their object of fear.
This may involve imagining they are holding an insect.
• Virtual reality exposure: This approach uses virtual reality technology, which may
help a person experience the sights, sounds, and smells associated with their object of
fear.

A psychologist may decide to use exposure therapy in one of the following ways:

• Graded exposure: During this approach, a person and a psychologist will create an
exposure fear hierarchy. They will rank certain objects, situations, or activities in order
of the level of fear they may cause. The psychologist will then begin with mild or more
moderate exposures before progressing to more difficult ones.
• Flooding: This approach uses the same fear hierarchy as graded exposure. However,
in the flooding approach, the psychologist will expose the person to the most difficult
tasks first.
• Systematic desensitization: In some cases, a psychologist may combine exposure
with certain relaxation exercises. This can make the challenging exposures feel more
manageable. It may also help the person associate the feared objects, situations, or
activities with relaxation.

Medications

If a person has an anxiety disorder such as nomophobia, they may wish to take medications to help
manage their symptoms. A person should always talk with a healthcare professional about possible
benefits, side effects, and risks of different medications.

Medications to help treat anxiety disorders may include medications and antidepressants,
according to NAMI. These medications aim to reduce the emotional and physical symptoms of
anxiety

Instructions at home

Lifestyle
 • Try to exercise. Get 150 or more minutes of physical activity each week. Also aim to
do strengthening exercises two or more times a week.
• Eat a healthy diet that includes plenty of vegetables, fruits, whole grains, low-fat dairy
products, and lean protein. Do not eat a lot of foods that are high in solid fats, added
sugars, or salt (sodium).
• Get the right amount and quality of sleep. Most adults need 7–9 hours of sleep each
night.
• Do not drink alcohol
• Do not use illegal drugs.

Alveena Fatima Malik 1479

GENERALIZED ANXIETY DISORDER

Generalized Anxiety disorder (GAD) is a widespread psychiatric syndrome involving significant

consequences on people's health. It is marked by excessive, exaggerated anxiety and worry
about everyday life events for no obvious reason.

It lasts longer than 6 months. People with symptoms of generalized anxiety disorder tend to always
expect disaster and can't stop worrying about health, money, family, work, or school. Generalized
anxiety disorder (GAD) is a serious mental illness that is listed in the Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition (DSM-5).
The percentage of adults who experienced mild, moderate, or severe symptoms of anxiety was
highest among those aged 18–29 and decreased with age. GAD tends to be more frequent
among women, blacks, young adults, and ones with low income or occupational status. The
lifetime prevalence of GAD in the general population has estimated to be between 1.9% and 5.4%.
In this regard, community surveys indicate a female to male preponderance of 2:1 in GAD1.

Difference between GAD and normal anxiety?

When people experience normal anxiety, they tend to worry about things related to the anxiety-
provoking situation or several other things that make them fearful. People with GAD tend to be
described as "worrying about everything all the time.” If that describes you, it may be more than
normal anxiety.

Does GAD lead to panic attacks?

Panic attacks have been reported by patients with generalized anxiety disorder (GAD) in response
to catastrophic worry.

SYMPTOMS

The symptoms of GAD can vary from one individual to another.

Symptoms may get better or worse at different times. Periods of high stress or physical illness, for
example, often cause symptoms to worsen for a while.
Emotional and cognitive symptoms of GAD include:
• Uncontrollable and persistent worries, fears, and concerns
• An inability to deal with uncertainty about the future
• Intrusive thoughts
• Excessive planning and troubleshooting
• Difficulty making decisions
• Fear of making the “wrong” decision
• Problems concentrating

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 • An inability to relax
Physical symptoms include:
• Tense or tight muscles
• Aches and pains
• Difficulty sleeping
• Fatigue
• Feeling restless, jumpy, or twitchy
• Heart palpitations
• Digestive problems, such as nausea or diarrhea
• Being easily startled
• Excessive sweating
• Needing to urinate more frequently than usual
Behavioral symptoms include:
• Being unable to relax or spend “quiet” time alone
• Switching between tasks or not finishing tasks due to finding it difficult to concentrate
• Spending excessive amounts of time completing simple tasks
• Redoing tasks because they are not “perfect”
• Avoiding situations that trigger anxiety, including socializing with others and speaking in
public
• Missing school or work due to fatigue, fear, or other symptoms
• Requiring reassurance and approval from others
The presence of other conditions
People with GAD often have co-occurring conditions. These may include:
• Other anxiety disorders, such as phobias, obsessive-compulsive disorder, or social anxiety
• Depression
• Drug or alcohol misuse32

DIAGNOSTIC CRITERIA
A doctor or mental health professional may diagnose GAD according to the criteria in the
American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.

