So in this lecture, we're going to talk about anxiety disorders more broadly. So anxiety disorders are the most frequent diagnoses in the general population. Anxiety disorders are co-morbid with depression about 50 percent of the time. Most individuals with one anxiety disorder also suffer from a second anxiety disorder. Women are two times more likely than men to develop anxiety disorders. All right. So what makes an anxiety disorder an actual disorder? There's a nice graphic here on the right-hand side of the screen from the ADAA, that basically describes the differences between everyday anxiety and what people deal with as part of an anxiety disorder. So what makes it a disorder is that it's severe enough to lower your quality of life, that it's chronic and frequent and interferes with your functioning, and the anxiety itself is out of proportion to the dangers that people truly face. Now it's important to note that just because cannabis may be helpful more broadly for anxiety or stress or tension in general, it doesn't necessarily mean that it's helpful for an anxiety disorder. So there are multiple different versions or types of anxiety disorders. For the purposes of this course, we're going to focus on four of them, and those four are over here in the red font. So for this course, we're going to focus on panic disorder, generalized anxiety disorder, social anxiety disorder, and post-traumatic stress disorder. You see here on the other side of the screen that there are a variety of other anxiety disorders that we will not be talking about in the context of this course. Okay. So we're going to start with panic disorder. Panic is an extreme anxiety reaction that can result when a real threat suddenly emerges. That makes a lot of sense, right. That's actually a healthy thing that you have this extreme anxiety reaction in the face of a real threat. However, the experience of panic attacks is different. A panic attack is characterized by sudden and repeated periods of overwhelming anxiety and fear, a feeling of being out of control or fear of death or doom. Physical symptoms like hard pounding or your heart racing, sweating, chills, shaking, trouble breathing. There's a whole host of physical symptoms that go along with a panic attack. Also on the cognitive side, intense worry about when the next panic attack will occur, and a fear or avoidance of places where panic attacks have happened in the past. Now, if you want more information about panic disorder and panic attacks, there is a great website at the bottom of the screen, that's put up by the National Institute of Mental Health. All right. Let's talk about what exactly is generalized anxiety disorder or GAD or G A D for short. So in terms of the clinical description of this, and basically this is when a person shifts from crisis to crisis, and worries about minor everyday concerns. I should say worries a lot about minor and everyday concerns. Also, those may come from worries may be related to jobs or family or chores or appointments or a whole host of things. Now statistically speaking, the prevalence of generalized anxiety disorder is about 3.1 percent in the past year, and 5.7 percent in terms of a lifetime prevalence rate. The rates are pretty similar around the world and typically, generalized anxiety source starts in early adulthood. It has a slow course of development, and also is characterized by chronic course that seems to persist and lasts over a long period of time. So here's a more detailed description of the kinds of symptoms and the kind of things that we're talking about with generalized anxiety disorder. So again characterized by worrying a lot about everyday things, having trouble controlling worries or feelings of nervousness, knowing that you worry more than you should, feeling restless and having trouble relaxing, having a hard time concentrating, being easily startled, having trouble falling asleep or staying asleep. Feeling easily tired or tired all the time. Headaches, muscle aches, stomach aches, or other unexplained pains. Difficulty swallowing, and trembling or twitchy. Being irritable or feeling on edge. Sweating a lot, feeling light-headed, having to go to the bathroom a lot. So that's a pretty long list of symptoms that characterize generalized anxiety disorder. Now, we're going to switch gears and talk for a second about, what is social anxiety disorder? So social anxiety disorder is characterized by fear in social situations, so strong that it gets in the way of going to work, attending school or doing everyday things. People with social anxiety disorder may worry about these situations for weeks before they happen. They may avoid places are events where they think they might have to do something socially that might embarrass them. When having to perform in front of other people or be around other people, individuals with social anxiety disorder tend to experience the following; a blushing, sweating, trembling, rapid heart rate, feeling like their minds going blank, feeling nauseous or sick in the stomach. Showing a rigid body pressure, avoiding eye contact or speaking in very softly. They might find it scary and difficult to be around other people. They might be very self-conscious in front of other