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Samenvatting OWG 1 leerdoelen uitgewerkt (hyperventilatie)
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Blok 4, taak 1: Anxiety and hyperventilation (DSM-V)1. Wanneer is er sprake van reële angst/ wanneer pathologische angst?
Bron: Craske, M. G., and Stein, M. B. (2016). Anxiety. The Lancet, 388(10063), 3048-3059.
doi:10.1016/S0140-6736(16)30381-6
Individuals with anxiety disorders are excessively fearful, anxious, or avoidant of perceived
threats in the environment (eg, social situations or unfamiliar locations) or internal to oneself
(eg, unusal bodily sensations). The response is out of proportion to the actual risk or danger
posed.
Fear occurs as a result of perceived imminent threat whereas anxiety is a state of
anticipation about perceived future threats.
Fear: angst voor iets dat er is
Anxiety: angst voor dreiging die kan komen, verwachten.
To be diagnosed as an anxiety disorder, the fear and anxiety are marked (excessive or out of
proportion to the actual threat posed), persistent and associated with impairments in social,
occupational, or other important areas of functioning.
The fear or anxiety must be marked, persistent, and impairing.
Although categorical diagnostic criteria can be clinically useful, anxiety is a dimensional
construct, and the distinction between what is normal and abnormal rests on clinical
judgments of severity, frequency of occurrence, persistence over time, and degree of distress
and impairment in functioning.
2. Kort definitie angststoornis
Bron: DSM 5
Anxiety disorders include disorders that share features of excessive fear and
anxiety and related behavioural disturbances. Fear is the emotional response to real or
perceived imminent threat, whereas anxiety is anticipation of future threat. Obviously, these
two states overlap, but they also differ, with fear more often associated with surges of
autonomic arousal necessary for fight or flight, thoughts of immediate danger, and escape
behaviors, and anxiety more often associated with muscle tension and vigilance in
preparation for future danger and cautious or avoidant behaviors. Sometimes the level of
fear or anxiety is reduced by pervasive avoidance behaviors. Panic attacks feature
prominently within the anxiety disorders as a particular type of fear response. Panic attacks
are not limited to anxiety disorders but rather can be seen in other mental disorders as well.
The anxiety disorders differ from one another in the types of objects or situations
that induce fear, anxiety, or avoidance behavior, and the associated cognitive ideation. Thus,
while the anxiety disorders tend to be highly comorbid with each other, they can be
differentiated by close examination of the types of situations that are feared or avoided
and the content of the associated thoughts or beliefs.
, Anxiety disorders differ from developmentally normative fear or anxiety by being
excessive or persisting beyond developmentally appropriate periods. They differ from
transient fear or anxiety, often stress-induced, by being persistent (e.g., typically lasting 6
months or more), although the criterion for duration is intended as a general guide with
allowance for some degree of flexibility and is sometimes of shorter duration in children (as
in separation anxiety disorder and selective mutism). Since individuals with anxiety disorders
typically overestimate the danger in situations they fear or avoid, the primary determination
of whether the fear or anxiety is excessive or out of proportion is made by the clinician,
taking cultural contextual factors into account. Many of the anxiety disorders develop in
childhood and tend to persist if not treated. Most occur more frequently in females than in
males (approximately 2:1 ratio). Each anxiety disorder is diagnosed only when the
symptoms are not attributable to the physiological effects of a substance/medication or to
another medical condition or are not better explained by another mental disorder.
Overschatten van gevaar, clinicus moet bepalen of het buiten proportie is.
3. Wat is een gegeneraliseerde angststoornis; klinisch beeld (symptomen; gedachten,
gevoelens etc.)
