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General Overview of Anxiety
Health Care Concepts II (NSG 211)
Germanna Community College
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Anxiety
exemplars: gad, panic disorder, phobias, ocd, ptsd Overview: Anxiety is a natural survival response to stress, helping individuals avoid potential threats by triggering feelings of fear, nervousness, or worry. It is often based on an anticipated future threat or stressful event. Initially, anxiety enhances performance by increasing blood flow to the heart, muscles, and brain, motivating the individual to take action. However, if anxiety becomes excessive or persistent, it can escalate to panic, impairing daily functioning. Seyle’s General Adaptation Syndrome (GAS) explains this physiological response to stress, showing how anxiety can shift from an adaptive mechanism to a maladaptive one, resulting in both psychological and physical distress. When anxiety reaches this level, it can be classified as an anxiety disorder, characterized by its disabling effects on normal life. Anxiety and stress are often confused, but they are distinct responses. Stress typically occurs as a proportional reaction to a specific situation, while anxiety is a reaction to stress and becomes a disorder when it is inappropriate for the situation, happens too frequently, interferes with functioning, or lasts too long. Simplified Pathophysiology of Anxiety: Anxiety shares some symptoms with stress and depression, like trouble sleeping, difficulty concentrating, and fatigue. The pathophysiology of anxiety starts with the brain's fear center, the amygdala, and the hypothalamus, which trigger the body's survival responses (fight, flight, freeze, fawn) by releasing stress hormones. This is controlled by the amygdala-centered circuit, which drives fear and panic. Another brain loop, the cortico-striato-thalamo-cortical circuit (CSTC), is linked to worry, obsessive thoughts, and anxiety. This loop involves neurotransmitters like serotonin, GABA, dopamine, and norepinephrine, which play key roles in anxiety and are targets for medications used in treatment. Seyle’s General Adaptation Syndrome (GAS) outlines the body's predictable response to stress through three stages:
- Alarm Phase: The body enters a heightened state of alert when exposed to stress, initiating the fight-flight-freeze-fawn response. Heart rate increases, cortisol is released, and the brain becomes more focused on managing the stressor.
- Resistance Stage: The body attempts to stabilize and recover from the alarm phase. While still in a heightened state of alert, the autonomic nervous system gradually downregulates. If the stressor resolves, the body returns to normal functioning; if it persists, the body remains stressed.
- Exhaustion Phase: If the stress continues without resolution, the body’s energy reserves are depleted, leading to an inability to self-regulate effectively, resulting in physical and mental exhaustion. Hildegard Peplau’s Theory of Interpersonal Relations is foundational for the nurse-client therapeutic relationship and outlines the nurse’s role in managing the client's anxiety. The theory describes four phases of the relationship: orientation, identification, exploitation, and resolution, which guide interactions. Peplau also highlights different levels of anxiety:
- Mild Anxiety: The client shows visible signs of anxiety, such as restlessness, seeking reassurance, and heightened focus. At this level, anxiety can enhance functioning, such as aiding concentration for studying.
- Moderate Anxiety: Symptoms intensify, including restlessness, irritability, and trouble concentrating or sleeping. The client may worry excessively, as seen in someone stressing over job loss.
- Severe Anxiety: The client becomes overwhelmed, and usual coping mechanisms fail. The individual may display intense anxiety, irritability, and an inability to perform daily tasks, such as a parent unable to act after losing a child.
