Anxiety may have an inherited component because first-degree
relatives of clients with increased anxiety have higher rates of developing
anxiety. Heritability refers to the
propor-tion of a disorder that can be attributed to genetic factors:
High heritabilities are greater than 0.6 and indicate that genetic
Moderate heritabilities are 0.3 to 0.5 and suggest an even greater
influence of genetic and nongenetic factors.
Heritabilities less than 0.3 mean that genetics are negligible as a
primary cause of the disorder.
Panic disorder and social and specific phobias, includ-ing
agoraphobia, have moderate heritability. GAD and OCD tend to be more common in
families, indicating a strong genetic component, but still require further
in-depth study (McMahon & Kassem, 2005). At this point, current re-search
indicates a clear genetic susceptibility to or vulner-ability for anxiety
disorders; however, additional factors are necessary for these disorders to
Gamma-aminobutyric acid ( -aminobutyric acid [GABA]) is the amino
acid neurotransmitter believed to be dysfunc-tional in anxiety disorders. GABA,
an inhibitory neurotrans-mitter, functions as the body’s natural antianxiety
agent by reducing cell excitability, thus decreasing the rate of neu-ronal
firing. It is available in one third of the nerve synapses, especially those in
the limbic system and in the locus ceruleus, the area where the
neurotransmitter norepineph-rine, which excites cellular function, is produced.
Because GABA reduces anxiety and norepinephrine increases it, researchers
believe that a problem with the regulation of these neurotransmitters occurs in
Serotonin, the indolamine neurotransmitter usually implicated in
psychosis and mood disorders, has many subtypes. 5-Hydroxytryptamine type 1a
plays a role in anxiety, and it also affects aggression and mood. Serotonin is
believed to play a distinct role in OCD, panic disorder, and GAD. An excess of
orepinephrine is suspected in panic disorder, GAD, and posttraumatic stress
disorder (Neumeister, Bonne, & Charney, 2005).
Agoraphobia is anxiety about or avoidance of places or situations from which escape
might be difficult or in which help might be unavailable.
Panic disorder is characterized by recurrent, unexpected panic attacks that cause
con-stant concern. Panic attack is
the sudden onset of intense apprehension, fearfulness, or terror associated
with feelings of impend-ing doom.
Specific phobia is characterized by significant anxiety provoked by a specific feared
object or situation, which often leads to avoidance behavior.
Social phobia is characterized by anxiety pro-voked by
certain types of social or perfor-mance situations, which often leads to
Obsessive–compulsive disorder involves ob-sessions (thoughts, impulses, or
images) that cause marked anxiety and/or compulsions (repetitive behaviors or
mental acts) that at-tempt to neutralize anxiety.
Generalized anxiety disorder is character-ized by at least 6 months of
persistent and excessive worry and anxiety.
Acute stress disorder is the development of anxiety, dissociation, and other symptoms within 1 month of
exposure to an extremely traumatic stressor; it lasts 2 days to 4 weeks.
Posttraumatic stress disorder is character-ized by the reexperiencing of an
extremely traumatic event, avoidance of stimuli associ-ated with the event,
numbing of responsive-ness, and persistent increased arousal; it begins within
3 months to years after the event and may last a few months or years.
Freud (1936) saw a person’s innate anxiety as the stimulus for
behavior. He described defense mechanisms as the human’s attempt to control
awareness of and to reduce anx-iety . Defense
mechanisms are cognitive distortions that a person uses unconsciously to
maintain a sense of being in control of a situation, to lessen discom-fort, and
to deal with stress. Because defense mechanisms arise from the unconscious, the
person is unaware of using them. Some people overuse defense mechanisms, which
stops them from learning a variety of appropriate methods to resolve
anxiety-producing situations. The dependence on one or two defense mechanisms
also can inhibit emo-tional growth, lead to poor problem-solving skills, and
cre-ate difficulty with relationships.
Harry Stack Sullivan (1952) viewed anxiety as being gen-erated from
problems in interpersonal relationships. Care-givers can communicate anxiety to
infants or children through inadequate nurturing, agitation when holding or
handling the child, and distorted messages. Such commu-nicated anxiety can
result in dysfunction such as failure to achieve age-appropriate developmental
tasks. In adults, anxiety arises from the person’s need to conform to the norms
and values of his or her cultural group. The higher the level of anxiety, the
lower the ability to communicate and to solve problems and the greater the
chance for anxi-ety disorders to develop.
Hildegard Peplau (1952) understood that humans exist in
interpersonal and physiologic realms; thus, the nurse can better help the
client to achieve health by attend-ing to both areas. She identified the four
levels of anxiety and developed nursing interventions and interpersonal
communication techniques based on Sullivan’s interper-sonal view of anxiety.
Nurses today use Peplau’s interper-sonal therapeutic communication techniques
to develop and to nurture the nurse–client relationship and to apply the
Behavioral theorists view anxiety as being learned through
experiences. Conversely, people can change or “unlearn” behaviors through new
experiences. Behaviorists believe that people can modify maladaptive behaviors
without gain-ing insight into their causes. They contend that disturbing
behaviors that develop and interfere with a person’s life can be extinguished
or unlearned by repeated experiences guided by a trained therapist.