Unit 3 - Panic, anxiety, obsessions, and their disorders

----------------------------------------------------------------------------------------------------------------

Explain the common causes, common risk factors, physical and psychological comorbidities
of anxiety disorders (C2)
----------------------------------------------------------------------------------------------------------------

Common Causes, Risk Factors, and Comorbidities of Anxiety Disorders

Anxiety disorders are among the most prevalent mental health conditions, characterized by
excessive fear, worry, and physiological symptoms that impair daily functioning.
Understanding the causes, risk factors, and associated comorbidities is crucial for effective
diagnosis and treatment.

1. Common Causes of Anxiety Disorders

Anxiety disorders develop due to a combination of biological, psychological, and

environmental factors.

A. Biological Causes

• Genetics: Anxiety disorders have a hereditary component. Studies suggest that individuals
with a family history of anxiety or mood disorders are at a higher risk

• Neurotransmitter Imbalance: Deficiencies in gamma-aminobutyric acid (GABA),

serotonin, and norepinephrine contribute to heightened anxiety levels

• Brain Structure and Functioning: The amygdala (fear processing center) and
prefrontal cortex (emotion regulation) play key roles in anxiety. An overactive amygdala
and an underactive prefrontal cortex can contribute to excessive fear responses

B. Psychological Causes

• Cognitive Distortions: Negative thought patterns such as catastrophizing (“Something

bad will definitely happen”) and hypervigilance contribute to chronic anxiety.

• Classical Conditioning: Anxiety can develop due to traumatic experiences, such as a dog
bite leading to dog phobia (specific phobia).

• Perceived Lack of Control: Individuals who feel powerless over their circumstances (e.g.,
childhood trauma, abusive relationships) are at greater risk
C. Environmental Causes

• Early Childhood Adversity: Emotional neglect, bullying, and parental overprotection can
shape anxious behaviors.

• Stressful Life Events: Loss of a loved one, divorce, financial difficulties, or job-related
stress often trigger anxiety disorders

• Substance Use: Chronic alcohol or drug use can increase anxiety symptoms, leading to
dependence as a coping mechanism

2. Common Risk Factors for Anxiety Disorders

Risk factors can be classified into temperamental, environmental, and genetic factors

A. Temperamental Factors

• Neuroticism: A personality trait associated with negative emotionality increases

vulnerability to anxiety

• Anxiety Sensitivity: The tendency to interpret physiological symptoms (e.g., increased

heart rate) as dangerous can lead to panic disorder.

B. Environmental Risk Factors

• Childhood Trauma: Emotional or physical abuse increases the likelihood of post-

traumatic stress disorder (PTSD) and generalized anxiety disorder (GAD).

• Chronic Stress: Long-term exposure to workplace stress, financial problems, or academic

pressure can lead to generalized anxiety disorder

• Substance Abuse: Smoking, alcohol, and drug use are associated with increased anxiety
symptoms.

C. Genetic and Physiological Risk Factors

• Family History: A person with a first-degree relative (parent or sibling) with anxiety is
more likely to develop an anxiety disorder.

• Medical Conditions: Conditions like hyperthyroidism and heart disease can mimic or
exacerbate anxiety symptoms
3. Physical and Psychological Comorbidities of Anxiety Disorders

Comorbidity is the simultaneous presence of two or more diseases or medical conditions in a

patient. Comorbid conditions often complicate diagnosis and treatment, making it essential to
identify coexisting disorders.

A. Physical Comorbidities

• Cardiovascular Diseases: Chronic anxiety increases blood pressure and heart rate,
raising the risk of heart disease.

