Chapter 11: Anxiety, Anxiety Disorders & Obsessive-Compulsive & Related Disorders

Anxiety, Anxiety Disorders & Obsessive-Compulsive & Related Disorders begins by defining anxiety as a subjective experience of distress triggered by perceived threats, contrasting it with fear, and categorizing it along a continuum of four levels: mild, moderate, severe, and panic, each with specific physical and behavioral characteristics that dictate appropriate nursing interventions. The text extensively explores the role of defense mechanisms—such as altruism, sublimation, repression, displacement, reaction formation, projection, and denial—classifying them from healthy and adaptive to immature and maladaptive behaviors used to ward off anxiety. A significant portion of the chapter is dedicated to the clinical manifestations and epidemiology of major anxiety disorders, including Panic Disorder (characterized by unpredictable panic attacks and impending doom), Generalized Anxiety Disorder (GAD), and Phobias, including specific phobias, social anxiety disorder, and agoraphobia. It also delves into Obsessive-Compulsive and Related Disorders, distinguishing between the intrusive thoughts (obsessions) and ritualistic behaviors (compulsions) of OCD, while also covering Body Dysmorphic Disorder (BDD) and Hoarding Disorder. The biological underpinnings of these conditions are analyzed, focusing on the limbic system ("emotional brain") and neurochemical dysregulation involving GABA, serotonin, and norepinephrine. The chapter outlines the nursing process for these patients, emphasizing the need to rule out medical causes and substance use during assessment, and details evidence-based interventions ranging from therapeutic communication and milieu therapy to health teaching. Finally, it reviews comprehensive treatment modalities, including Cognitive-Behavioral Therapy (CBT), behavioral techniques like systematic desensitization and flooding, and psychopharmacological strategies involving SSRIs, SNRIs, benzodiazepines for short-term stabilization, and non-addictive options like buspirone.