06 Anxiety and Related Disorders
Learn to distinguish anxiety, trauma-related, obsessive-compulsive, and somatic symptom disorders and apply respectful, safety-focused nursing care.
Recognizing and its patterns
is a normal response to perceived threat. It may affect thoughts and behavior as well as the body, causing restlessness, tension, irritability, trouble concentrating, sweating, trembling, nausea, shortness of breath, or a rapid heartbeat. It becomes a clinical concern when fear or worry is persistent or disproportionate, difficult to manage, and interferes with daily functioning.
Different disorders have distinct patterns:
involves hard-to-control worry across several areas of life.
involves recurrent, unexpected panic attacks and ongoing concern or behavior changes related to future attacks.
Social disorder centers on fear of scrutiny or embarrassment.
Specific phobia involves marked fear of a particular object or situation.
Symptoms that resemble can also arise from medical conditions, medications, or substance use. Assessment should consider these possibilities rather than assuming a psychiatric cause.
Responding to acute or panic
During acute or panic, begin by assessing immediate safety and physical status, especially if symptoms are new, severe, or could signal a medical emergency. A calm voice, brief concrete statements, and a steady presence can help. Reduce unnecessary stimulation and offer simple choices. If a person is panicking, stay with them if possible and offer slow, comfortable breathing or grounding if they find it helpful.
Avoid arguing about fears, giving lengthy explanations, or asking for complex decisions while distress is intense. Reflect the person’s feelings without confirming a catastrophic conclusion. For example: “Your heart is racing, and that feels frightening. I’m here with you while we check what’s happening.”
Once the person is calmer, ask what helped and plan for future episodes. Also assess sleep, functioning, triggers, coping, medication use, alcohol or other substance use, and risk of self-harm. In a crisis, prioritize safety and follow local emergency procedures.
Treatment approaches for
Treatment is tailored to the person’s diagnosis, health history, risks, and preferences. helps people identify and change unhelpful thought and behavior patterns. Exposure-based CBT may reduce avoidance through gradual, planned contact with feared situations or sensations.
Medication may also be part of treatment. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are among the options used for disorders; medication effects may take time. Benzodiazepines can reduce quickly but may cause tolerance and dependence, so they are generally used cautiously and, when prescribed, for limited periods under clinical supervision.
Explain options, expected benefits, and risks through shared decision-making. Encourage consultation before a person changes or stops prescribed medication.
Trauma-related disorders and supportive care
Distress after trauma does not by itself establish a disorder, and traumatic experiences affect people differently. Acute stress disorder may be diagnosed when significant symptoms occur from three days to one month after trauma. involves trauma-related symptoms lasting more than one month and causing distress or impaired functioning.
PTSD symptoms can include:
Intrusion or re-experiencing, such as nightmares.
Avoidance of reminders.
Negative changes in thoughts or mood, such as feeling detached or unsafe.
Increased arousal or reactivity, such as irritability, hypervigilance, or disrupted sleep.
supports physical and emotional safety. Explain what will happen before care or touch, ask permission, and offer choices where possible. Do not pressure a person to disclose or recount trauma. Maintain predictable boundaries and collaborate on a plan that supports the person’s sense of control. During a flashback or dissociation, speak calmly, identify yourself and the current setting, and offer grounding. Do not touch unless the person agrees and touch is clinically necessary.
Evidence-based PTSD treatments include cognitive processing therapy, prolonged exposure, and eye movement desensitization and reprocessing (EMDR). Medication may be considered through shared decision-making. Nursing support includes monitoring symptoms and safety, reinforcing engagement in treatment, helping identify triggers and coping strategies, and screening for co-occurring depression or substance use without judgment.
Understanding obsessive-compulsive disorder
involves , , or both. are recurrent, unwanted thoughts, urges, or images that cause distress. are repetitive behaviors or mental acts performed to reduce distress or prevent a feared outcome. For example, a person who fears contamination may wash repeatedly. Any relief is often temporary, and the cycle can consume time and interfere with daily life. OCD is not simply liking order or being careful.
Treatment commonly includes CBT with . The person gradually faces a trigger while practicing not performing the usual compulsion. SSRIs may also be used, sometimes alongside therapy.
Ask about rituals and intrusive thoughts in a matter-of-fact, nonjudgmental way. Assess distress, daily functioning, skin injury, nutrition, and safety, and support referral to an OCD-informed clinician. Do not ridicule rituals or abruptly prevent them as a stand-alone intervention. When supporting a planned ERP program, follow the clinician’s treatment plan and encourage participation rather than giving repeated reassurance that maintains the ritual cycle.
Somatic symptoms and coordinated care
involves one or more distressing physical symptoms together with excessive thoughts, , or time and energy devoted to those symptoms. Symptoms may occur with a diagnosed medical condition or without a clear medical explanation. SSD is not diagnosed simply because tests fail to identify a cause, and symptoms are not assumed to be fabricated.
Related conditions include illness disorder, in which illness fear is prominent despite few or no physical symptoms, and functional neurological symptom disorder, which involves altered movement or sensation.
Validate the person’s experience while appropriately assessing new, changing, or urgent physical symptoms. Avoid implying that symptoms are imaginary or “all in the person’s head.” Support regular follow-up with a consistent care team, agreed symptom-focused assessment, and clear limits on unnecessary repeated testing. CBT and other psychotherapy can help with distress, coping, activity, and functioning; treat co-occurring or depression when present. A practical goal is improved function and quality of life, even when symptoms do not disappear completely.
Shared nursing priorities
Across these conditions, effective nursing care starts with a comprehensive, respectful assessment and a collaborative plan.
Assess comprehensively: Ask about symptom patterns, duration, triggers, functioning, medical history, medications, substance use, supports, and patient goals.
Prioritize safety: Assess suicide or self-harm risk when indicated; respond promptly to medical emergencies and severe impairment.
Communicate therapeutically: Listen actively, use open-ended questions, acknowledge distress, avoid stigma, and collaborate on achievable next steps.
Support coping and recovery: Encourage skills practiced in treatment, sleep and activity routines, social support, and follow-up. With permission, include supportive family or chosen supports in education.
Use shared decision-making: Discuss treatment options, expected benefits, and risks; monitor response and adverse effects; and encourage consultation before medication changes.
Across , trauma-related, obsessive-compulsive, and somatic symptom disorders, validate distress while supporting safety, autonomy, coping, and daily functioning.