1. Anxiety Disorders Assessment & Diagnosis SW 593

2. Introduction  Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults.  Anxiety disorders are chronic, relentless, and can grow progressively worse if not treated.  Each anxiety disorder has its own distinctive features, but they are all bound together by the common theme of excessive, irrational fear and dread.

3. Building Blocks  Two non-codable disorders: Agoraphobia – anxiety focused on situations or places from which the client may not be able to escape and/or receive help if the anxiety were to become too acute. Panic attack – an episode of anxiety usually lasting less than a half hour during which the client experiences a number of physical complaints and/or cognitive fears about the outcome of the “attack”.

4. Phobias  Specific Phobias: the client fears some specific object or situation. The phobia is directly related to a discernible event and is understood by the client to be an “overreaction”.  Social Phobia: The specific fear involves at least one type of social or performance situation that involves being “judged” by others.

5. Generalized Anxiety  Concern is usually focused on everyday events and tends to shift over a number of events or activities.  The client may not view the worries as excessive.  They do experience distress associated with an inability to control the concerns.  The condition is more chronic; must have persisted for at least 6 months.

6. Obsessive-Compulsive Disorder  Characterized by the presence of recurrent obsessions and/or compulsions.  Obsessions are intrusive and persistent thoughts, ideas, impulses, or images that are associated with marked anxiety or distress.  The specific content of obsessions does not usually involve any real- life problems.

7. Obsessive-Compulsive Disorder  Compulsions are repetitive behaviors that are performed to prevent or reduce anxiety.  These behaviors are clearly either excessive or not realistically associated with preventing or reducing the feared situation.  Clients suffering from this disorder have at one time realized that their symptoms are excessive or unreasonable, such insight may be tenuous.

8. Trauma Related Disorders  Associated with direct exposure to extreme traumatic events involving threats of serious injury or death to the client or another person.  Acute Stress Disorder: Symptoms begin during or immediately after the trauma Last for at least 2 days Resolve within 4 weeks.

9. Trauma Related Disorders  The symptoms tend to be largely dissociative in nature  Include some form of re- experiencing the trauma  Lead to patterns of avoiding reminders of the event  If the symptoms are not resolved in the time period, another diagnosis is in order.

10. Trauma Related Disorders  Posttraumatic Stress Disorder (PTSD): Symptoms have persisted for at least a month although the exposure to trauma may have occurred at any time prior to symptom onset. Characterized by persistent re-experiencing of the traumatic event Avoidance of stimuli associated with the trauma Client evidences both numbing of general responses and persistent symptoms of arousal that were not present before the traumatic event.

11. Etiological Factors  Anxiety disorder due to a General Medical condition is used when the anxiety is directly related to a diagnosable organic problem.  Substance-Induced Anxiety Disorder is used when to anxiety is directly related to the use of recreational drugs, prescribed medications, or a toxin.

12. Worth Noting  People suffering from anxiety do not necessarily seek treatment.  Anxiety tends to be variable and many clients attain symptom relief through avoidance strategies.  Symptoms are relieved when stress is reduced.  Self - medication

13. Assessment  Attention will be focused on the person’s fears and worries.  It is difficult for clients to present detailed and accurate information.  Tendency to minimize symptoms because of internalized stigma.  When panic attacks are involved, collateral medical referrals are warranted.

14. Cultural Considerations  Culture undoubtedly influences what is viewed as anxiety-provoking.  Culture can influence what level of anxiety is considered problematic.  The standards for displays of emotion vary by gender.  Little differences are noticed between the sexes for social phobia, acute stress disorder, PTSD, GAD, and OCD.

15. Cultural Considerations  These all share either a link to an intense psychosocial stressor or a relatively private set of symptoms.  The female to male ratio for specific phobias and panic disorders is 2:1.  Some evidence indicates that males suffering from panic attacks are more likely to “self-medicate”.