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To receive a diagnosis of GAD, a person must have at least three of the following symptoms (or
just one symptom in the case of children):
• Feeling restless, wound-up, or on-edge.
• Being easily fatigued.
• Having difficulty concentrating.
• Being irritable.
• Having headaches, muscle aches, stomachaches, or unexplained pains.
• Difficulty controlling feelings of worry.
• Having sleep problems, such as difficulty falling or staying asleep.
Also, these symptoms must not result from substance use or another medical condition.
To confirm a diagnosis or rule out physical conditions that may be causing symptoms, a doctor
may:
➢ perform a physical examination
➢ take a detailed medical and family history
➢ use a psychological questionnaire
➢ order blood or urine tests

CAUSES
As with many other mental health issues, the exact cause is unknown. It is usually a combination
of biological, psychological and social factors. Other factors including genetics, daily stress, work
pressure or financial problems are also known to cause anxiety.
• Genetics
Having a family history of GAD increases the risk of developing it. For example, children of
people with GAD are more likely to develop the condition themselves than those whose parents
do not have it.
• Brain chemistry and structure
Differences in brain functioning may increase the risk of developing an anxiety disorder. People
with GAD also show differences in brain structure on neuroimaging studies using functional MRI
scans. An imbalance of serotonin and other brain chemicals are also present in people with GAD
and other anxiety disorders.
• Personality
People who are timid or pessimistic may be more likely to develop GAD. Some resources also
suggest a link between anxiety disorders and neuroticism, a personality trait wherein people view
the world as unsafe and threatening.
• Life experiences and environmental factors
Having a history of trauma, such as abuse or bereavement, may also contribute to GAD. In
addition, having a chronic illness can increase the chance of developing an anxiety disorder, as can
misusing addictive substances.
• Sex
Estimates suggest that females are twice as likely as males to have GAD.
• Age
GAD can affect anyone of any age. However, the chance of developing it seems to
be highest “between childhood and middle age.”
The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse,
a medication) or another medical condition (e.g., hyperthyroidism) according to DSM-5.

TREATMENT
Living with anxiety can be challenging. However, like other anxiety disorders, GAD is highly
treatable. Some of the most effective treatments include psychotherapy, medication, and making
lifestyle changes. Treatment options for GAD depend on the severity of a person’s symptoms and
the presence of any other conditions.
Treatment options include:
• Psychotherapy
Working with a therapist can help people effectively manage their symptoms. Doctors and mental
health professionals will often recommend cognitive behavioral therapy (CBT) for anxiety, as it is
both safe and effective.
Studies shows that CBT reduces worry in people with GAD, with the effects being equal to those
of medications and more effective 6 months after treatment completion.
• Medication
In some cases, a healthcare professional may recommend medication to help with the symptoms
of GAD.
Several types of medication can treat GAD, including:
Antidepressants
Most commonly, doctors will prescribe selective serotonin reuptake inhibitors or serotonin and
norepinephrine reuptake inhibitors for GAD. These drugs can take several weeks to work.
Buspirone
This is an antianxiety medication that reduces the physical symptoms of anxiety. Buspirone can
take several weeks to take effect.
Benzodiazepines
Occasionally, doctors may prescribe a benzodiazepine for short term anxiety relief. These
medications are fast acting, but they are highly addictive and may not be suitable for people with
a history of addiction.

