Online Education And Degree. Part 23. Common Features of Anxiety Disorders

Although different types of anxiety disorders exist, according to Michael Telch, Jasper Smits, Matt Brown, and Victoria Beckner, there are some common features across these different disorders. Common features include escape and avoidance behaviors, chronic worry, attentional hypervigilance, faulty threat perception, and sympathetic activation. Individuals with an anxiety disorder try to avoid or escape from stimuli or situations that make them anxious, and they constantly worry about current and future events. These individuals attend excessively to cues that they perceive as threatening. The excessive attention given to these cues is referred to as attentional hypervigilance. Faulty threat perception is another common feature found among individuals with an anxiety disorder. These individuals erroneously perceive situations as threatening. Sympathetic activation is also a core feature found among individuals with an anxiety disorder. Activation of the sympathetic nervous system producing physiological changes in the body occurs in individuals with an anxiety disorder when there is no real or potential threat. Physiological changes experienced by these individuals in the absence of a real or potential threat may include accelerated heart rate, muscle tension, and increased perspiration and respiration.
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Types of Anxiety Disorders
The Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) (DSM-IV-TR) has identified 15 types of anxiety disorders, including generalized anxiety disorder, separation anxiety disorder, specific phobia, social anxiety disorder, obsessive-compulsive disorder, posttraumatic stress disorder, acute stress disorder, panic attack, panic disorder with and without agoraphobia, agoraphobia without a history of panic disorder, anxiety disorder not otherwise specified, anxiety disorder due to a general medical condition, and substance-induced anxiety disorder. Generalized anxiety disorders, phobias, obsessive-compulsive disorders, panic disorders, and posttraumatic stress disorders are the most common types of anxiety disorders.
Although there are several types of anxiety disorders, each involves an excessive degree of worry or fear about certain stimuli, situations, or events, which significantly interferes with an individual's normal state of functioning. Generalized anxiety disorder is characterized by a chronic, excessive, and uncontrollable degree of worry about a variety of events or situations, such as friends, family, school, work, or the future. Symptoms of generalized anxiety disorder include fatigue, irritability, restlessness, muscle tension, and difficulties with concentration and sleep. Another common anxiety disorder, specific phobia, is characterized by an extreme and irrational fear in response to a specific stimulus, such as animals or insects (e.g., dogs), aspects of the natural environment (e.g., storms), blood (e.g., viewing blood or receiving an injection), situations (e.g., being in small spaces), or other stimuli (e.g., loud sounds or costumed characters). This worry must be present for at least 6 months and may lead to symptoms in children such as crying, clinging, tantrumming, dizziness, shortness of breath, and fainting.
Like a specific phobia, social phobia is associated with particular circumstances and must involve symptoms present for at least 6 months. An individual with a social phobia experiences extreme worry regarding social situations. The individual may worry over or fear the possibility of ridicule, humiliation, or embarrassment in social situations, such as speaking in class or conversing with peers. Individuals with a social anxiety disorder may attempt to avoid or escape social behaviors, and they often have poor social skills. These individuals may also experience symptoms such as trembling hands or voice, perspiration, muscle tension, and blushing.
Obsessive-compulsive disorder involves obsessions (recurrent or persistent thoughts or worries that intrude on, and interfere with, an individual's normal functioning) and compulsions (repetitive behaviors, rituals, or practices in which the individual engages to provide relief from, or comply with, the obsessive thoughts or worries). Common obsessions and compulsions in children include contamination (hand washing), safety (checking), preoccupations with orderliness and symmetry (ordering, aligning), and counting or touching rituals. Individuals with an obsessive-compulsive disorder may feel embarrassed by their compulsions and may experience difficulties related to concentration, preoccupations, and perfectionist tendencies.
Posttraumatic stress disorder refers to stress or worry experienced by an individual following a traumatic event (such as a serious injury, death, or catastrophic event). The individual reexperiences the event (via flashbacks, nightmares, or images), as well as the accompanying physiological arousal, and may attempt to avoid stimuli associated with the event. Following the event, the individual may feel helpless, fearful, agitated, or disorganized and may experience hypervigilance, irritability, and difficulties with concentration or sleep. These symptoms must be present for at least 1 month following the traumatic event. If symptoms are present for less than 1 month, then an acute stress disorder may be present. Similar to posttraumatic stress disorder, acute stress disorder also results from witnessing or experiencing a traumatic event. Symptoms include reexperiencing the event and the accompanying physiological arousal; however, these symptoms are present for no more than 1 month.
