1
LU 7 - ANXIETY DISORDERS, OBSESSIVE COMPULSIVE AND RELATED
DIORDERS (OCD, hoarding disorder and body dysmorphic disorder).
The classification of abnormal behaviour according to the DSM-5 classification system is based on
observable behaviour (symptoms) and not on the presumed aetiology.
According to the DSM-5 classification system, Anxiety disorders and Obsessive-compulsive and
Related disorders are two separate types of disorders, each with its own unique characteristic
symptoms. In comparison to the Anxiety Disorders which are primarily characterised by excessive
fear and anxiety and related behavioural disturbances, Obsessive-Compulsive and related disorders
have obsessive thoughts and/or repetitive behaviours as key features. However, there are close
relationships between the anxiety disorders and some OCD and Related disorders. Example, most
individuals diagnosed with OCD experience severe anxiety and distress.
Anxiety disorders:
Fear is defined as “... the emotional response to real or perceived imminent threat” by the American
Psychiatric Association. It is also an intense emotion experienced in response to a threatening
situation. “Anxiety is the anticipation of future threat”. It is s fundamental human emotion that
produces bodily reactions that prepare us for “fight or flight”; anxiety is anticipatory-the dreaded
event or situation has not yet occurred.
Anxiety and fear are regarded as normal adaptive responses to threats and perceived threats as long
as they are mild and realistic reactions given the circumstances and if they do not cause intense
discomfort or impairment in our functioning. Unfortunately, some individuals suffer such disabling
fear or anxiety that they cannot lead normal lives. Their anxieties and fears are severe, chronic, and
interfere with their lives. The amount of anxiety or fear experienced is out of proportion to the harm
the threat could cause, their concerns persist when the threat passes and their anxieties and fears
result in illogical, maladaptive behavioural patterns.
Pathological anxiety and fear manifest in various ways in different people as seen in the following
brief overview. Some individuals experience a general sense of diffuse anxiety and worry about
many potentially bad things that may happen (characteristic of a Generalised Anxiety Disorder),
other individuals may have a persistent and disproportionate fear of some specific object or
situation that presents little or no danger and yet leads to a great deal of avoidance of the feared
object or situation (characteristic of a Specific Phobia, Social Anxiety Disorder and Agoraphobia).
Some individuals may experience excessive fear or anxiety concerning separation from home or
attachment figures (characteristic of Separation Anxiety Disorder) while other individuals may
experience recurrent, unexpected urges of intense fear of discomfort which reach a peak within
minutes (panic attack) and are persistently worried about having more panic attacks (characteristic
of Panic Disorder). Some other individuals may experience such high social anxiety in certain social
situations that they become mute in those social situations (characteristic of Selective Mutism).
Although these people are aware of the illogical and self- defeating nature of some of their
behaviours, they seem incapable of controlling them.
, 2
Types of Anxiety Disorders:
Anxiety Disorders are rooted in maladaptive anxiety or fear.
Anxiety is described as: future-oriented mood state in which a person apprehensively anticipates
danger or misfortune. This emotional state is characterised by physiological arousal, unpleasant
feelings of tension and a sense of apprehension or foreboding. Fear is a present-oriented mood
state characterised by an immediate alarm reaction to a dangerous or life-threatening situation.
Fear is a basic emotion that involves activation of the "fight or flight" response of the autonomic
nervous system.
Anxiety and fear are characterised by a wide range of symptoms that cut across affective, physical,
behavioural and cognitive domains:
• Affective or emotional symptoms may include a sense of fearfulness and watchfulness and a sense
of dread, terror and restlessness.
• Cognitive symptoms range from mild, unrealistic worry to panic. Harm may be anticipated, danger
may be exaggerated and severe forms can bring a conviction of impending doom (the end of the
world or death). Concentration problems, fears of losing control and dying, a sense of unreality and
hyper vigilance may also be experienced.
• Behavioural symptoms may include avoidance behaviour, freezing, clinging, dependent and
agitated behaviour.
• Somatic symptoms are changes in a person’s physiological or biological reactions. These symptoms
may include increased heart rate and perspiration, elevated blood pressure, tense muscles, goose
bumps, shallow breathing, mouth dryness, cold hands and feet, diarrhoea, frequent urination,
dilated pupils, light-headedness, faintness and indigestion.
, 3
Separation anxiety disorder:
Separation Anxiety Disorder is not limited to the childhood years. Although the symptoms often
develop in childhood, they can be expressed throughout adulthood as well.
The manifestation of Separation Anxiety Disorder varies with age. For example, children may be
reluctant to go to school and may not want to be physically separated from their parents, even at
home, while adults with Separation Anxiety Disorder typically experience excessive difficulty to cope
with changing circumstances such as leaving home and getting married. They typically experience
excessive discomfort when they are separated from their loved ones. They often need to check on
the whereabouts and wellbeing of their spouses and children.
Selective Mutism:
Agoraphobia and Panic Disorder: Symptoms last for 6months or more.
Agoraphobia: the fear of being trapped in a situation or place from which escape might be difficult
(or possibly embarrassing) or in which help would not be readily available if the individual
experiences panic-like symptoms or if a panic attack occurs.
The following situations (at least two or more) are feared and avoided: being in a crowd of people
or standing in line, using public transportation, or being in open spaces or in enclosed places or
being outside of the home alone.