people, and feeling embarrassed or awkward. They might be very afraid that other people will judge them, and ultimately staying away from places where there are other people. Again for more information, NIMH website is the great place to go. Okay. So now let's talk about post-traumatic stress disorder. What is post-traumatic stress disorder? PTSD is a disorder that can develop after experiencing a shocking, scary traumatic, dangerous event. So of course when going through such an event and immediately after, it's normal and natural to feel afraid. But PTSD is different in that because it involves the continuation of stress, the continuation of fear and anxiety and problems long after the danger has passed. So in this situation, symptoms usually begin within about three months of the traumatic incident, but it also can begin even later than that and typically lasts more than a month and be severe enough to interfere with functioning in daily life. Now, some people will recover within six months, but others have symptoms that become chronic and may last years and years. So to be diagnosed with PTSD, an adult must have all the following for at least one month: At least one re-experiencing symptom, at least one avoidance symptom, at least two arousal and reactivity symptoms, at least two cognition and mood symptoms. Now, what do we mean by that? Well, for re-experiencing symptoms, this is the kind of things we're talking about here. So flashbacks involving basically re-experiencing the trauma, relieving the trauma. That includes physical symptoms like heart racing or sweating, and bad dreams is another example of re-experiencing symptoms. Frightening thoughts. Re-experiencing symptoms may cause problems as you can imagine in everyday life. These symptoms can be triggered by thoughts or feelings or words or objects or situations that remind people of the original event. So in terms of avoidance symptoms, we're talking about things like sitting away from places or events or objects that serve as reminders of that original traumatic experience. We're talking about avoiding thoughts or feelings that are related to that traumatic event. Or things or situations that remind people of the traumatic event can trigger avoidance and cause changes to behavior. Now in terms of arousal and reactivity symptoms, here we're talking about being easily startled, feeling tense or very much on edge, having difficulty sleeping or having angry outbursts. Arousal symptoms are usually constant, making it harder to do daily tasks like sleeping or eating or concentrating. Then finally, when we talk about cognition and mood symptoms, we are talking about for example having trouble remembering key aspects of the original traumatic events, negative thoughts about oneself or the world, distorted feelings related to guilt or blame, loss of interest in enjoyable activities. Cognitive and mood symptoms can make the person feel alienated or detached from friends or family members. Now, in terms of the onset of PTSD, I already mentioned usually within the first few months after the traumatic event, although it can be delayed by months or even years before you start to see symptoms. So here's another interesting piece of information with immediate onset. That basically is prognostic or better response to treatment, and less severe symptoms and fewer complications. Oftentimes, the symptoms will resolve within six months. Delayed onset however is characterized by an onset symptoms at least six months after the stressor, the original traumatic event. Is associated with symptoms and conditions that tend to be more chronic and may involve repressed memories and importantly, with delayed onset, we have a worse prognosis. In terms of the course of PTSD, the emergence of symptoms and dealing with symptoms can vary over time. The duration also often varies. Symptom reactivation may occur following again reminders of the trauma, and also other life stressors and new traumatic events can cause the reactivation of symptoms. Factors influencing the likelihood of developing PTSD are things like the severity of the trauma, the duration, the proximity to the traumatic event. All of those things can influence the development of PTSD. PTSD can develop in individuals without any predisposing conditions, and particularly if the stressor is extreme. So even if you don't have risk factors, if the original trauma, if the original stress is extreme enough, you can still develop PTSD. The disorder may be especially severe or long-lasting when the stressor is of human design or involves humans, and these are things like torture and rape. That type of stressor can cause severe long-lasting PTSD. So in summary, anxiety disorders are the most frequent psychiatric diagnoses. Panic disorder is characterized by sudden overwhelming anxiety and fear with physical symptoms. Generalized anxiety disorder is basically excessive worry about everyday things that interferes with your life. Social anxiety disorder is fear of social events or social interactions, so strong that interferes with your daily life and functioning. PTSD involves the continuation of stress and fear and anxiety and problems, interfering with your life long after an original trauma or danger has passed
