Therapy for anxiety Therapy for anxiety
Related Articles
Anxiety Syndromes and Disorders.
In the first chapter we reviewed the major subjective, cognitive, physiologic, and behavioral aspects of anxiety.
Can certain syndromes or types of anxiety be identified by constellations of these symptoms, precipitating events, and course?
This is a surprisingly controversial question and is related to the issue of how to diagnose anxiety. Our own position is that a number of different types of anxiety syndromes may be identified in clinical practice.
These syndromes should not necessarily be considered disorders, a term we reserve for syndromes meeting the criteria established by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, DSM-III-R, 1987). The common syndromes are:
- Fear. Fear or acute anxiety occurs in response to a definable real or
imagined stimulus. These can sometimes be diagnosed as simple
phobias. - Generalized anxiety (sometimes called trait or chronic anxiety),
characterized by increased levels of arousal present most of the
time. Such patients experience constant jitteriness, worry, and other
symptoms, which may sometimes be diagnosed as generalized
anxiety disorder. - Episodic, intense anxiety attacks characterized by rapid onset and multiple
symptoms (panic attacks). Such attacks can be spontaneous—having
no identifiable cause—or situational, that is, occurring in predictable
situations. Such patients may sometimes be diagnosed as having
panic disorder (uncomplicated) or panic disorder with agoraphobia. - Anticipatory anxiety related to internal or external actual or imagined
threatening events. Most of us experience small levels of anticipatory
www.freepsychotherapybooks.org 63
anxiety fairly frequently. - Mild episodic anxiety. Mild episodic anxiety occurs for reasons that are
difficult for the patient to identify. Such anxiety is a common
phenomenon in therapy. We include so-called death or existential
anxiety in this category. - Mild anxiety and mild depression, sometimes called distress. This is
probably the most common anxiety disorder. Patients with mild
anxiety and depression and concomitant medical problems are the
most frequent users of sedative medications. - Anxiety related to specific social, family, or work situations. In such patients
the anxiety is usually bearable and is seen as secondary to the
primary problem. Such patients sometimes meet the criteria for
social phobia. - Anxiety following traumatic events. Such patients may meet the DSM-III-R
criteria for post-traumatic stress syndrome.
All of these types of anxiety exist on a normal distribution of intensity,
frequency, and symptomology. However, these syndromes, when severe, often
meet the criteria for DSM-III-R anxiety disorders.