• Lifestyle changes

Making lifestyle modifications can help people keep their worries and concerns under better
control. Some examples of helpful changes to make, include:

➢ Exercising regularly
➢ Eating a healthful diet
➢ Reducing exposure to stressors
➢ Prioritizing issues and events
➢ Practicing mindfulness, meditation, or yoga
➢ Keeping a journal to help identify anxiety triggers and coping strategies
➢ Avoiding alcohol and drugs, and limiting or avoiding nicotine or caffeine
➢ Setting a sleep schedule to ensure 7–9 hours’ sleep per night
What assessments are used for generalized anxiety disorder?

• Hamilton Rating Scale for Anxiety. ...

• Beck's Depression Inventory. ...
• Generalized Anxiety Disorder questionnaire (GAD-7) ...
• Personal Health Questionnaire PHQ-9.

SUMMARY
Anxiousness is a normal part of life, but excessive anxiety or worry especially if it interferes with
everyday functioning or relationships with others can indicate an anxiety disorder.
GAD is common and highly treatable. Individuals who have concerns about their mental health
should see a doctor or psychotherapist for treatment. The earlier a person seeks treatment, the
better the outlook3.

Sahiba Shabeer 1574

ETIOLOGY OF ANXIETY DISORDERS

(Common Risk Factors across the Anxiety Disorders)
Risk factors are the factors that seem to increase risk for all of the anxiety disorders. The existence
of such risk factors may help explain why people with one anxiety disorder are likely to develop a
second one that is, some risk factors increase the odds of having more than one anxiety disorder.
For example, the risk factors that causes phobias my also lead to panic disorders.
FEAR CONDITIONING
In all anxiety disorders the common thing is a constant fear of something. The question is where
this fear come from.it is answered by Behavioral theory of anxiety disorders which focuses on
conditioning. Mowrer’s two-factor model of anxiety disorders, published in 1947, explains two
steps in the development of an anxiety disorder.
• Classical conditioning: when a neutral stimuli (CS) is paired with an aversive stimuli
(UCS).
• Operant conditioning: the person starts avoiding CS to get relief, as this avoiding behavior
is reducing the fear, also called reinforcing.

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Consider an example. Imagine that a man is bitten by a dog and then develops a phobia of dogs.
Through classical conditioning, he has learned to associate dogs (the CS) with painful bites (the UCS).
This corresponds to step 1 above. In step 2, the man reduces his fear by avoiding dogs as much as
possible; the avoidant behavior is reinforced by the reduction in fear. This second step explains why
the phobia isn’t extinguished. With repeated exposure to dogs that don’t bite, the man would have lost
his fear of dogs, but by avoiding dogs, the man gets little or no such exposure. It could occur by direct
experience, like the conditioned fear of dogs in the example above. It could occur by direct experience,
like the conditioned fear of dogs in the example above.
1. It could occur by seeing another person harmed or frightened by a stimulus (e.g., seeing a dog
bites a man or watching a YouTube video of a vicious dog attack). This type of learning is
called modeling. In one study, researchers showed participants a movie of a man who received
shocks. Participants were told that they would receive shocks next. When watching the stranger
receive shocks, participants demonstrated increased activity in the amygdala, just as they
would if they had personally experienced the aversive stimulus (Olsson, Nearing, & Phelps,
2007).
2. It could occur by verbal instruction—for example, by a parent warning a child that dogs are
dangerous.
3. It could also occur by direct experience of dangerous event

Susan Mineka’s research showed that when monkeys observe another monkey display fear of a
snake, they also acquire the fear. This indicates that modeling may play a role in phobias.
The extinction phase of this conditioning may differ from the people who have anxiety disorders and
those who don’t have any anxiety disorder. Most studies of this phenomenon use carefully controlled
tests in a laboratory setting. For example, in one study, researchers conditioned people to fear a neutral
picture of a Rorschach card (see p. 88) by pairing the card with a shock six times (Michael, Blechert,
Vriends, et al., 2007). After receiving six shocks, most of the people in the study learned to fear the
Rorschach card, as measured using skin conductance responses to seeing the card— even those
without an anxiety disorder developed this conditioned response. Those with and without an anxiety
disorder differed in the extinction phase of the study, when the card was shown without any shock
being provided. People who were not diagnosed with panic disorder showed a quick drop in their fear
responses during the extinction phase, but people with panic disorder showed very little drop in their
fear response. Hence, people with panic disorder appear to sustain classically conditioned fears
longer.4

