Understanding Anxiety and Trauma-Related Disorders
Understanding Anxiety
What is Anxiety?
Anxiety is a fundamental human emotion that affects both our mental and physical well-being.
When Does Anxiety Become a Problem?
Anxiety becomes pathological when:
- It’s disproportionate to the situation.
- It persists after the danger has passed.
- It appears without a reasonable external cause.
- It interferes with normal daily functioning.
Generalized Anxiety Disorder (GAD)
GAD involves persistent anxiety and worry for at least six months, significantly impacting work, social life, or other important areas.
Anxiety Disorders vs. Anxiety Syndrome
In anxiety disorders, anxiety is the primary and central symptom. In anxiety syndrome, anxiety symptoms are present but may not be the defining characteristic.
Differential Diagnosis of GAD
Individuals with GAD excessively worry about family, work, finances, and health, to the point where it disrupts their lives.
Trauma-Related Disorders
Acute Stress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD)
These disorders were formally described after 1980 in the DSM-III.
Key Features of ASD and PTSD:
- Exposure to a traumatic event involving death, serious injury, or threat to oneself or others.
- Re-experiencing the event through intrusive memories, nightmares, flashbacks, or intense psychological/physiological reactions.
- Persistent avoidance of trauma-related stimuli and emotional numbing.
- Persistent symptoms of increased arousal (e.g., difficulty sleeping, irritability, hypervigilance).
- Significant disruption in social, occupational, or other important areas of life.
Acute Stress Disorder (ASD)
ASD is a transient, yet serious, phenomenon that occurs as a stress response to an exceptional event. It typically appears within minutes of the stressor and resolves within hours or days. Amnesia of the event can sometimes occur.
Characteristics of ASD:
- Sudden onset of anxiety
- Dissociative symptoms
- Symptoms emerge within one month of the traumatic event
Symptoms of ASD:
- Re-experiencing the traumatic event
- Avoiding trauma-related stimuli
- Clinically significant distress and interference with daily activities
- Symptoms lasting at least two days but no longer than four weeks
- Other potential causes (substance use, physical/mental illness) must be ruled out
- Decreased emotional reactivity
- Difficulty sleeping, irritability, poor concentration, hypervigilance, exaggerated startle response, motor restlessness
- Feelings of despair (bordering on depression)
- Potential guilt or self-blame related to the event
- Increased risk of developing PTSD
Post-Traumatic Stress Disorder (PTSD)
PTSD is a delayed response to a traumatic event. Certain personality traits (e.g., asthenic, compulsive) may predispose individuals to PTSD.
Traumatic events that can lead to PTSD include natural disasters, accidents, violence, and other life-threatening experiences.
Diagnostic Criteria for PTSD (DSM-IV):
A. Exposure to a traumatic event:
- Experiencing, witnessing, or confronting an event involving actual or threatened death, serious injury, or threat to physical integrity.
- Responding with fear, helplessness, or horror.
B. Persistent re-experiencing of the traumatic event:
- Intrusive distressing memories
- Distressing dreams
- Flashbacks
- Intense psychological distress upon exposure to trauma-related cues
C. Persistent avoidance and emotional numbing:
- Avoiding thoughts, feelings, or conversations about the trauma
- Avoiding activities, places, or people that trigger memories
- Inability to recall important aspects of the trauma
- Decreased interest in activities
- Feeling detached from others
- Restricted range of emotions
- Sense of a foreshortened future
D. Persistent symptoms of increased arousal:
- Difficulty sleeping
- Irritability or anger outbursts
- Difficulty concentrating
- Hypervigilance
- Exaggerated startle response