Anxiety disorders and its treatment: the stigma remains

General Studies Paper 2

Context

• Anxiety disorders are among the most frequently occurring mental health problems in the community today. They often go unrecognised in primary care settings due tolack of awareness and available human resources.

Introduction

• Anxiety, as an emotion, is experienced by many in day-to-day life. In some, it can become persistent and disabling.
• Fear is an emotional response to perceived imminent threat or danger associated with urges to flee or fight.
• This ‘fight-or-flight response’ is characterised by a startled response and physiological changes.
• In contrast, anxiety is the apprehensive anticipation of future danger or misfortune accompanied by a feeling of worry, distress, and/or bodily symptoms of tension.

Historical context

• Until the last part of the 19th century, anxiety disorders were not classified separately from other mood disorders, such as depression.
• In 1895, Sigmund Freud first suggested that people with mainly anxiety symptoms should be differentiated from depression. He gave the name “anxiety neurosis” to this entity.
• Freud’s original anxiety neurosis included people with phobias and panic attacks. He subsequently divided them into two groups – anxiety neurosis and anxiety hysteria.
• The first group included people with mainly psychological symptoms of anxiety, while the second group had people with phobias and physical symptoms of anxiety.

Prevalence and onset of anxiety

• India’s National Mental Health Survey (NMHS) of 2015-2016 found the prevalence of neurosis and stress-related disorders to be 3.5%.
• These disorders were twice as common in women as compared to men.
• There is evidence that the developmental period of childhood, adolescence, and early adulthood are periods of high risk for the onset of anxiety disorders.

Clinical features of anxiety

• Generalised anxiety disorder (GAD) is characterised by excessive worrying (which lasts more than six months) and is not restricted to particular circumstances — for example, only when attending a social event.
• Common features include apprehension, tension, difficulty concentrating, and autonomic symptoms such as dry mouth or abdominal discomfort.
• Panic disorder is characterised by recurrent unexpected surges of severe anxiety (also known as panic attacks), which typically peak within 10 minutes and last around 30-45 minutes.
• They are characterised by a sudden onset of palpitations, choking sensation, chest pain, dizziness, depersonalisation (patients feel that they have changed and feel divorced from their own self), derealisation (patients feel that the world has become unreal, distorted or falsified), and fear of dying or losing control.
• Social anxiety disorder is characterised by the intense, persistent fear of being scrutinised or evaluated negatively by others.
• Patients anticipate ridicule or humiliation, and avoid many social situations or endure them with great distress.
• Shyness is a core symptom of social phobia
• Separation anxiety disorder is characterised by fear or anxiety concerning separation from those to whom an individual is attached.
• Common features include excessive distress when experiencing or anticipating separation from home, and persistent excessive worries about potential harms to attachment figures or untoward events that might result in separation.
• Specific (simple) phobia is characterised by the fear of particular objects, animals or situations. Common specific phobias include fears of animals, blood, injection, flying, heights, lifts, enclosed spaces, dental treatment, and choking.

Treating anxiety

• The need for treatment is determined by ascertaining the severity and persistence of symptoms, their impact on everyday life, the co-occurrence of depressive symptoms, and previous response to medication or psychotherapy.
• The choice of treatment is influenced by clinical characteristics, patient and doctor preferences, and the local availability of potential interventions.
• There is much overlap across anxiety disorders for evidence-based effective therapies, such as the prescription of a selective serotonin re uptake inhibitor (SSRI) or a course of cognitive behavioural therapy (CBT), but there are differences in treatment response between disorders.

Conclusion

• Anxiety disorders are among the most frequently occurring mental health problems in the community today. They often go unrecognised in primary care settings due to stigma, lack of awareness, and lack of locally available human resources. Therefore it is vital to increase public awareness of anxiety disorders and the fact that they are treatable with effective interventions.