Genetic Causes:
Research on identical twins has provided some evidence that anxiety disorders have a genetic
component. Additionally, genome studies have shown that some genes are common in individuals
with anxiety disorders.
Twin studies suggest a heritability of 20–40 percent for specific phobias, social anxiety disorder, GAD
and PTSD, and about 50 percent for panic disorder (Hettema, Neale, & Kendler, 2001; True, Rice,
Eisen, et al., 1993). Some genes may elevate risk for several different types of anxiety disorder, while
others may elevate risk for a specific type of anxiety disorder (Hettema, Prescott, Myers, et al., 2005).
For example, having a family member with a phobia increases the risk of developing not only a phobia
but also other anxiety disorders (Kendler et al., 2001). Research on identical twins has provided some
evidence that anxiety disorders have a genetic component. Additionally, genome studies have shown
that some genes are common in individuals with anxiety disorders, though more information is needed

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to understand which genes cause anxiety and how this interacts with environmental factors such as
stress and trauma to cause someone to develop an anxiety disorder.

Neurobiological Factors: The Fear Circuit and the Activity of Neurotransmitters.

A set of brain structures called the fear circuit tend to be involved when people are feeling anxious
or fearful. The fear circuit is related to anxiety disorders. The part of fear circuit that seems to be highly
activated among anxiety disorders is Amygdala. The amygdala sends signals to a range of different
brain structures involved in the fear circuit. Studies suggest that when shown pictures of angry faces
(one signal of threat), people with several different anxiety disorders respond with greater activity in
the amygdala than do people without anxiety disorders (Blair, Shaywitz, Smith, et al., 2008; Monk,
Nelson, McClun, et al.,
Hence, elevated activity in the fear circuit, particularly the amygdala, may help explain many different
anxiety disorders.

Another region of fear circuit involved in anxiety disorders is The Medial Prefrontal Cortex which
help to regulate the amygdala activity.it extinguish fears and uses emotions control strategies to control
emotions. Researchers have found that people who meet diagnostic criteria for anxiety disorders
display less activity in the medial prefrontal cortex. More evidences suggest that the connectivity
between these two parts is deficits among people with anxiety disorders that will in turn fail to regulate
and remove anxiety.
Many of the neurotransmitters involved in the fear circuit are involved in anxiety disorders. For
instance, anxiety disorders seem to be related to poor functioning of the serotonin and higher-than-
normal levels of norepinephrine. GABA appears to be involved in inhibiting activity throughout the
brain, and one of its effects is decreased anxiety. Poor GABA function, then, could contribute to
anxiety.5
Personality Factors: Behavioral Inhibition and Neuroticism.
Some infants show the trait of behavioral inhibition, a tendency to become agitated and cry when
faced with novel toys, people, or other stimuli. This behavioral pattern, which has been described in

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infants as young as 4 months old, may be inherited and may set the stage for the later development of
anxiety disorders. One study followed infants from 14 months through 7.5 years; 45 percent of those
who showed elevated behavioral inhibition levels at 14 months showed symptoms of anxiety at age
7.5, compared to only 15 percent of those who had shown low behavioral inhibition Behavioral
inhibition appears to be a particularly strong predictor of social anxiety disorder: 30 percent of infants
showing elevated behavioral inhibition developed social anxiety disorder by adolescence. What
factors influence the stability of behavioral inhibition?
There has been little research on factors reducing the stability of behavioral inhibition across
childhood. A few studies suggest that some caregiving strategies may be helpful in reducing the
stability of BI. Specifically, a caregiving style that encourages children to develop independence and
confidence may help children reduce their distress in new social environments. More specifically,
caregivers could provide children with opportunities to engage in social activities and to excel in these
social activities. A few studies suggest that when caregivers are over-responsive (i.e., provide
assistance when a child does not need help) or impose control when it is not necessary to do so, these
strategies may reinforce children’s anxiety in new situations. Some researchers hypothesize that
responding with help when it is not needed sends the child the message that their anxiety was
warranted. In turn, this reinforces the presence of anxiety in that particular situation. In summary,
limited research suggests that the best way to encourage children to feel independent and less afraid
in social environments is to help them to feel as though they don’t need to depend on them in these
novel situations.

