Case uitwerking
Task 1. Anxiety and hyperventilation
GGZ2024. Anxiety and Related Disorders. Taak 1 uitgewerkt: Anxiety and hyperventilation. De aantekeningen van de tutorial zijn toegevoegd in het groen. Voor alle taken, zie de bundel
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Task 1. Anxiety and hyperventilationAmerican Psychiatric Association (2013). Diagnostics and statistical manual of mental
disorders, DSM-V
Anxiety disorders include disorders that share features of excessive fear and anxiety and
related behavioral disturbances. Fear is the emotional response to real or perceived
imminent threat, whereas anxiety is anticipation of future threat. Panic attacks feature
prominently within the anxiety disorders as a particular type of fear response. 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.
Specific Phobia
A. Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals,
receiving an injection , seeing blood). Note: In children, the fear or anxiety may be
expressed by crying, tantrums, freezing, or clinging.
B. The phobic object or situation almost always provokes immediate fear or anxiety.
C. The phobic object or situation is actively avoided or endured with intense fear or anxiety.
D. The fear or anxiety is out of proportion to the actual danger posed by the specific object
or situation and to the sociocultural context.
E. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
F. The fear, anxiety, or avoidance causes clinically significant distress or impairment in
social, occupational , or other important areas of functioning.
G. The disturbance is not better explained by the symptoms of another mental disorder,
including fear, anxiety, and avoidance of situations associated with panic-like symptoms
or other incapacitating symptoms (as in agoraphobia); objects or situations related to
obsessions (as in obsessive-compulsive disorder); reminders of traumatic events (as in
posttraumatic stress disorder); separation from home or attachment figures (as in
separation anxiety disorder); or social situations (as in social anxiety disorder).
Comorbidity
Specific phobia is rarely seen in medical-clinical settings in the absence of other
psychopathology and is more frequently seen in nonmedical mental health settings. Specific
phobia is frequently associated with a range of other disorders, especially depression in
older adults. Because of early onset, specific phobia is typically the temporally primary
disorder. Individuals with specific phobia are at increased risk for the development of other
disorders, including other anxiety disorders, depressive and bipolar disorders, substance
related disorders, somatic symptom and related disorders, and personality disorders
(particularly dependent personality disorder).
Social Anxiety Disorder (Social Phobia)
A. Marked fear or anxiety about one or more social situations in which the individual is
exposed to possible scrutiny by others. Examples include social interactions (e.g., having
a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and
performing in front of others (e.g., giving a speech). Note: In children, the anxiety must
occur in peer settings and not just during interactions with adults.
,B. The individual fears that he or she will act in a way or show anxiety symptoms that will
be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or
offend others).
C. The social situations almost always provoke fear or anxiety. Note: In children, the fear or
anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to
speak in social situations.
D. The social situations are avoided or endured with intense fear or anxiety.
E. The fear or anxiety is out of proportion to the actual threat posed by the social situation
and to the sociocultural context.
F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
H. The fear, anxiety, or avoidance is not attributable to the physiological effects of a
substance (e.g., a drug of abuse, a medication) or another medical condition.
I. The fear, anxiety, or avoidance is not better explained by the symptoms of another
mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum
disorder.
J. If another medical condition (e.g., Parkinson's disease, obesity, disfigurement from burns
or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.
Comorbidity
Social anxiety disorder is often comorbid with other anxiety disorders, major depressive
disorder, and substance use disorders, and the onset of social anxiety disorder generally
precedes that of the other disorders, except for specific phobia and separation anxiety
disorder. Chronic social isolation in the course of a social anxiety disorder may result in
major depressive disorder. Comorbidity with depression is high also in older adults.
Substances may be used as self-medication for social fears, but the symptoms of substance
intoxication or withdrawal, such as trembling, may also be a source of (further) social fear.
Social anxiety disorder is frequently comorbid with bipolar disorder or body dysmorphic
disorder; for example, an individual has body dysmorphic disorder concerning a
preoccupation with a slight irregularity of her nose, as well as social anxiety disorder because
of a severe fear of sounding unintelligent. The more generalized form of social anxiety
disorder, but not social anxiety disorder, performance only, is often comorbid with avoidant
personality disorder. In children, comorbidities with high-functioning autism and selective
mutism are common.
Panic disorder
A. Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or
intense discomfort that reaches a peak within minutes, and during which time four (or
more) of the following symptoms occur:
1. Palpitations, pounding heart, or accelerated heart rate
2. Sweating
3. Trembling or shaking
4. Sensations of shortness of breath or smothering
5. Feelings of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
, 8. Feeling dizzy, unsteady, light-headed, or faint
9. Chills or heat sensations
10. Paresthesias (numbness or tingling sensations)
11. Derealization (feelings of unreality) or depersonalization (being detached from one
self)
12. Fear of losing control or "going crazy”
13. Fear of dying
B. At least one of the attacks has been followed by 1 month (or more) of one or both of the
following:
1. Persistent concern or worry about additional panic attacks or their consequences
(e.g., losing control, having a heart attack, "going crazy'')
2. A significant maladaptive change in behavior related to the attacks (e.g., behaviors
designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar
situations)
C. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug
of abuse, a medication) or another medical condition (e.g., hyperthyroidism,
cardiopulmonary disorders).
D. The disturbance is not better explained by another mental disorder (e.g., the panic at
tacks do not occur only in response to feared social situations, as in social anxiety dis
order: in response to circumscribed phobic objects or situations, as in specific phobia; in
response to obsessions, as in obsessive-compulsive disorder; in response to reminders of
traumatic events, as in posttraumatic stress disorder: or in response to separation from
attachment figures, as in separation anxiety disorder).
Comorbidity
Panic disorder infrequently occurs in clinical settings in the absence of other
psychopathology. The prevalence of panic disorder is elevated in individuals with other
disorders, particularly other anxiety disorders (and especially agoraphobia), major
depression, bipolar disorder, and possibly mild alcohol use disorder. While panic disorder
often has an earlier age at onset than the comorbid disorder(s), onset sometimes occurs
after the comorbid disorder and may be seen as a severity marker of the comorbid illness.
Reported lifetime rates of comorbidity between major depressive disorder and panic
disorder vary widely, ranging from 10% to 65% in individuals with panic disorder. In
approximately one-third of individuals with both disorders, the depression precedes the
onset of panic disorder. In the remaining two-thirds, depression occurs coincident with or
following the onset of panic disorder. A subset of individuals with panic disorder develop a
substance-related disorder, which for some represents an attempt to treat their anxiety
Agoraphobia
A. Marked fear or anxiety about two (or more) of the following five situations:
1. Using public transportation (e.g., automobiles, buses, trains, ships, planes).
2. Being in open spaces (e.g., parking lots, marketplaces, bridges).
3. Being in enclosed places (e.g., shops, theatres, cinemas).
4. Standing in line or being in a crowd.
5. Being outside of the home alone.
B. The individual fears or avoids these situations because of thoughts that escape might be
difficult or help might not be available in the event of developing panic-like symptoms or
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