- Panic: The client experiences terror, is detached from reality, unable to communicate or function, and may be at risk for self-harm, as in a person stuck in an elevator and overcome with fear. The Diathesis-Stress Model helps explain how anxiety disorders develop by looking at the interaction between genetic and environmental factors. This model suggests that certain individuals are born with vulnerabilities—such as genetic, biological, or cognitive predispositions—that make them more likely to develop mental health issues. When these vulnerabilities combine with environmental stressors, like traumatic events or chronic stress, the likelihood of developing an anxiety disorder increases. For example, a child raised in a violent home, a combat veteran adjusting to civilian life, or a car accident survivor afraid to drive all demonstrate how genetic predisposition combined with life experiences can trigger anxiety disorders. This model shows how both nature (genetics) and nurture (environment) shape mental health. Anxiety Levels:
- Mild: Restlessness, increased motivation, irritability
- Moderate: Agitation and muscle tightness
- Severe: Inability to function, ritualistic behavior, unresponsive
- Panic: Distorted perception, loss of rational thought, and immobility Practice Questions
- A client is experiencing severe anxiety. Which of the following manifestations should the nurse expect? (Select all that apply.) A. Restlessness B. Ritualistic behavior C. Muscle tightness D. Inability to function E. Distorted perception
- A nurse is assessing a client who is experiencing panic-level anxiety. Which of the following manifestations would the nurse expect to find? (Select all that apply.) A. Distorted perception B. Restlessness C. Loss of rational thought D. Agitation E. Immobility
trigger an attack, and constant worry about experiencing another episode. These attacks are time- limited, with fear or anxiety peaking in intensity during the episode. A. Signs and Symptoms: Palpitations, SOB, hoking or smothering sensation, chest pain, nausea, depersonalization, fear of dying or insanity, chills or hot flashes, behavioral changes, or persistent worry (about next attack that may happen) B. DSM-5-TR Criteria: A. Panic disorder involves recurrent, unexpected panic attacks, which are characterized by an abrupt surge of intense fear or discomfort that peaks within minutes. During a panic attack, four or more of the following symptoms occur:
- Palpitations, pounding heart, or accelerated heart rate
- Sweating
- Trembling or shaking
- Sensations of shortness of breath or smothering
- Feelings of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, light-headed, or faint
- Chills or heat sensations
- Paresthesia (numbness or tingling sensations)
- Derealization (feelings of unreality) or depersonalization (being detached from oneself)
- Fear of losing control or “going crazy”
- Fear of dying B. NOTE: Culture-specific symptoms, such as tinnitus, neck soreness, headache, uncontrollable screaming, or crying, may also occur but should not be counted as one of the four required symptoms. C. After at least one panic attack, the individual experiences one or both of the following for at least 1 month or more:
- Persistent concern or worry about additional panic attacks or their consequences (e., losing control, having a heart attack, “going crazy”)
- A significant maladaptive change in behavior related to the attacks, such as avoidance of activities or situations that may trigger an attack (e., avoiding exercise or unfamiliar environments) D. The disturbance is not due to substance use, a medical condition, or better explained by another mental disorder (e., social anxiety, phobias, OCD, or separation anxiety). C. Diagnosis: Panic Disorder Severity Scale
- Phobias: Experiencing an irrational fear or marked anxiety of a certain object or situation. Examples are: Animals, nature, heights, inoculations (vaccines), blood spiders, snakes, or strangers. The client can also report a fear of specific experiences like flying, being in the dark, riding in an elevator, or being in an enclosed space. A. Signs and Symptoms: Experiences anxiety manifestations just by thinking about the object or situation they are scared of and might attempt to decrease it through alcohol or other substances. B. Types: A. Monophobia: fear of being alone B. Zoophobia: fear of animals
C. Acrophobia: fear of heights D. Agoraphobia: fear of certain places or situations (outdoors, being on a bridge, doing an MRI) C. Diagnosis: Fear Questionnaire (phobias) 4. Obsessive Compulsive Disorder (OCD): Triggered by anxiety and involves persistent, unwanted, and unrealistic obsessions—recurring thoughts or urges—that become intrusive. To reduce this anxiety, individuals engage in compulsions, repetitive behaviors such as handwashing or cleaning an object. These behaviors are time-consuming and interfere with daily functioning, affecting social and occupational roles. Although individuals with OCD recognize that their thoughts and actions are irrational, they feel compelled to continue and cannot stop. OCD can affect both children and adults, with compulsive behaviors in children often reflecting their developmental stage and more easily recognized, and adolescents more likely to exhibit obsessions related to religion or sexuality. A. Examples of Obsessions:
- Thoughts about being harmed or harming someone else
- Fears for safety
- Concern about cleanliness or germs
- Fear of offending a higher power or deity
- Fear of forgetting something important
- Worry about how tidy or neatly arranged items are B. Examples of Compulsions:
- Checking and rechecking that a door is locked
- Ritualistic handwashing
- Repeating specific words or phrases
- Hurting self (e., hair-pulling)
- Counting objects, items, or actions
- Repeating an activity a specific number of times C. Signs and Symptoms: Experiencing a pattern of uncontrollable obsessive thoughts and associated compulsive behaviors or rituals:
- Cleaning
- Handwashing
- Ordering or counting objects
- Taboo or forbidden thoughts D. DSM-5-TR Criteria:
- Obsessions are defined by both:
- Recurrent, persistent, intrusive, and unwanted thoughts, urges, or images causing marked anxiety or distress.