A panic disorder refers to recurrent and unexpected panic attacks that are followed for at least 1 month by concern about, or consequences of, having another attack and/or a change of behavior related to the attack. Panic attacks develop abruptly, often last for approximately 10 minutes, and involve symptoms such as heart palpitations, sweating, chest pain, dizziness, fear of dying, feelings of detaching from one's body, and feelings of losing control. If the attacks become more frequent, the individual may come to fear experiencing a panic attack in public places, and develop agoraphobia (fear of public places) as well. However, agoraphobia may also develop in the absence of, and without resulting from, a panic disorder. In these cases, individuals may avoid public situations, such as being in a crowd or traveling in a train, and may experience symptoms of panic in these situations.
Separation anxiety disorder is an anxiety disorder commonly found in children. Separation anxiety disorder refers to excessive and unrealistic worry in response to separation from home or a caregiver. Children with separation anxiety disorder may experience nightmares with separation themes, headaches, stomachaches, or nausea. These symptoms must be present for at least 4 weeks. Separation anxiety disorders tend to decrease with an increase in age. That is, this type of anxiety disorder is common during the childhood years but declines during the adolescent and adulthood years.
Anxiety disorders may also result from external factors, such as a general medical condition or substance use. Finally, for individuals who experience symptoms of anxiety, but whose symptoms, duration, or impairment do not meet the criteria for a specific disorder, a diagnosis of anxiety disorder not otherwise specified (NOS) may be appropriate.
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EDITOR Neil J. Salkind
Copyright © 2008 by SAGE Publications, Inc.

American Indians and Alaska Natives 2.

The 21 st Century
Today, the U.S. Census Bureau reports that the First Nations are a young population as compared with other ethnicities, with just less than half living on a reservation or federal trust land and a little more than half living in urban areas. First Nations persons are overrepresented within the numbers of negative social and economic indicators of disparity. Though rates vary widely between tribes and geographic regions, the First Nations find themselves with many of the most disparaging statistical measures of societal success. Economically, they lag behind other ethnic populations, having high poverty and unemployment rates and disproportionately low educational opportunities and graduation rates at all levels. Physical health disparities include high rates of diabetes and heart disease. Mental and behavioral health disparities include depression, posttraumatic stress disorder, and alcohol abuse for the First Nations as a whole.
First Nations children and youth receive disproportionately low levels of prenatal care as compared with other populations. They are exposed to alcohol in utero at higher rates and thus suffer rates of fetal alcohol syndrome disproportionately. As a group, First Nations youth endure disproportionate rates of diabetes, obesity, inner ear infection, cancer, and toxin exposure. The lack of accessible culturally competent health care compounds the negative impact on First Nations health. Suicide and homicide are among the top 10 causes of death for First Nations youth ages 5 through 14 years, and loss and grief follow this young population as a whole, given the historical and persistent struggles with which it is faced. Emerging public health issues for the First Nations include high rates of pregnancy for young women and girls who have insufficient access to prenatal care, escalating rates of sexually transmitted disease (including HIV/AIDS), and an explosion of gang involvement, even in reservation areas.
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Health, Resiliency, and the Balance way
The disparities and impacts of coloniztion with which many First Nations struggle is best conceptualized through an Indigenous worldview. The situation then becomes historically bound and has been framed by First Nations elders and tradition keepers as transcending time in a spatial fashion and experienced both individually and collectively. Thus, historical events are experienced in real time by individuals and their communities. Healing occurs through communal support and recognition of suffering and ritual interventions. In this way, suffering is acknowledged by the individual and his or her support system, and assessment, diagnosis, and treatment occur via a vehicle that emphasizes both individual and group strategies. First Nations scholars and clinicians advocate for an intervention framework that recognizes the inter- and multigenera-tional nature of the loss, stress, and trauma to which American Indians and Alaska Natives are exposed. Such a framework is congruent with the First Nations concept of time and healing and draws upon the use of traditional concepts and strategies.
Assessment, Diagnosis, and Treatment: First Nations Values and Ancient Knowledge
Despite the breath of diversity within the First Nations population, pan-cultural values and worldview perspectives exist. One commonly held view is that of time as cyclical and spatial versus linear, as conceived by the mainstream. Emphasis is on process rather than product. Contextual space or environment is often closely tied with experience and thus with healing. The First Nations see all as connected, whether celestial, elemental, mineral, fauna, animal, or human. Relationships are not compartmentalized along blood lines but rather viewed as broad connections that invoke relational roles. For example, siblings and cousins may be seen as equivalent relationships for an individual, and both will be referred to as brothers or sisters. In this spatial worldview, conceptions of wellness and ill health, life and death are grounded in the idea of keeping balance internally and with the world around one's self, and moving from one time-space domain to the next, respectively. Traditional healers utilize place (e.g., sacred locations) and integrate the help of other elements (e.g., plants, animals) to aid in helping the indi-vidual rebalance. Given the value placed on process and the cyclical nature of existence, all human experiences are held as important. Events such as dreams, visions, and premonitions are integrated into the healing process and not pathologized in the vein of mainstream psychology. Traditionally, there is a broad acceptance of difference and individual diversity, and thus a strategy of relative noninterference exists. Persons are supported through change individually with a healer and/or communally, and they are encouraged to find their own path to meaning and balance, utilizing their own gifts and strengths in doing so. This idea of individual difference and noninterference is quite divergent from mainstream thinking and is particularly evident in mainstream socially constructed concepts, such as that of gender or sexual orientation/preference. Pan-culturally, First Nations persons traditionally view gender as discrete from sexual orientation, identity, and preference.
