Treatment Of Anxiety In Clinical Practice Symptoms of Anxiety

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The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) of the American Psychiatric Association (1994) includes eight major types of anxiety disorders, most of which have been summarized in previous chapters, including PTSD (Chapter 11), panic attacks (Chapter 12), obsessive-compulsive disorders (Chapter 13), and various acute stress reactions (Chapter 4). Here we will be primarily concerned with generalized anxiety disorders, but the coverage is also relevant for specific phobias, including social phobias and agoraphobia. The most common clinical symptom of all these disorders is excessive worry and sustained feelings of mental anguish. Among the common symptoms of generalized anxiety there are a variety of psychological disturbances, such as uncontrollable apprehensive expectations, jumpiness, and a tendency for excessive vigilance and fidgeting. The accompanying autonomic symptoms commonly include gastrointestinal irritability, diarrhea, and frequent urination, as well as other visceral symptoms such as tachycardia, chronic dryness of the mouth, and increased but shallow respiration. Some are bothered more by the physical symptoms, while in others psychological distress is the prevailing concern. Practically all of these autonomic and psychological changes can be promoted by artificial activation of the FEAR system.

The specific phobias may reflect classical conditioning of specific fear responses. The social phobias may be based more on overactivity of yet other aversive brain systems such as the PANIC system, which mediates separation distress (Panksepp et al., 1988). Chronic, low-level arousal of separation feelings may tend to generate shyness and resulting attempts to sustain socioaffective homeostasis by restricting social activities to those with whom one is closely bonded (Schmidt and Schulkin, 1999). To some extent, distinct neurochemistries (e.g., neuropeptides) regulate these distinct types of anxiety (Chapter 21).

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