Anxiety disorders
Anxiety disorders include several types of disorders that differ from more typical feelings of nervousness or worry. Anxiety disorder diagnoses encompass reports of excessive fear or anxiety that are out of proportion to the situation and that hinder daily functioning for specified periods of time (APA, 2017a).
These disorders include:
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Generalized anxiety disorder
Excessive, uncontrollable and often irrational worry around a range of concerns, accompanied by other physical or cognitive symptoms.
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Specific phobias
Excessive fear of a specific thing or situation, such as excessive fear of spiders or heights.
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Panic disorder
sudden periods of intense fear characterized by recurrent unexpected panic attacks.
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Agoraphobia
Excessive fear of being in an overcrowded space.
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Social anxiety disorder
Excessive fear of social gatherings and being scrutinized by others.
(APA, 2017)
The physical and emotional symptoms that can accompany anxiety disorders are due to the release of adrenaline in the body. They include:
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Physiological symptoms
Such as heart palpitations, sweating, dizziness, muscle tension, nausea, numbness or tingling in the hands or feet, or shortness of breath.
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Emotional symptoms
Such as restlessness, feelings of panic, fear, uneasiness or a sense of impending doom.
Rates: Similarities and differences
Over 30% of the general adult population will experience an anxiety disorder during their lifetime (APA, 2017a). Anxiety disorders are highly comorbid with one another, as well as with other disorders such as depression and posttraumatic stress disorder (APA, 2013; Bogic et al., 2015; CMHA, 2016). Refugees and asylum seekers experience a higher prevalence of diagnosed and self-reported anxiety (13% and 2% respectively) (Henkelmann et al, 2020), as do immigrants in general (28%), compared to the non-war affected general population (Lindert et al., 2009).
Although longer-term immigrants in Canada between the ages of 18 and 59 exhibit a lower risk of anxiety disorders, this protective effect is significantly less marked for recent immigrant categories (Aglipay et al., 2013). This remains the case in regards to the impacts of COVID-19 on immigrants' mental health, with recent immigrants reporting fair or poor mental health compared to established immigrants and the Canadian-born population (Evra & Mongrain, 2020).
There also appear to be differences between immigrant and non-immigrant groups within the same ethnic group. For instance, a study found that South Asian immigrants report statistically significantly higher rates of diagnosed anxiety disorders (3.44%) compared to the Canadian-born South Asian population (1.09%) (Islam et al., 2014)
Assessment
It is important to consider both culture and context when assessing for anxiety disorders.
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- Cambodians may show anxiety-related symptoms that are based on fears of disturbed “inner wind” and blood flow. These events, called “wind attacks,” are characterized by a mix of panic attack symptoms, such as dizziness and culture-specific symptoms, such as tinnitus and neck soreness (Hofmann & Hinton, 2014).
- Individuals of Latin American descent may show evidence of a cultural syndrome known as “ataque de nervios” (attack of nerves). These attacks are characterized by a sense of being out of control and frequently occur as a direct result of a stressful event relating to the family (APA, 2013c).
Culture
There are considerable cultural variations in the expression of anxiety disorders. Different cultural groups express mental disorders, including anxiety disorders, according to their own understanding of the body's functioning.
For example:
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- In cultures where women have limited access to public life and are confined to their homes, agoraphobia may not be an appropriate diagnosis.
- Fears of the dark may be reasonable in a context of ongoing violence, and may not indicate a phobia.
- Behaviours that appear socially anxious may be a sign of respect and may be appropriate in certain cultures.
Context
Social norms and expectations can influence fear of certain situations. An individual's sociocultural context should be considered during assessment.
For example:
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