Anxiety-Related Disorders

Key Points

• Anxiety disorders involve persistent, excessive fear/worry that disrupts daily functioning.
• Major subtypes include generalized anxiety disorder, phobias, and panic disorder.
• Effective care combines psychoeducation, psychotherapy, and selective pharmacologic support.
• Nursing priorities include risk assessment, panic de-escalation, and coping-skill reinforcement.

Pathophysiology

Anxiety disorders reflect dysregulated threat detection, autonomic arousal, and maladaptive cognitive processing. Genetic predisposition, stress/trauma exposure, and learned avoidance patterns all contribute to symptom persistence.

Avoidance temporarily lowers distress but reinforces long-term anxiety severity.

Classification

• GAD: Chronic, excessive worry across multiple domains for prolonged periods.
• Phobia disorders: Excessive fear tied to specific objects/situations or social/performance settings.
• Panic disorder: Recurrent panic attacks with anticipatory fear and behavioral avoidance.

Nursing Assessment

NCLEX Focus

Distinguish panic attack from medical emergencies while treating both as urgent until ruled out.

• Assess symptom duration, triggers, and functional impairment.
• Assess panic physiology (palpitations, dyspnea, chest discomfort, derealization).
• Assess avoidance behaviors and safety impact on work/school/social life.
• Assess comorbid depression, substance use, and sleep disturbance.
• Assess treatment readiness and prior response to therapy/medication.

Nursing Interventions

• Use calm, brief communication and breathing coaching during panic episodes.
• Guide gradual exposure and coping rehearsal for phobic avoidance reduction.
• Teach anxiety-management skills (grounding, relaxation, cognitive reframing).
• Support adherence to psychotherapy (CBT/ERP/exposure approaches).
• Monitor medication use and reinforce safe short-term versus long-term strategies.

Avoidance Reinforcement Loop

Repeated avoidance strengthens fear conditioning and worsens long-term disability.

Pharmacology

Common options include SSRIs/SNRIs and buspirone for long-term management, with cautious short-term benzodiazepine use when indicated. Nurses should monitor sedation, dependence risk, and medication-response timelines.

Clinical Judgment Application

Clinical Scenario

A client with recurrent sudden dyspnea, chest tightness, and fear of dying avoids public transport after two episodes.

Recognize Cues: Panic-pattern symptoms with escalating avoidance behavior. Analyze Cues: Functional impairment now extends beyond isolated episodes. Prioritize Hypotheses: Priority is panic disorder stabilization and avoidance-cycle interruption. Generate Solutions: Initiate panic education, exposure-based plan, and medication review. Take Action: Implement coping protocol and coordinate psychotherapy referral. Evaluate Outcomes: Track attack frequency, avoidance reduction, and daily-function recovery.

Related Concepts

• stress-and-anxiety - Provides foundational stress/anxiety physiology and coping framework.
• obsessive-compulsive-and-related-disorders - Distinguishes anxiety spectrum from OCD-related patterns.
• trauma-induced-and-stress-related-disorders - Supports differential diagnosis with trauma-driven symptoms.
• self-harm-and-suicide - Addresses risk when severe anxiety coexists with hopelessness.
• psychopharmacology - Expands medication safety and class-level considerations.