Anxiety disorders

Generalized anxiety disorder or GAD

It presents with excessive anxiety and worry, occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance), with difficulty controlling the worry and associated with three (or more) of the following six symptoms:

1. Restlessness
2. Being easily fatigued
3. Difficulty concentrating or mind going blank
4. Irritability
5. Muscle tension
6. Sleep disturbance

To diagnose as GAD, the symptoms should cause significant impairment in functioning at work, socially etc. and should not be attributed to the use of any drugs or to underlying medical conditions like hyperthyroidism. Patients may complain of somatic symptoms like headache, chest tightness, GI symptoms, sweating and palpitations.

Panic disorder

It is characterized by recurrent panic attacks, associated with excessive worry about having another panic attack, maladaptive behavior change to avoid another panic attack and is not caused by an underlying medical condition or drug use. Panic attack is an abrupt sense of intense fear or intense discomfort that reaches a peak within minutes and is accompanied by symptoms such as palpitations, sweating, shakiness, shortness of breath, chest pain, dizziness, nausea, tingling numbness, derealization, depersonalization, fear of losing control or fear of dying. May be associated with GAD, depression and substance abuse risk.

Specific phobia

Marked fear or anxiety about a specific object or situation, e.g., flying, heights, animals, snakes, receiving an injection, seeing blood, etc., that lasts for 6 months or more. The fear is irrational, out of proportion to the actual danger caused by the object; the object or situation is actively avoided, and it causes significant functional impairment at work, social interactions, etc.

Social anxiety disorder is the phobia related to social situations like public speaking. Agoraphobia involves fear of open or closed spaces like crowds, public transport, with patients refusing to leave their homes in extreme cases.

Obsessive compulsive disorder or OCD

It is a chronic disorder characterized by uncontrollable, reoccurring thoughts (obsessions) and/or behaviors (compulsions) that interfere with all aspects of life, such as work, school, and personal relationships.

Obsessions are repeated thoughts, urges, or mental images that cause anxiety, as follows:

1. Fear of germs or contamination
2. Unwanted forbidden or taboo thoughts involving sex, religion, or harm
3. Aggressive thoughts towards others or self
4. Having things symmetrical or in a perfect order

Compulsions are repetitive behaviors that a person with OCD feels the urge to do in response to an obsessive thought. Common compulsions include:

1. Excessive cleaning and/or handwashing
2. Ordering and arranging things in a particular, precise way
3. Repeatedly checking on things, such as repeatedly checking to see if the door is locked or that the oven is off
4. Compulsive counting

A person with OCD cannot control his or her thoughts or behaviors, even when those thoughts or behaviors are recognized as excessive (ego dystonic), spend at least an hour a day on obsessions and compulsions, may feel brief relief from anxiety by following compulsions or rituals and suffer from disruptions in their social relationships or work due to the OCD. It may be associated with tic disorder like Tourette syndrome.

In DSM V, trichotillomania is grouped with OCD. It is characterized by repetitive pulling out of one’s own hair.

Separation anxiety disorder

It is characterized by unusually strong fear or anxiety to separating from people they feel a strong attachment to like parents, grandparents etc. They show unusual, prolonged and severe distress for their developmental level. Children suffering from the disorder may refuse to go to school and make excuses like abdominal pain, earache etc. It is diagnosed when the symptoms last for more than 4 weeks in children and more than 6 months in adults. It is worth noting that distress upon separation from a parent is normal for a child from the age of 8 months-15 months.