• Gastrointestinal Disorders: Anxiety can contribute to irritable bowel syndrome (IBS),

acid reflux, and stomach ulcers

• Chronic Pain: Conditions like fibromyalgia and migraines are commonly reported in
individuals with anxiety

B. Psychological Comorbidities

• Depressive Disorders: Depression and anxiety often coexist, with shared symptoms like
fatigue, sleep disturbances, and negative thinking

• Substance Use Disorders: Individuals with anxiety may use alcohol, nicotine, or drugs as
a coping mechanism, leading to addiction

• Obsessive-Compulsive Disorder (OCD): Anxiety-related intrusive thoughts can lead to

compulsive behaviors, such as excessive handwashing or checking

• Personality Disorders: Avoidant personality disorder is often comorbid with social

anxiety disorder

Conclusion

Anxiety disorders arise from a combination of genetic, biological, and environmental

factors, with neurotransmitter imbalances, early life trauma, and chronic stress playing
significant roles. Identifying risk factors and comorbidities is essential for proper diagnosis
and treatment.
ICD-11 and DSM-5 Codes for Anxiety Disorders

Anxiety disorders are classified differently in ICD-11 (International Classification of

Diseases, 11th Revision) and DSM-5 (Diagnostic and Statistical Manual of Mental
Disorders, 5th Edition). Below are the respective codes:

ICD-11 Codes for Anxiety Disorders

ICD-11 categorizes anxiety disorders under “Anxiety and Fear-Related Disorders” and
includes:

• 6B00 – Generalized Anxiety Disorder

• 6B01 – Panic Disorder

• 6B02 – Agoraphobia

• 6B03 – Specific Phobia

• 6B04 – Social Anxiety Disorder

• 6A73 – Mixed Depressive and Anxiety Disorder

DSM-5 Codes for Anxiety Disorders

DSM-5 classifies anxiety disorders with F-codes from the ICD-10-CM system:

• F41.0 – Panic Disorder

• F40.00 – Agoraphobia

• F40.10 – Social Anxiety Disorder

• F41.1 – Generalized Anxiety Disorder

• F40.218 – Specific Phobia

• F43.22 – Adjustment Disorder with Anxiety

• F41.9 – Unspecified Anxiety Disorder

These classification systems help in standardized diagnosis and treatment planning across
different healthcare settings.
----------------------------------------------------------------------------------------------------------------
Outline the clinical descriptions, statistics, causes and treatments of generalized anxiety
disorder; panic disorder with and without agoraphobia; specific phobia; social phobia (social
anxiety disorder); post-traumatic stress disorder and obsessive-compulsive disorder (C2)

----------------------------------------------------------------------------------------------------------------

Easy Way to Remember: “G-P-S-S-P-O”

• G – GAD

• P – Panic Disorder

• S – Specific Phobia

• S – Social Anxiety

• P – PTSD

• O – OCD

----------------------------------------------------------------------------------------------------------------

Overview of Anxiety-Related Disorders

1. Generalized Anxiety Disorder (GAD)

ICD-11 Code: 6B00

DSM-5 Code: F41.1

Clinical Description

GAD is characterized by excessive and uncontrollable worry about various life events (e.g.,
work, health, finances) lasting at least six months

Symptoms include:

• Restlessness, fatigue, difficulty concentrating

• Muscle tension, sleep disturbances, irritability

 Example: A student constantly worries about failing exams despite studying thoroughly.

Prevalence Statistics

• Lifetime prevalence: 5-6% of the population

• More common in women than men.

Causes

• Biological: Genetic predisposition, GABA deficiency (leading to excessive brain activity).

• Psychological: Cognitive distortions (e.g., catastrophic thinking).

• Environmental: Chronic stress, overprotective parenting

Treatments

• Cognitive-Behavioral Therapy (CBT): Restructures negative thought patterns.

• Medication: SSRIs (e.g., Fluoxetine), benzodiazepines for short-term relief.

• Lifestyle Changes: Exercise, relaxation techniques.

2. Panic Disorder (With and Without Agoraphobia)

ICD-11 Code: 6B01 (Panic Disorder), 6B02 (Agoraphobia)

DSM-5 Code: F41.0 (Panic Disorder), F40.00 (Agoraphobia)

Clinical Description

Panic disorder involves recurrent and unexpected panic attacks with intense fear and
physiological symptoms such as palpitations, dizziness, and shortness of breath

• With Agoraphobia: Fear of places where escape might be difficult.

• Without Agoraphobia: Panic attacks occur without avoidance behavior.

 Example: A person suddenly experiences a racing heart, sweating, and dizziness in a
shopping mall and avoids going there again.

