Anxiety, Obsessive-Compulsive, and Related Disorders

Anxiety, Obsessive-Compulsive, and Related Disorders 150 150 Tony Guo

Anxiety, Obsessive-Compulsive, and Related Disorders

  • Anxiety is an emotional response to anticipation of danger, the source of which is largely unknown or unrecognized.
  • Anxiety is a necessary force for survival. It is not the same as stress.
  • A stressor is an external pressure that is brought to bear on the individual.
  • Anxiety is the subjective emotional response to that stressor.
  • Anxiety may be distinguished from fear in that anxiety is an emotional process, whereas fear is a cognitive one.

Historical Aspects

  • Anxiety was once identified by its physiological symptoms, focusing largely on the cardiovascular system.
  • Freud was the first to associate anxiety with neurotic behaviors.
  • For many years, anxiety disorders were viewed as purely psychological or purely biological in nature.

Epidemiological Statistics

  • Anxiety disorders are the most common of all psychiatric illnesses.
  • More common in women than in men
  • A familial predisposition probably exists.
  • When anxiety is out of proportion to the situation that is creating it
  • When anxiety interferes with social, occupational, or other important areas of functioning


Application of Nursing Process

Panic disorder: Assessment

  • Characterized by recurrent panic attacks, the onset of which are unpredictable and manifested by intense apprehension, fear, or terror, often associated with feelings of impending doom and accompanied by intense physical discomfort
  • Attacks may last minutes or rarely hours and individual often experience varying degrees of nervousness and apprehension between attacks.
  • May or may not be accompanied by agoraphobia

Symptoms of panic attack

  • Sweating, trembling, shaking
  • Shortness of breath, chest pain, or discomfort
  • Nausea or abdominal distress
  • Derealization or depersonalization
  • Fear of dying
  • Dizziness, chills, or hot flashes
  • Numbness or tingling sensations
  • Fear of losing control or “going crazy”


Generalized anxiety disorder (G A D)

  • Characterized by chronic, unrealistic, and excessive anxiety and worry
  • The disorder may begin in childhood or adolescence, but onset is not uncommon after they turn 20. 


Predisposing factors: Panic attacks and G A D

Psychodynamic theory

  • Ego unable to intervene between id and superego
  • Overuse or ineffective use of ego defense mechanisms results in maladaptive responses to anxiety
  • Use of defense mechanisms rather than coping and management skills result in maladaptive responses to anxiety

Cognitive theory

  • Faulty, distorted, or counterproductive thinking patterns result in anxiety that is maintained by mistaken or dysfunctional appraisal of a situation.
  • Individuals have loss of ability to reason regarding the problem and feels vulnerable in a given situation, and distorted thinking results in an irritation appraisal thus a negative outcome

Biological aspects

  • Genetics
  • Neuroanatomical
  • Biochemical
  • Neurochemical




  • Fear of being vulnerable in places or situations from which escape might be difficult or in which help might not be available in the event of panic-like symptoms or other incapacitating symptoms.
    • Traveling in public transportation
    • Being in open spaces
    • Being in shops, theaters, or cinemas
    • Standing in line or being in a crowd
    • Being outside of the home alone in other situations

Social anxiety disorder (social phobia)

  • Excessive fear of situations in which the affected person might do something embarrassing or be evaluated negatively by others
  • Exposure to the phobic situation usually results in feelings of panic anxiety with sweating, tachycardia, and dyspnea.
  • It appears to be more common in women than in men.

Specific phobia

  • Fear of specific objects or situations that could conceivably cause harm, but the person’s reaction to them is excessive, unreasonable, and inappropriate
  • Exposure to the phobic object produces overwhelming symptoms of panic, including palpitations, sweating, dizziness, and difficulty breathing
  • After a period of time, the person recognizes that their fear is excessive or unreasonable but is powerless to change, even though they occasionally endure the phobic stimulus when experiencing intense anxiety.

Type specifiers

  • Animal 
  • Natural environment type 
  • Blood-injection-injury type
  • Situational type 
  • Other type


Predisposing factors to phobias

  • Psychoanalytical theory 
    • Unconscious fears may be expressed in a symbolic manner as phobia. 
  • Learning theory 
    • Fears are conditioned responses and thus are learned by imposing reinforcements for certain behaviors.
  • Cognitive theory
    • Anxiety is the product of faulty cognitions or anxiety-inducing self-instructions.
      • Negative self-statements
      • Irrational beliefs
    • The individual begins to seek out avoidance behaviors to prevent the anxiety reaction, and phobias results.
    • Types of phobia
Classifications Fear Classifications Fear
Acrophobia Height Mysophobia Dirt, germs, contamination
Ailurophobia Cats Numerophobia Numbers
Algophobia Pain Nyctophobia Darkness
Anthophobia Flowers Ochophobia Riding in a car
Anthropophobia People Ophidiophobia Snakes
Aquaphobia Water Pyrophobia Fire
Arachnophobia Spiders Scoleciphobia Worms
Astraphobia Lightning Siderodromophobia Railroads or train travel
Belonephobia Needles Taphophobia Being buried alive
Brontophobia Thunder Thanatophobia Death
Claustrophobia Closed spaces Trichophobia Hair
Cynophobia Dogs Triskaidekaphobia The number 13
Dementophobia Insanity Xenophobia Strangers
Equinophobia Horses Zoophobia Animals
Gamophobia Marriage
Herpetophobia Lizards, reptiles
Homophobia Homosexuality
Murophobia Mice


  • Biological aspects
    • Neuroanatomical- Specific areas in the prefrontal cortex and the amygdala play a role in storing and recalling information about threatening or potentially deadly events.
    • Temperament- Children experience fears as a part of normal development
    • Characteristics with which one is born that influence how he or she responds throughout life to specific situations (for example, innate fears)
  • Life experiences
    • Early experiences may set the stage for phobic reactions later in life.

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