Chapter 15: Anxiety & Obsessive-Compulsive Disorders

Essential to patient assessment is understanding Peplau’s defined four levels of anxiety—mild, moderate, severe, and panic—which dramatically influence the patient's perceptual field, problem-solving capacity, and overall functioning. The text extensively covers how individuals utilize defense mechanisms as automatic coping styles, emphasizing the critical difference between their adaptive and potentially harmful maladaptive uses, particularly when immature defenses are overused. A comprehensive range of anxiety disorders are detailed, including specific phobias, social anxiety disorder, panic disorder, generalized anxiety disorder (GAD), agoraphobia, and separation anxiety disorder, noting their significant comorbidity with conditions like major depressive disorder. Furthermore, the chapter groups Obsessive-Compulsive Disorder (OCD) with related conditions such as Body Dysmorphic Disorder, Hoarding Disorder, Trichotillomania (hair pulling), and Excoriation Disorder (skin picking), defining obsessions as persistent, unwelcome thoughts and compulsions as the ritualistic behaviors used to temporarily mitigate anxiety. Treatment modalities are thoroughly reviewed, highlighting selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) as primary pharmacologic interventions, while benzodiazepines are reserved for short-term use due to dependency risk. Nursing interventions are tailored to the patient’s level of anxiety, ranging from using open-ended communication for mild/moderate states to prioritizing safety and providing firm, simple direction during severe or panic states. Finally, the chapter stresses the importance of psychological therapies, including behavioral techniques like systematic desensitization and flooding, and cognitive-behavioral therapy (CBT), which aims to help patients replace catastrophic, distorted thoughts with realistic appraisals of situations.