Friday, 5 May 2017

ABC's of the DSM-V: A is for Anxiety!

The aim of this project is to go through the DSM-V and educate you all on the most interesting/little understood disorders in the book to give you all a better understanding of the various mental health disorders in the world! Maybe even help some of you to understand what a friend or family member is going through, or what you may be going through yourself. If there's a specific disorder you would like me to cover for this, please do get in touch! This week we are starting off with one of the most commonly diagnosed and yet misunderstood disorders: Anxiety!

Anxiety is one of biggest mental health disorders affecting the world, alongside depression it is a huge cause of disability worldwide. There are various subtypes of anxiety – social anxiety, panic disorder, generalised anxiety disorder, stage fright and even mathematical anxiety! For anyone suffering from the disorder, they know it’s more than just being nervous – it’s a state of mind that affects your lifestyle and everything you do – like depression, in severe cases it can leave you completely unable to function. It’s a debilitating state of fear and anticipation, and one that needs to be taken more seriously considering the implications. The DSM-V refers to anxiety as being an anticipation of future threat, causing muscle tension and vigilance in preparation for future danger and cautious or avoidant behaviours. The difference between anxiety and nervousness, is that anxiety is an excessive fear – it persists far beyond appropriate periods of time and levels of fear. What one person may think of being slightly nerve wracking such as public speaking – another person may find it so fearful they may respond as they would to fearful stimuli – crying, sweating, completely unable to rationally process the situation.

A lot of the pathophysiological cause of anxiety is to do with the hippocampus and amygdala – areas within the limbic system of the brain; area’s known for emotional processing and regulation. Only recently have specific mechanisms understanding the reason for inappropriate periods of time and levels of fear have been understood – different areas of the medial prefrontal cortex are responsible for fear renewal (the return of fear away from a fearful stimulus) and extinction recall (the disappearance of fear following the loss of fearful stimulus). The dorsal and ventral medial prefrontal cortex mediate the effect of the hippocampus on the right amygdala during fear renewal and fear extinction respectfully, areas responsible for memory, reasoning, attention etc. The circuitry responsible for fear extinction has predominant function in memory function, which makes sense as a lack of fear extinction is a lot to do with memory – the memory of a fearful stimulus keeps flashing at us even when it’s not there and you ruminate on it whereas if function was unimpaired, that feeling of fear would not be so predominant.
Quick Fact: The Limbic System is a circuit in the inner part of the brain and includes the hypothalamus, thalamus, amygdala and hippocampus. These areas are highly involved in emotion so is sometimes referred to as the emotion circuit.

The difference in anxiety suffered in ethological settings – social anxiety, stage fright – has been investigated as being a result of dysfunction in the anterior (front) hippocampus, whereas trait anxiety – generalized anxiety disorder – is found to be a responsibility of the posterior (back) hippocampus. When you look at it, the hippocampus and amygdala are tiny areas in the brain, they’re incredibly small and it’s incredible to think how these tiny areas are responsible for such a hugely debilitating disorder, and how many different types.

In this regard, fears and phobias are a result of poor fear extinction function as they allow people to ruminate on the fear rather than allowing the brain to naturally extinguish that fear and sending emotional arousal to an appropriate baseline. A bit like computers, the brain is like a computer and the first experience with the fearful stimulus (which then becomes the phobia) is like a virus – it doesn’t go away and takes over the computer and destroys it. The memory and feeling in that exact moment is stuck – that’s exactly what’s going on with the hippocampus and amygdala when fear extinction is disrupted.

So what about anti-virus? Well, several medications are used to treat anxiety including therapy treatments. CBT is a commonly used form of treatment, particularly for phobias, as it approaches changing the pattern of thinking which in a sense is trying to rewire the circuitry responsible for poor fear extinction. Benzodiazepines are commonly prescribed for those with generalized anxiety disorder and panic disorder as palpitations and panic (well duh!) are a common complaint with these disorders, and benzodiazepines help reduce the increased heart rate and as a result leave the patient feeling slightly calmer and potentially avoiding panic attacks and high anxious responses in the first place. SSRI’s are generally the first line of treatment as they have been found effective in a majority of cases, probably due to the fact that anxiety disorders are so commonly comorbid with depression and generally the treatment of depression can alleviate the symptoms of anxiety and as a result, better response to medication.

So, next time someone tells you they have anxiety – it’s not a case of being nervous, it’s a genuine change in brain connectivity, it’s a virus in a computer and needs to be treated just as seriously as any other illness. Anxiety and phobias are not stupid or small fears, they are an irrational fear response and needs to respected and treated as such.

If you would like to buy the DSM-V, you can buy it here on Amazon. If you would instead rather buy a copy of the classification of mental health and behavioural disorders from the ICD-10 you can get it here! Buying from my link helps me fund this blog and bring you the best quality content!

Although the UK follows ICD guidelines, I have chosen to do the DSM as my studies have been based around it rather than the ICD and personally, I find it a much more comprehensive and easier to follow tool in comparison. (Please don't throw vegetables at me)

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