Anxiety, Obsessive-Compulsive and Trauma-Related Disorders
Core concepts
Distinguish generalised anxiety disorder, panic disorder with/without agoraphobia, social anxiety disorder, specific phobias, OCD, PTSD, and acute stress disorder. PTSD requires exposure to trauma plus intrusion, avoidance, negative cognitions/mood, and hyperarousal lasting >1 month; acute stress disorder is 3 days–1 month. OCD requires obsessions and/or compulsions that are time-consuming or impairing and not better explained by another disorder.
Treatment
First-line for anxiety and OCD: SSRIs (higher doses for OCD) plus CBT with exposure and response prevention. Trauma-focused CBT and EMDR are first-line for PTSD. Benzodiazepines are not first-line and risk dependence.
Traps
- Confusing panic attack (a symptom) with panic disorder (recurrent unexpected attacks plus worry/behaviour change).
- Missing OCD with poor insight or delusional variants.
- Diagnosing PTSD before 1 month (that is acute stress disorder).
- Overlooking medical mimics: hyperthyroidism, arrhythmia, phaeochromocytoma, substance withdrawal.
Rule of thumb
If a patient presents with recurrent panic, screen for depression and substance use - comorbidity is the rule rather than the exception.