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Panic
disorder is caracterized by the presence of unexecpected panic attack.
A panic attack is an experience occurring during a well delimited period
of time, marked by sudden occurrence of intense apprehension and a fear
or terror often associated with feelings of imminent catastrophe. During
these attacks, which generally reach their peak intensity over the course
of 10 minutes, an individual may experience one or more of the following
symptoms:
- palpitations,
chest pain, tremors, perspiration, etc;
- feelings of unreality,
fear of dying, of becoming insane or losing control.
Panic
disorder with agoraphobia, on the other hand, can be characterized by
the simultaneous co-occurrence of unexpected panic attacks and agoraphobia.
Agoraphobia is related to the avoidance of places or situations from which
escape might be difficult (or embarrassing) or in which help may not be
available in the event of having a panic attack.
It
should be noted that a diagnosis of panic disorder requires that the individual
experienced a minimum of four panic attacks occurring in the past month.
Agoraphobia
without panic disorder can be defined by the presence of agoraphobia and
panic-like symptoms without a having a prior history of unexpected panic
attacks.
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Specific
phobia is characterized by the presence of a clinically significant level
of anxiety, provoked by an exposure to an object or to a specific dreaded
situation, often leading to avoidance behaviors. The importance of accurately
distinguishing the fear reaction from the phobic symptoms is often mentioned
in case studies of phobic disorder.
Exposure
to the feared stimulus causes an immediate quasi-systematic anxious reaction
that can take the form of panic attacks independent or facilitated by
the situation. The phobias are generally grouped within five class-types:
a)
animal phobias (dogs, insects, mice, etc.)
b) nature-related or environmental phobias (storms,
height, water, etc.)
c) blood-related phobias e.g. injection, accident (wounds,
punctures, vaccinations etc.)
d) situation-related phobias (public transportation,
tunnel, airplane etc.)
e) other phobias (fear of suffocation, fear of vomiting,
etc.)
Specific
Phobia vs. Normal Fear:
Fear is a normal human response; children experience certain non-pathological
fears during the course of their development. According to Andre (1999)
children under one year of age normally experience a fear of strong noises,
strangers and suddenly appearing objects. Until the age of four, the fears
most commonly experiences are those related to animals, the dark, nighttime
noises and fear of being separated from their parents. From five years
of age and onward, typical fears experienced by children are those related
to physical wounds, thunder and “malicious people”, etc. From
a developmental point of view, childhood fears appear to follow an age
related sequence. Indeed, when very young, children fear for their survival;
towards 5-6 years of age, they fear for their integrity. Although the
possibility of a fear developing into a phobia always exists, childhood
fears generally disappear by the age of 8-9.
An
empirical study carried out by Öst (1987) demonstrated that the development
of certain types of clinically significant phobias come into play according
to age specific categories. For example, animal phobias begin around age
7, blood phobias around age 9 and the dental phobia around age 12.
Towards
age 6-7, as the child’s development progresses, “normal”
childhood fears tend to disappear as a result of psychological maturation
and an increasing appreciation of their exaggerated nature. Children are
considered phobic if they present with symptoms mentioned above before
the age indicated, for the duration of at least six months and if their
fear significantly affects their daily functioning (school performance,
relations with parents and peers, etc.).
References:
- André,
C. (1999). Les phobies. Paris: Dominos Flammarion.
- Öst (1987).
Age of onset in different phobias. Journal of Abnormal Psychology,
96(3), 233-229.
Symptoms
of anxiety related to the phobic reaction:
Following exposure to a fear stimulus, a panic attack provokes in the
phobic individual a number of anxiety-related symptoms. These include
cardiac palpitations, perspiration, trembling, a sensation of choking,
nausea, thoracic pain, hot flashes, etc. The panic attack may also cause
the individual to develop false beliefs linked to the fear of losing control,
of dying, of making a social infraction or of fainting. The person will
consequently tend to increasingly avoid situations that can provoke an
anxious reaction. Among children, the anxiety often manifests differently
compared with adults: crying, excessive anger, becoming immobile or clingy.
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Post-traumatic
stress occurs following a traumatic event (after 4 weeks), during which
an individual experienced intense fear, horror, or a feeling of profound
powerlessness. The traumatising event is then relived sporadically in
the form of obsessive thoughts, repetitive nightmares, intrusive memories
etc. Moreover, to decrease the anxiety associated with this event, the
individual avoids any stimulus directly related to the trauma, or any
event or situation that may provoke memories of the traumatic event. The
post-traumatic state of stress is accompanied by persistent symptoms of
neurovegetative hyperactivity (e.g. sleep related problems, irritability
or excess anger, exaggerated startle reflex).
The
state of acute stress is characterized by symptoms similar to those of
post-traumatic stress but ones that occur during the time period immediately
following the trauma (minimum 2 days and maximum 4 weeks).
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Generalized
anxiety disorder is characterized by a period of at least six months of
anxiety and persistent and excessive concern, regarding a certain number
of events or activities (e.g. family, work). An individual who suffers
from this disorder has difficulty managing their anxiety and may cognitively
ruminate over possible negative scenarios.
The anxiety and the
nervousness must be accompanied by at least three of the six following
symptoms: agitation, fatigue, disturbed memory, irritability, sleep disorder,
muscular tension. Moreover, the individual may present with hyper vigilance
as well as increased sensitivity to environmental stressors.
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