Neuroticism is a personality trait defined by the tendency to react to events with greater than-average
negative affect. How does neuroticism relate to anxiety disorders? In a sample of 7,076 adults,
neuroticism predicted the onset of both anxiety disorders and depression (de Graaf et al., 2002). People
with high levels of neuroticism were more than twice as likely to develop an anxiety disorder as those
with low levels. In another study of 606 adults followed over 2 years, neuroticism was a major
predictor of anxiety disorder.6

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Sociocultural and gender impact on anxiety disorders

Gender;
Several studies suggest that women are at least twice as likely as men to be diagnosed with an anxiety
disorder (de Graaf, Bijl, Ravelli, et al., 2002). There is a pretty clear consensus in the field that women
are more vulnerable to anxiety disorders than are men. There are many different theories about why
women are more likely to develop anxiety disorders than men are. Women may be more likely to
report their symptoms. Psychological differences also might help explain these gender gaps. For
example, men may be raised to believe more in their personal control over situations, a variable we
will discuss later as protective against anxiety disorders. Social factors, like gender roles, are also
likely to play a role.
For example, men may experience more social pressure than women to face fears—as you will see
below, facing fears may be the basis for one of the most effective treatments available. Women may
also experience different life circumstances than do men. For example, women are much more likely
than men to be sexually assaulted during childhood and adulthood (Tolin & Foa, 2006). These
traumatic events may interfere with developing a sense of control over one’s environment, and, as we
will see below, having less control over one’s environment may set the stage for anxiety disorders7.

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Culture:
People in every culture seem to experience problems with anxiety disorders. But the focus of these
problems appears to vary by culture. For example, in Japan a syndrome called taijin kyofusho involves
fear of displeasing or embarrassing others; people with this syndrome typically fear such things as
making direct eye contact, blushing, having body odor, or having a bodily deformity. The symptoms
of this disorder overlap with those of social anxiety disorder, but focus on others’ feelings is distinct.
Perhaps this focus is related to characteristics of traditional Japanese culture that encourage extreme
concern for the feelings of others and discourage the direct communication of one’s own feelings
(McNal).
Whereas ethno psychology/ethno physiology factors influence the expression of anxiety disorders
based on the person’s understanding of one’s own body (and the nature of psychological process and
the effects on the body), contextual factors determine the expression of anxiety disorders due to social
context and norms. A concept that has been given a considerable degree of attention in cross-cultural
research is the notion of individualism/collectivism. The term collectivism refers to the relationship
between members of social organizations that emphasize the interdependence of its members.
Collectivistic cultures value harmony within the group and the individual gain is considered to be less
important than improvement of the social group. In individualistic societies, individual achievements
and success receive the greatest reward and social admiration, whereas collectivistic cultures emphasis
the maintenance of social harmony8.

REFERENCES

https://www.nimh.nih.gov/health/topics/anxiety-disorders
https://www.nhs.uk/mental-health/conditions/generalised-anxiety-
disorder/overview/#:~:text=GAD%20is%20a%20long%2Dterm,last%20time%20they%20felt%2
0relaxed.
https://www.mayoclinic.org/diseases-conditions/generalized-anxiety-disorder/diagnosis-
treatment/drc-20361045
The effects of domestic violence on children and young people | Family & Community Services

https://www.psychologytoday.com/us/blog/the-mindful-self-express/201909/understanding-
brain-circuits-fear-stress-and-anxiety

https://www.psychologytoday.com/us/basics/neuroticism

https://www.texashealth.org/Health-and-Wellness/Behavioral-Health/How-Anxiety-Affects-
Men-and-Women-
Differently#:~:text=Women%20are%20twice%20as%20likely,than%20men%20(14.3%20perce
nt).

https://www.sciencedirect.com/topics/nursing-and-health-professions/clinical-neuropsychology

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