anxiety disorder

1.1. Anxiety Disorder Definition

Although anxiety is a functional emotion that makes it easier for people to be prepared for the dangers they may face, some people experience anxiety and worry for a long time in an intense and chronic state that can be called irrational even in the smallest event they encounter (Hooley, Butcher, Nock, & Mineka, 2017).

The state of anxiety and worry, which has become ingrained in people’s daily existence, does not show the feature of being associated with a specific object, situation or event (Whitbourne, 2017). Therefore, it is not easy to control this anxiety, which people cannot even understand the reason for the feeling, and try to get rid of it by passing it off. Anxiety, which does not have a specific focus, harms the normal functioning of individuals by oscillating in different subjects and areas (Barlow & Durand, 2015). As a result of this situation, it can be interpreted that it may become difficult for individuals to focus attention and stay in the moment.

1.2. Symptoms of Anxiety Disorder

Although it is said that the rate of individuals with anxiety disorder is estimated to be 10% as a result of the studies, it is emphasized that the results are below the expectations. Researchers state that patients can have YPD even years before they are diagnosed, and it is observed that the symptoms increase gradually and steadily. The 12-month prevalence rate was 2% in men, 4.3% in women, and 3.1% in total; lifetime prevalence rate was 3.6% in men, 6.6% in women and 5.1% in total; The 30-day prevalence rate was found to be 0.8%. In addition, 25% of cases occur at 25 years, 50% at 39 years, and 75% at 53 years. (Wittchen, 2002; Ruscio et al., 2017; Kessler, Chiu, Demler, and Walters 2005).

Many patients reported that their anxiety symptoms have been present for many years or that their severity increased during the transition from adolescence to adulthood (Hazlett-Stevens, 2008). When we look at the studies conducted to determine the age ranges in parallel, the rates are; It is expressed as 4.1% between the ages of 18-29, 6.8% between the ages of 30-44, 7.7% between the ages of 45-59 and 3.6% between the ages of 60 and over (Kessler, Berglund, Demler, Jin, Merikangas et al., 2005).

It can be difficult to diagnose anxiety disorder symptoms, which are also seen in children and adolescents, at an early age. In the cross-sectional comparison study conducted by Ruscio et al. (2017) in 26 different countries, it is seen that the onset of SPD is around the age of 13 in 5% of the participants. In addition; Another study conducted with adolescents aged 13-17 reported a one-year prevalence rate of 1.1% (Kessler, Avenevoli, Costello, Georgiades, Green et al., 2012).

Looking at the older ages, in a study conducted by Bayers, Yaffe, Covinsky, Friedman, and Bruce (2010) with a high number of participants, individuals aged 55 and over; It is explained that anxiety disorder is mostly seen in adults between the ages of 55-64, which they call young-old. According to Rubio and Lopez-Ibor’s research on anxiety disorder, which lasted forty years; 38% of 50-year-olds and 88% of 60-year-olds showed improvement. In addition, the data indicate that anxiety disorder decreases after the age of 50 and is replaced by somatic symptom disorders (2007). All these data show us that the views that the symptoms of anxiety disorder decrease with age are supported.

Mental and physical diseases accompanying anxiety disorder are given below.

1.2.1. Comorbid Disorders

It is known that when anxiety disorder is combined with other accompanying diseases, it is more difficult to recognize and diagnose. In addition, studies indicate that many people with anxiety disorders seek further treatment only when they develop another illness (van der Heiden et al., 2011).

In addition to mental diseases accompanying anxiety disorder, insomnia in people; tiredness; Physical pain such as head, back and neck pain can also be seen frequently. Ulcers and other stomach problems; hernia; liver, kidney problems and cardiovascular diseases are other conditions known to accompany generalized anxiety disorder. In addition, studies indicate that individuals with irritable bowel syndrome have a common anxiety disorder comorbidity (Klingler, 2014).

1.2.2. Etiological Factors

In studies on the etiology of anxiety disorder, genetic, biological, psychoanalytic, cognitive and psychosocial factors are encountered (Nevid et al., 2018). In addition; Anxiety Avoidance Theory (Borkovec, Alcaine, & Behar, 2004), Intolerance of Uncertainty Theory (Dugas, Buhr & Ladouceur, 2004), Metacognitive Approach (Wells, 2004), Computing Approach (MacLeod & Rutherford 2004), Emotion Regulation Difficulty Theory (Mennin, Heimberg, Turk, & Fresco, 2002; Decker, Turk, Hess, & Murray, 2008), Humanistic Approach (Rogers, 1954), Existential View (May, 1958) and Attachment Theory (Bowlby, 1983; Ainsworth, 1979) YKB It is one of the important studies that sheds light on understanding the etiology of .

1.2.3 .Genetic Factors

It is a fact expressed by research that psychopathology in the family poses a risk for family members. Studies conducted with children with anxiety disorders underline that 77.5% of the family members of these children have at least one psychological problem, especially traces of anxiety disorders (Barlow & Durand, 2015). On the other hand, although the genetics of the individual is considered a risk factor, the researchers stated that the effect of genetics will have an effect between 30% and 40% in individuals. It is among other known data that the effect rate of this genetic transmission is equal for men and women. The fact that the variance is so low shows us how important the environmental impact is (Fisher, 2007; Hudson & Rapee, 2004).

1.2.4. Psychological and Social Factors

1.2.4.1. Learning Approach

Bandura’s work includes research that explains that children can learn from others by observing or modeling their behavior (Bandura, Ross, & Ross, 1961). Other research on modeling behaviors has shown that children can learn about anxiety by witnessing anxiety and worry-related behaviors from their parents or relatives. Therefore, it is stated that for a parent or child, any behavior related to anxiety of an important individual in their environment may contribute to the modeling of this situation or affective state, thus contributing to the development of anxiety disorder (Oltmanns & Emery, 2012).

1.2.4.2. Attachment Theory

Attachment theory, which helps us to understand the etiology of many mental health disorders, also creates an important theoretical background in generalized anxiety disorder. Attachment behavior, which Bowlby (1983) defines as the pursuit of closeness to another individual and the maintenance of this closeness, is essential for the child to feel safe and protected. Similarly, Ainsworth frequently mentions in his studies that attachment acts as a protective and safe zone, especially during infancy. It is stated that the infant’s understanding of the behaviors coming from his caregivers in the early period and regulating himself according to the stimuli in the early period has the risk of developing an anxiety disorder by affecting the behaviors with both the living and the inanimate environment (Ainsworth, 1979).

1.2.4.3. Psychosocial Factors

Parent Attitudes: Many studies have been conducted stating that parental attitudes and behaviors affect the development of anxiety disorder. As a result of the observations, it is understood that in the presence of a difficult and stressful situation, the mothers of anxious children do not allow their children to overcome this situation by releasing them. Mothers who have more negative emotions than the mothers in the control group may contribute to the formation of anxiety by acting overly intrusive and not allowing their children to struggle in situations that may cause anxiety (Hudson & Rapee, 2001).

Other Environmental Factors: Studies indicate that individuals with anxiety disorders have experienced more predictable or uncontrollable events in their lives. When environmental factors are examined, firstly, in the research conducted with adolescents, it is reached that violence in their neighborhood, exposure to traumatic news and pressure at school can significantly increase the risk of developing anxiety disorder by increasing the sensitivity to anxiety (Slopen, Fitzmaurice, Williams, & Gilman, 2012; Barlow & Durand, 2015).

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