Bron: Craske, M. G., and Stein, M. B. (2016). Anxiety. The Lancet, 388(10063), 3048-3059.
doi:10.1016/S0140-6736(16)30381-6
DSM 5: Generalised anxiety disorder
- Marked anxiety and worry, more days than not, about various domains, such as work and
school performance, which the individual finds difficult to control, for at least 6 months
- At least three (DSM-5) or four (ICD-10) physical symptoms: restlessness or feeling keyed up
or on edge, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep
disturbance (ie, difficulty falling or staying asleep or unsatisfying sleep), and symptoms of
autonomic arousal (ICD-10)
Bron: Stevens, E. S., Jendrusina, A. A., Sarapas, C. and Behar, E. (2014) Generalized Anxiety
Disorder, in The Wiley Handbook of Anxiety Disorders (eds P. Emmelkamp and T. Ehring,
378-382 and 385-401), John Wiley and Sons, Ltd, Chichester, UK. doi:
10.1002/9781118775349.ch21
As expressed in DSM 4, the diagnostic criteria included excessive anxiety and worry that
occurs a majority of days for at least 6 months, and difficulty controlling the worry. In
addition, diagnosis was contingent upon the endorsement of at least three of six associated
symptoms:
1. restlessness or feeling keyed up or on edge
2. being easily fatigued
3. difficulty concentrating or mind going blank
4. irritability
5. muscle tension
6. sleep disturbance (difficulty falling or staying asleep, or restless/unsatisfying sleep)
Moreover, the anxiety and/or topics of worry must not have been alternatively explained
by other Axis 1 diagnosis (e.g., fear of social situations) and must also cause significant
clinical distress and/or impairment.
, Additionally, the symptoms could not be better accounted for by substance use or a
medical condition. Lastly, a diagnostic hierarchy existed such that the symptoms could not
occur exclusively during a mood disorder, psychotic disorder, or pervasive developmental
disorder.
De DSM 5 behield de diagnostische criteria zoals in de DSM 4 beschreven!!
Dingen die onderscheid maken tussen GAD met hoge mate van zorgen maken en enkel de
hoge mate van zorgen maken:
- the chronic/excessive worry and distress/impairment criteria
- uncontrollability of worry
- topics of worry: meer topics en meer diverse onderwerpen (bijvoorbeeld dagelijkse
dingen) bij GAD.
Ieder persoon met GAD maakt zich zorgen over andere onderwerpen, dat is niet toe te
schrijven aan vaste onderwerpen waarover ze zich zorgen maken.
In contrast to other anxiety syndromes, GAD is not characterized by motoric avoidance of
disorder-specific situations. Instead, current theoretical models conceptualize worry as
entailing cognitive avoidance of threatening material. This lack of motoric avoidance makes
traditional behavioral exposure techniques impossible in the treatment of worry. Instead,
approaches to treating GAD rely on our knowledge of chronic worriers’ nonadaptive patterns
involving awareness, physiology, behavior, cognition, and emotion.
Nonadaptive awareness
Individuals with GAD are highly focused on repetitive verbal activity regarding potential
future negative events. As a result of this almost constant focus on future threat, chronic
worriers lack the attentional resources needed to attend to the other components of their
realities as well as to the present moment. This lack of awareness leads to multiple
challenges. For example, chronic worriers do not recognize the causal relationship between
their cognitions, emotions, physiology, and behavior, and how those interconnected
elements influence both the internal and external problems in their lives. Additionally, this
lack of awareness often leads chronic worriers to believe that their anxiety escalates quickly
and spontaneously, instead of recognizing that anxiety spirals slowly and results from a
variety of maladaptive ways of thinking and behaving. Finally, this lack of awareness inhibits
individuals’ ability to focus on the present moment, which would otherwise have the
potential to bring them joy.
Nonadaptive physiology
The only physiological symptom shown to be elevated in individuals with GAD is muscle
tension, in contrast to other anxiety disorders which are characterized by elevations in
sympathetic reactivity to fear cues.
Nonadaptive behavior
Although consistent behavioral avoidance of a discrete stimulus is not a diagnostic feature of
GAD, many individuals with GAD show signs of behavioral avoidance of various stimuli and
situations. Indeed, individuals with GAD show rigid behaviors in various domains, including
interpersonal. One potentially useful approach to helping chronic worriers is thus to help
them identify the core values in their lives, and to recognize ways in which their worries
distract them from being present during valued activities.
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