Prevalence Statistics

• Lifetime prevalence: 2-3% of adults

• More common in women than men.

Causes

• Biological: Overactive amygdala, serotonin/norepinephrine imbalances.

• Psychological: Fear of bodily sensations (interoceptive conditioning).

• Environmental: Stressful life events, trauma

Treatments

• CBT: Exposure therapy to feared sensations.

• Medications: SSRIs, benzodiazepines (short-term).

• Relaxation Techniques: Breathing exercises to manage attacks.

3. Specific Phobia

ICD-11 Code: 6B03

DSM-5 Code: F40.218

Clinical Description

Specific phobia involves intense, irrational fear of a specific object or situation (e.g.,
heights, snakes, flying), leading to avoidance behavior

Example: A person refuses to enter elevators due to extreme fear of enclosed spaces
(claustrophobia).
Prevalence Statistics

• Lifetime prevalence: 7-9%.

• Onset usually in childhood

Causes

• Biological: Genetic predisposition (inherited fear responses).

• Psychological: Classical conditioning (e.g., dog bite → fear of dogs).

• Environmental: Observational learning (e.g., seeing a parent afraid of heights).

Treatments

• Exposure Therapy: Gradual exposure to the feared stimulus.

• Cognitive Therapy: Challenging irrational beliefs.

• Medications: Beta-blockers for short-term anxiety relief.

4. Social Anxiety Disorder (Social Phobia)

ICD-11 Code: 6B04

DSM-5 Code: F40.10

Clinical Description

Social anxiety disorder is characterized by intense fear of social situations due to fear of
embarrassment, judgment, or humiliation

Example: A student avoids presentations due to extreme fear of speaking in front of

peers.
Prevalence Statistics

• Lifetime prevalence: 7%.

• More common in adolescents

Causes

• Biological: Increased activation in the amygdala.

• Psychological: Fear of negative evaluation.

• Environmental: Childhood bullying, parental criticism

Treatments

• CBT: Exposure therapy and cognitive restructuring.

• Medications: SSRIs, beta-blockers for performance anxiety.

• Social Skills Training: Improves confidence in interactions.

5. Post-Traumatic Stress Disorder (PTSD)

ICD-11 Code: 6B40

DSM-5 Code: F43.10

Clinical Description

PTSD occurs after exposure to traumatic events (e.g., war, assault, accidents) and includes
intrusive memories, hypervigilance, emotional numbing, and avoidance behavior

Example: A car accident survivor experiences flashbacks, avoids driving, and has sleep
disturbances.
Prevalence Statistics

• Lifetime prevalence: 3.5%.

• More common in women due to higher exposure to trauma.

Causes

• Biological: Overactive stress response, altered hippocampus function.

• Psychological: Conditioned fear responses, maladaptive coping.

• Environmental: Severity of trauma, lack of social support

Treatments

• Trauma-Focused CBT: Gradual exposure to trauma-related memories.

• EMDR (Eye Movement Desensitization and Reprocessing).

• Medications: SSRIs (e.g., Paroxetine), Prazosin for nightmares.

6. Obsessive-Compulsive Disorder (OCD)

ICD-11 Code: 6B20

DSM-5 Code: F42

Clinical Description

OCD involves obsessions (intrusive, distressing thoughts) and compulsions (repetitive

behaviors performed to reduce anxiety)

Example: A person repeatedly washes their hands due to fear of germs (contamination
OCD).
Prevalence Statistics

• Lifetime prevalence: 2-3%.

• Equally common in men and women

Causes

• Biological: Dysfunction in the orbitofrontal cortex and basal ganglia.

• Psychological: Thought-action fusion (believing thoughts are dangerous).

• Environmental: Early-life trauma, perfectionistic upbringing.

Treatments

• Exposure and Response Prevention (ERP): Prevents compulsive behaviors.

• CBT: Restructuring obsessive thoughts.

• Medications: SSRIs (e.g., Fluoxetine), Clomipramine (TCA).

Conclusion

Understanding the clinical features, prevalence, causes, and treatments of these disorders
helps in effective diagnosis and management.

----------------------------------------------------------------------------------------------------------------