Symptoms and treatment approaches in clinical practice

Anxiety Disorder

Case Study in Anxiety Disorders

In the current case study, an adult female patient has presented with a range of episodic symptoms which included sweating, trembling, nausea, palpitations and chest pains. These symptoms have typically accompanied feelings of overwhelming anxiety and dread. The subject, Marge, also reported experiencing elevated stress due to her husband Homer's recent difficulties at work.

Diagnosis:

Marge visited her General Practitioner indicating a fear that she might be suffering from a chronic heart condition. All evidence in her case suggests, however, that Marge is more likely suffering from an anxiety disorder with stress that may be increasing in its severity. Anxiety disorders can vary widely in their severity and the frequency of related episodes. However, in most cases, the recurrence of these episodes is stimulated by the kind of elevated stress that Marge has been experiencing. According to WebMD, "Anxiety disorders . . . can cause such distress that it interferes with a person's ability to lead a normal life. An anxiety disorder is a serious mental illness. For people with anxiety disorders, worry and fear are constant and overwhelming, and can be crippling."(p. 1) This diagnosis appears to accurately characterize Marge's experiences.

Biological Mechanisms:

With respect to the biological mechanisms which play a role in the nature of the anxiety disorder, medical research has increasingly come to suggest that there may be a specific chemical disorder which makes individuals especially susceptible to anxiety attacks and other stress-related episodes. In Marge's case, though her suddenly high occurrence of episodes appears to have been triggered by elevated stress levels relating to Homer's difficulties at work, it is in fact likely that a latent anxiety disorder has given her a higher predisposition for said episodes. According to the text by Dratcu (2000), anxiety attacks may actually be stimulated by a combination of the elevated carbon dioxide levels in the brain caused by higher stress levels and the presence of uniquely sensitive CO2 chemocreceptors. According to the study by Dratcu, "evidence from provocation studies using lactate, but particularly carbon dioxide (CO2) mixtures, suggests that panic patients may have hypersensitive CO2 chemoreceptors. Klein proposed that PD may be due to a dysfunctional brain's suffocation alarm and that panic patients hyperventilate to keep pCO2 low." (p. 1069)

This means that the anxiety attack is the result of abnormally functioning stress-coping mechanisms in the brain. Consequently, as the body begins to endure symptoms that resemble a massive coronary event, as has been the case with Marge, the brain magnifies these symptoms causing the subject to perceive an impending heart attack. Indeed, as the text by Smith et al. (2012) indicates, it is quite common for the sufferer of such attacks to mistake these incidences for symptoms of a heart condition or other catastrophic medical problem. According to Smith & Segal, this does create a critical imperative for the subject to seek the proper treatment. The article by Smith & Segal reports that "anxiety attacks usually peak within ten minutes, and they rarely last more than thirty minutes. But during that short time, the terror can be so severe that you feel as if you're about to die or totally lose control. The physical symptoms of anxiety attacks are themselves so frightening that many people believe they're having a heart attack. After an anxiety attack is over, you may be worried about having another one, particularly in a public place where help isn't available or you can't easily escape." (p. 1) This denotes the importance of managing an anxiety disorder so as to prevent this sense of being trapped when episodes do occur unexpectedly.

In Marge's case, we cannot immediately ascertain for certain what biological mechanisms have played a role in her episodic attacks. However, we can deduce that she is vulnerable to the general range of physiological symptoms relating to an anxiety disorder as a result of external triggers which may be socially, domestically or pressure-induced. It is also likely that her increased fear of the recurrence of her anxiety attacks is making her increasingly sensitive to their possibility.

Possible Treatments:

With respect to treatment, both biological and psychological paths are appropriate. First and foremost, it is appropriate to rule out the possibility that Marge is suffering from a heart condition. In doing due medical diligence, she should receive chest x-rays, blood tests, screening of vitals and stress tests intended to measure her heart health. In addition to elucidating any physiological causes for the symptoms she describes, greater awareness of her heart health may bring psychological equanimity to the subject.

Thereafter, Marge should be recommended for clinical therapy aimed at uncovering the root causes of her anxieties. By attempting to determine the sequence of events that tend to trigger anxiety-related panic attacks, an effective counseling course could help her to find ways of coping and preempting the onset of future attacks.

Marge may also be a candidate for medication as assistance for managing her anxieties. According to the National Institute of Mental Health (NIHM)(2011) "Antidepressants were developed to treat depression but are also effective for anxiety disorders. Although these medications begin to alter brain chemistry after the very first dose, their full effect requires a series of changes to occur; it is usually about 4 to 6 weeks before symptoms start to fade. It is important to continue taking these medications long enough to let them work." (p. 1) the NIMH indicates that the medication decision should be based on patient profiles and possible side effects.

Strengths and Weaknesses of Treatment:

One of the marked strengths of psychological treatment is its continuity and its capacity to help uncover the root causes of an anxiety disorder. While biological causes may heighten an individual's vulnerability, positive clinical psychology approaches can help to bring greater clarity to anxiety management strategies. Most importantly, proper counseling can represent the difference between the recurrence of attacks and the onset of a full-fledged disorder. According to Geyer (2001), psychology "provides a framework for understanding when and how things become less than normal for individuals and providing suggestions or solutions in that context." (Geyer, 1)