Distinctions between anxiety, fear, and worry can be blurred. Key factors include
Nature of threat – what’s feared and how one reacts
Timing – present vs. future threat; immediate vs. anticipatory response
Specificity – clear object/event vs. vague, diffuse source
Involvement – level of cognitive, behavioural, and physiological response (fear being least cognitively mediated)
How might fear look?
Cognitive: “Call 000 – I’m in mortal danger.”
Physiological: Rapid onset, hard to control, quick dissipation (e.g., racing heart).
Behavioural: Urgent avoidance / flight to ensure safety
How might anxiety look
Cognitive: “What if there’s a snake? I’m terrified of snakes.”
Physiological: Slower onset and dissipation; controllable (e.g., breathing can calm elevated heart rate).
Behavioural: Avoidance or attempts to reduce/control anxious feelings.
How might worry look
Cognitive: “I’m worried about what might happen in the future.” (apprehensive expectation)
Physiological: Low-level, ongoing physical tension; no clear onset or offset.
Behavioural: Avoidance difficult due to everyday, non-immediate nature of concerns
Historical perspectives – DSM view
DSM-1 and 2: Anxiety categorised under “neuroses”
- DSM 3 (1980): “Anxiety” becomes a new disorder
category - DSM-III-R to DSM-IV-TR (2000): Disorder criteria
refined. - DSM-5 (2013): major changes.
- DSM-5-TR (2022) no major change
What are phobias
Phobias produce focused anxiety or fear that is “out of proportion” to the actual or perceived threat or
danger, after considering all the factors of the environment and situation. The pattern of fear/avoidance is “persistent” (present for at least 6 months).
What is generalised anxiety disorders
Persistent & excessive anxiety & worry (apprehensive expectation) that is:
* generalised [about several events or activities],
* difficult to control
* normally about everyday things
*occurs almost daily for at least 6 months
What are the symptoms Generalised Anxiety Disorder
- restlessness, feeling keyed-up/on edge
- fatiguing easily
- difficulty concentrating / mind blanks
- irritability
- muscle tension
- sleep disturbance
Not a fleeting nor rare sensation: occurs almost
daily, for at least 6 months distress, dysfunction
What is panic disorder
A sudden unexpected & overwhelming (but short-
lived) period of intense fear or discomfort; surges abruptly, peaks within minutes
- be understood as a “normal” incorrectly triggered
fear response - have situational cues or triggers (or be uncued)
- have specific ‘symptoms’
Recurrent panic attacks
one attack that had “lasting” effects i.e., it led to one month of
* Persistent concerns about attacks and/or
* A significant, maladaptive, behaviour change
–> this may move diagnosis from a attack to a disorder
Panic attack symptoms
≥ 4 symptoms from a list of 13 incl.:
* Palpitations, pounding, racing heart rate
* Sweating
* Trembling, shaking
* Feeling short of breath, difficulty breathing
* Chills or hot flushes
* Feelings of derealisation or depersonalisation
5 specific phobia subtypes
- animals
- natural environment
- situations
- blood injection injury
- other - vomiting
Prevalence of anxiety by age
- Prevalence is highest in younger adults
- But there is also a peak in the aged (70+) – why?
- An exception to the general ‘rule’ that new anxiety disorders don’t manifest in the elderly? A condition referred to as “late life onset agoraphobia
Is anxiety the most common psychopathology?
Yes
Critcisiscm of GAD
- people questioning timeframes
- concerns about overlapping systems
What did Allen francis think about GAD
DSM-5 obscures the already fuzzy boundary between GAD and the worries of everyday life. Small changes in definition can create millions of anxiety new ‘patients’ and expand the alreadywidespread practice of inappropriately prescribing addicting anti- anxiety medications
What section was OCD in in the DSM before it became its own
anxiety section
OCD core feature
unwanted intrusive thoughts
In addition to OCD, the DSM created a group with
- Trichotillomania (hair pulling disorder)
- Hoarding disorder
- Excoriation (skin picking disorder), and
- Body dysmorphic disorder
What is OCD?
- can have obsessions or compulsions or both
The obsessions or compulsions (or both) occupy
a considerable amount of time (>1 hour per day)
Feeling driven to perform the act to get relief.
What is an obsession
repetitive, uncontrollable, intrusive, unwanted
thoughts/urges/images that usually provoke “marked
anxiety”
What is a compulsion?
a repetitive behaviour or mental act or ritual
that is undertaken with the intent to reduce anxiety (but is
unlikely to do so) or is “clearly excessive”
What are some OCD differential diagnosise?
- If relief is sought for generalised worry that is
“excessive” consider GAD; - If the obsession is with bodily appearance only/primarily consider body dysmorphic disorder;
- If compulsion is to store objects to alleviate unwanted thoughts consider hoarding disorder.
From a biological lens why do Anxiety and obsessive-
compulsive disorders develop
Genetic predisposition, anxiety sensitivity; –>theory says that people inherit a different degree of sensitivity
Neurochemical imbalances/changes