- Attempts to ignore, suppress, or neutralize these thoughts with other actions or thoughts (compulsions).
- Compulsions are defined by both:
- Repetitive behaviors (e., handwashing, checking) or mental acts (e., praying, counting) performed in response to an obsession or rigid rules.
- The behaviors aim to reduce anxiety or prevent a dreaded event, though they are unrealistic or excessive.
The obsessions or compulsions are time-consuming (take more than 1 hour per day) or cause significant distress or impairment in daily functioning.
Functional impact: The symptoms cause significant distress and impair daily life functioning.
Timeline: PTSD occurs when these symptoms persist for over a month; shorter duration would be classified as acute stress disorder (ASD). — DSM-5-TR Criteria for Post-Traumatic Stress Disorder in Children 6 Years and Younger Criterion A: Stressor (One Required)
Direct experience of a traumatic event (e., real or threatened death, serious injury, or sexual violence)
Witnessing the event (excluding media or screen exposure)
Learning about a traumatic event that happened to a caregiver Criterion B: Intrusion Symptoms (One Required)
Spontaneous and intrusive memories of the trauma (can be expressed through play)
Recurring distressing dreams about the trauma
Flashbacks or dissociative reactions (can be seen through play)
Intense emotional distress in response to trauma reminders
Strong physical reactions (e., increased heart rate) to trauma reminders Criterion C: Avoidance and Mood Changes (One Required)
Avoidance of activities, places, or reminders of the trauma
Avoidance of people, conversations, or interpersonal situations that trigger trauma memories
Negative emotional states such as fear, shame, or sadness
Loss of interest in previously enjoyable activities
Social withdrawal
Reduced expression of positive emotions Criterion D: Arousal and Reactivity Changes (One Required)
Irritable behavior or angry outbursts (including severe temper tantrums)
Hypervigilance (constantly on guard)
Exaggerated startle response
Difficulty concentrating
Problems with sleep Additional Criteria:
Symptoms must last for at least one month
Causes significant distress or problems in relationships or school behavior
Symptoms are not better explained by substance use or another medical condition — DSM-5-TR Criteria for Post-Traumatic Stress Disorder (PTSD) in Individuals Older Than 6 Years All of the following criteria must be met for a PTSD diagnosis: Criterion A: Stressor (One Required) The person was exposed to death, threatened death, serious injury, or sexual violence through one or more of the following:
Direct exposure
Witnessing the trauma
Learning that a relative or close friend was exposed to trauma
Indirect exposure to trauma details (e., first responders)
Criterion B: Intrusion Symptoms (One Required) The traumatic event is reexperienced in one or more of the following: - Unwanted upsetting memories - Nightmares - Flashbacks - Emotional distress after exposure to reminders - Physical reactivity after exposure to reminders Criterion C: Avoidance (One Required) Avoidance of trauma-related stimuli in one or more of the following: - Trauma-related thoughts or feelings - External reminders related to the trauma Criterion D: Negative Alterations in Cognition and Mood (Two Required) Negative thoughts or feelings that started or worsened after the trauma: - Inability to recall key details of the trauma - Overly negative thoughts or assumptions about oneself or the world - Exaggerated blame of self or others for causing the trauma - Persistent negative emotions - Decreased interest in activities - Feeling isolated - Difficulty experiencing positive emotions Criterion E: Alterations in Arousal and Reactivity (Two Required) Increased arousal and reactivity, starting or worsening after the trauma: - Irritability or aggression - Risky or destructive behavior - Hypervigilance - Heightened startle reaction - Difficulty concentrating - Difficulty sleeping Criterion F: Duration (Required) Symptoms last for more than one month. Criterion G: Functional Significance (Required) Symptoms cause significant distress or impairment in social, occupational, or other areas of functioning. Criterion H: Exclusion (Required) Symptoms are not due to medication, substance use, or another medical condition. Specifications: - Dissociative Specification: High levels of depersonalization or derealization in reaction to trauma-related stimuli. ◦ Depersonalization: Feeling detached from oneself. ◦ Derealization: Feeling of unreality or distortion. - Delayed Specification: Full criteria not met until at least six months after the trauma, though symptoms may appear earlier. —
General Overview of Anxiety
Course: Health Care Concepts II (NSG 211)
University: Germanna Community College
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