Given the historical context within which the fields of psychology and education have developed and the current statistics the First Nations face, it is clear that pervasive cultural competence is lacking in assessment, diagnosis, and treatment of this population. Stereotyping, stigma, and discrimination pervade the intervention process with the First Nations and are highly correlated with low rates of contact and retention within the helping professions. Clinicians must consider the possibility of institutional distrust on the part of First Nations clients. Accommodation must be made for cultural differences present between the client and the clinician as well as between the client and the system of service. Language can pose a particular roadblock to intervention, regardless of whether the client speaks English as a second or a first language. Previous generations pass down the cultural worldview housed in Indigenous languages. First Nations languages are relational and descriptive in nature and do not accommodate compartmentalization as English does. Most Indigenous languages provide an understanding of the world as either animate or inanimate, not living or dead. Gendered language too is relatively nonexistent in the fashion of Western-mainstream languages. A close examination of popular standardized assessment and diagnostic tools quickly reveals their inability to competently accommodate First Nations clients. The vast majority of such tools, including the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) (DSM-W-TR), have been developed through a linear, White mainstream worldview, and few have been standardized or explored in relationship to their use with the First Nations.
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Learning: indigenous Science and Knowledge Acquisition
American Indians and Alaska Natives have had sophisticated systems of hypothesis testing and knowledge acquisition for thousands of years. This knowledge has persisted in oral, written, pictorial, and ritual traditions. Unfortunately, systemic racism, discrimination, and ignorance have all played a role in the perpetuation of the stereotype of First Nations science as a proto-knowledge, a less sophisticated form of Western-mainstream constructs. It is in this atmosphere that First Nations persons are educated by mainstream institutions of learning. Acculturation and assimilation pressures are significant for First Nations children in educational settings and persist through higher education.
Preschoolers may encounter difficulties adjusting to their new setting and its demands. Traditionally, First Nations youth are raised with close attention to attachment building and may share a bed with their primary caretaker(s), may be breastfed until they are 3 or 4 years old, and may enjoy the attention of multiple caretakers regardless of blood ties. Children entering ele-mentary school are often encountering mainstream culture for the first time and can be shaken by the shift in worldviews within which they must function. Boys may be ridiculed for keeping their hair traditionally long, and all youth are subject to defending themselves against the onslaught of holidays and practices celebrated in school systems that may be Christian-focused or U.S. nationalist. Language issues can be a particular challenge, and children may be required to shift from an experientially based traditional educational focus at home to a more linear, prescribed learning style in the educational setting. By middle and high school, First Nations youth often confront the full force of stereotyping and discrimination, as well as the aforementioned risk factors. They may encounter existential crises, struggling to integrate traditional spiritual beliefs with mainstream culture. The risk for internalized oppression is great, as teens strive for identity and self-preservation. A traditional adolescent may attend a school that promotes stereotyping and demeans the spiritual worldview of First Nations persons via Indian mascots or the promotion of, and forced participation in, Christian-based activities. This pressure mounts as those First Nations youth who do graduate from high school attempt to make their way to college. College students may have to travel great distances from their tribal communities and lands, deepening existential struggles. In higher education they find few First Nations mentors, little funding, and can struggle greatly to resolve the rift between their traditional worldview and that of the Western mainstream.
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Indigenizing the Mainstream
Best practices with American Indians and Alaska Natives mandate the integration of traditional knowledge, practices, community, and tradition keepers. Successful strategies and programs are individualized and recognize the potential for divergent worldviews and diversity within this group. Legitimate ways of knowing and healing are held within the First Nations culture and have been utilized for thousands of years to educate and heal this group. The educational psychologist will find a wealth of helpers within the commu-nity's natural supportive structure. Elders, traditional healers and mentors, extended family, and many others can be of assistance for case conceptualization and treatment. Traditional knowledge and values can be found in a group's original instructions (creation story) and provide a useful framework for conceptualizing a client's struggle, as well as his or her ethnic identity. Finally, policies that support the integration of understanding between the mainstream and First Nations may be supported by educational psychology as socially just objectives that promote healing and understanding for both groups.
Leah M. Rouse Arndt




EDITOR Neil J. Salkind
Copyright © 2008 by SAGE Publications, Inc.