Chapter 27: Anxiety, Trauma, OCD & Dissociative Disorders

Anxiety, Trauma, OCD & Dissociative Disorders exploration of psychiatric health focuses on the complex landscape of anxiety-based, obsessive-compulsive, trauma-informed, somatic, and dissociative conditions. The foundation of these disorders is built upon understanding human reactions to stress, contrasting the physiological focus of the Selye Stress Adaptation Model—which outlines the stages of alarm, resistance, and exhaustion—with the cognitive appraisal methods proposed by Lazarus. It delves into the biological underpinnings of anxiety, highlighting neurochemical shifts involving the hypothalamic-pituitary-adrenal axis and neurotransmitters such as serotonin, GABA, and norepinephrine. Detailed clinical frameworks are provided for Generalized Anxiety Disorder (GAD), where chronic worry impairs daily life, and Panic Disorder, which is characterized by sudden, intense surges of fear and physical discomfort. The text examines various phobias, including agoraphobia and social anxiety, before addressing the intrusive nature of Obsessive-Compulsive Disorder (OCD) and its related manifestations like body dysmorphic concerns, hoarding, and hair-pulling behaviors. A significant portion is dedicated to trauma and stressor-related conditions such as Posttraumatic Stress Disorder (PTSD) and Acute Stress Disorder (ASD), emphasizing the neurobiological impact of extreme events on memory, arousal, and the sensitization of the nervous system. Furthermore, the chapter investigates somatic symptom disorders, where psychological distress is converted into physical complaints without an organic medical cause, and dissociative disorders, where the mind employs detachment and memory fragmentation as survival mechanisms against overwhelming emotional pain. Comprehensive nursing management is emphasized throughout, integrating therapeutic communication strategies, psychopharmacological interventions involving antidepressants and benzodiazepines, and milieu management techniques like cognitive-behavioral therapy (CBT) and relaxation training to foster adaptive coping and patient recovery.