Moderate-to-Severe Anxiety
• Anxiety at the moderate-to-severe level that remains unresolved over an
extended period of time can con tribute to a number of physiological
disorders. The DSM-5 (APA, 2013) describes these disorders under the
category of “Psychological Factors Affecting Other Medical Conditions.”
The psychological factors may exacerbate symptoms of, delay recovery
from, or interfere with treatment of the medical condition. The condition
may be initiated or exacerbated by an environmental situation that the
individual perceives as stressful. Measurable pathophysiology can be
demonstrated. It is thought that psychological and behavioral factors may
affect the course of almost every major category of disease, including, but
not limited to, cardiovascular, gastrointestinal, neoplastic, neurological, and
pulmonary conditions.
Severe Anxiety
• Extended periods of repressed severe anxiety can result in psychoneurotic
patterns of behaving. Neurosis is no longer considered a separate
category of mental disorder. However, the term sometimes is still
used in the literature to further describe the symptomatology of
certain disorders and to differentiate from behaviors that occur at
the more serious level of psychosis. Neuroses are psychiatric
disturbances, characterized by excessive anxiety that is expressed
directly or altered through defense mechanisms. It appears as a
symptom, such as an obsession, a compulsion, a phobia, or a
sexual dysfunction (Sadock & Sadock, 2007).
The following are common
characteristics of people with neuroses:
• ■ They are aware that they are experiencing distress.
• ■ They are aware that their behaviors are maladaptive.
• ■ They are unaware of any possible psychological causes of
the distress.
• ■ They feel helpless to change their situation.
• ■ They experience no loss of contact with reality.
The following disorders are examples
of psychoneurotic responses to anxiety
as they appear in the DSM-5:
• 1. Anxiety Disorders. Disorders in which the characteristic features
are symptoms of anxiety and avoidance behavior (e.g., phobias, panic
disorder, generalized anxiety disorder, and separation anxiety
disorder).
• 2. Somatic Symptom Disorders. Disorders in which the characteristic
features are physical symptoms for which there is no demonstrable
organic pathology. Psychological factors are judged to play a
significant role in the onset, severity, exacerbation, or maintenance of
the symptoms (e.g., somatic symptom disorder, illness anxiety
disorder, conversion disorder, and factitious disorder).
• Somatic symptom disorder is a condition where a
person has an excessive focus on physical symptoms,
like pain or shortness of breath. This can cause
significant distress and make it difficult to function.
Symptoms:
• Pain
• Weakness
• Shortness of breath
• Excessive thoughts, feelings, and behaviors related
to physical symptoms
• Illness anxiety disorder, sometimes called hypochondriasis
or health anxiety, is worrying excessively that you are or may become
seriously ill.
• Conversion disorder, also known as functional
neurological symptom disorder (FND), is a mental health
condition that causes physical symptoms that can't be
explained by medical conditions.
Symptoms:
• Blindness, Paralysis, Difficulty swallowing, Balance
problems, Tremors, Difficulty walking, Hallucinations,
Seizures, Impaired vision or double vision, and Impaired
hearing.
• Factitious disorder is a mental health condition where a
person intentionally deceives others by pretending to be
ill. It was previously known as Munchausen syndrome.
Symptoms:
• Faking symptoms
• Getting sick on purpose
• Hurting themselves
• Altering medical records
• Taking steps to produce false laboratory results
• Exaggerating symptoms of a previous diagnosis
Panic Anxiety
• At this extreme level of anxiety, an individual is not capable
of processing what is happening in the environment, and
may lose contact with reality. Psychosis is defined as “a
severe mental disorder characterized by gross impairment in
reality testing, typically manifested by delusions,
hallucinations, disorganized speech, or disorganized or
catatonic behavior” (Black & Andreasen, 2011, p. 618).
The following are common
characteristics of people with
psychoses:
• ■ They exhibit minimal distress (emotional tone is flat, bland, or
inappropriate).
• ■ They are unaware that their behavior is maladaptive.
• ■ They are unaware of any psychological problems.
• ■ They are exhibiting a flight from reality into a less stressful world
or into one in which they are attempting to adapt.
• Examples of psychotic responses to anxiety include the
schizophrenic, schizoaffective, and delusional disorders.
Grief
Grief
•Grief
Grief is a subjective state of
emotional, physical, and social responses
to the loss of a valued entity.
• Most individuals experience intense emotional anguish in
response to a significant personal loss. A loss is anything that
is perceived as such by the individual. Losses may be real, in
which case they can be substantiated by others (e.g., death
of a loved one, loss of personal possessions), or they may be
perceived by the individual alone, unable to be shared or
identified by others (e.g., loss of the feeling of femininity
following mastectomy). Any situation that creates change for
an individual can be identified as a loss. Failure (either real or
perceived) also can be viewed as a loss.
• The loss, or anticipated loss, of anything of value to
an individual can trigger the grief response. This
period of characteristic emotions and behaviors is
called mourning. The “normal” mourning process is
adaptive and is characterized by feelings of sadness,
guilt, anger, helplessness, hopelessness, and despair.
Indeed, an absence of mourning after a loss may be
considered maladaptive.
