Panic Disorder, Agoraphobia, GAD, OCD,

Anxiety – a negative mood state characterized by bodily symptoms of physical tension & by apprehension about the future (APA 1994; Barlow 2002)

Panic Attack– an abrupt experience of intense fear or acute discomfort.

Accompanying physical signs include dizziness, lightheadedness, rapid pulse, trembling, chest pains, shortness of breath, nausea, numbness, and a fear of going crazy or dying. Some people convince themselves that they are dying during an attack. The feelings can feel so intense and real to the person that a sense of "lack of control" is usually felt too.

Three Types of panic attacks:
1. Situationally bound – you know you’re going to have one because you’re afraid of something specific (a specific phobia is common).

2. Unexpected – you don’t know when the next attack will occur.

3. Situationally predisposed – between the two.. you may have an attack in a place you already did.

Panic Disorder Without Agoraphobia

- Recurrent unexpected Panic Attacks
- Persistent concern about having additional attacks - - Worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, "going crazy")
- Absence of Agoraphobia
- The Panic Attacks are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism).
- The Panic Attacks are not better accounted for by another disorder.

Panic Disorder With Agoraphobia
- Persistant concern about having additional attacks - - Worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, "going crazy")
- Significant change in behavior related to the attacks
- The presence of Agoraphobia.
- The Panic Attacks are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical
condition (e.g., hyperthyroidism).
(continued)
- The Panic Attacks are not better accounted for by another disorder.

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Agoraphobia

• Fear or avoidance of situations/events
• May develop as a reaction to a history of panic attacks
• Symptoms and concern persists for 1 month or more

When a person with panic disorder begins to fear going places because of the possibilitey of panic or the fear of not being able to get to safety, he/she might be diagnosed with agoraphobia.

Agoraphobic fears typically involve situations that include being outside the home alone; being in a crowd or standing in a line; being on a bridge; and traveling in a bus, train, or automobile. The situations are avoided are marked with distress over having a Panic Attack or panic-like symptoms, or not having safety.

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Generalized Anxiety Disorder

Generally Generalized Anxiety Disorder (GAD) excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance). The person finds it difficult to control the worry.

It is called generalized anxiety because it is categorized as a "generalized and excessive feeling of anxiety." Sometimes these feelings of anxiety are not associated with any particular circumstance.

Usually, the constant worrying is related to matters in daily life.

The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months).
Note: Only one item is required in children.
(1) restlessness or feeling keyed up or on edge
(2) being easily fatigued
(3) difficulty concentrating or mind going blank
(4) irritability
(5) muscle tension
(6) sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)

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Obsessive-Compulsive Disorder (OCD)

People with obsessive-compulsive disorder (OCD) suffer from unwanted and intrusive thoughts that they can't seem to stop (obsessions) and feel compelled to repeatedly perform ritualistic behaviors and neutralizing strategies (compulsions) to try and ease their anxiety. Most people who have OCD are aware that their obsessions and compulsions are irrational, yet feel powerless to stop them. Some spend hours at a time performing complicated rituals (mental rituals or physical rituals)

Common obsessions include:

* Constant, irrational worry about dirt, germs or contamination;

* Sexual thoughts that cause the person to be distressed

* Violent thoughts of hurting other people or themselves. Fear of those thoughts.

* Nagging feelings that something bad will happen if certain items aren't in an exact place, position or order;

* Preoccupation with a particular image or thought.

* Obsessing over the thought of one's bodily functions.

* Fear that one's negative or blasphemous thoughts or images will cause personal harm or harm to a loved one;

* Preoccupation with losing or throwing away objects with little or no value;

* Rumination about accidentally or purposefully injuring another person.

Common compulsions include:

* Cleaning - Repeatedly washing one's hands, bathing or cleaning household items, often for hours at a time;

* Checking - Checking and re-checking, several to hundreds of times per day, that the doors are locked, stove is turned off, hairdryer is unplugged, etc.;

* Repeating - Unable to stop repeating a name, phrase or tune;

*Slowness - Excessive, painstakingly slow and methodical approach to daily activities; and

* Hoarding - Saving useless items such as old newspapers or magazines, bottle caps or rubber bands.

* Mental checking and repeating

* Thought suppression

* Mental reassurance

Obsessions and rituals can substantially interfere with a person's normal routine, schoolwork, job, family or social activities. Several hours each day may be spent focusing on obsessive thoughts and performing seemingly senseless rituals. Trying to concentrate on normal daily activities may be difficult. If left untreated, OCD can interfere with all aspects of one's life.

Children can suffer from OCD as well (see Children & Adolescents) as adults. Unlike adults, however, children with OCD may not realize that their obsessions and compulsions are excessive.

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Note: Physical illness can sometimes resemble symptoms of severe anxiety, panic, and depression. Check with your doctor before starting any self-help program!