Anxiety, Obsessive-Compulsive and Trauma-Related Disorders
Anxiety disorders
Know the defining features of generalised anxiety disorder (≥6 months of excessive worry across domains), panic disorder (recurrent unexpected attacks plus ≥1 month of concern/behaviour change), agoraphobia, social anxiety disorder, and specific phobia. Distinguish normal anxiety from disorder by duration, distress and functional impairment.
OCD
Obsessions are intrusive, unwanted and ego-dystonic; compulsions are repetitive behaviours or mental acts performed to reduce distress. Know the contamination/washing, checking, and symmetry/ordering clusters, and the distinction from OCPD (pervasive perfectionism, ego-syntonic). First-line treatment is SSRI plus CBT with exposure and response prevention.
Trauma-related disorders
PTSD requires exposure to trauma plus intrusion, avoidance, negative cognitions/mood, and hyperarousal for >1 month; acute stress disorder is 3 days to 1 month. Adjustment disorder follows a stressor with disproportionate distress but does not meet PTSD criteria. Complex PTSD (ICD-11) adds affect dysregulation, negative self-concept, and relational disturbance.
Traps
- Confusing panic attack (a symptom, not a diagnosis) with panic disorder.
- Mixing OCD with OCPD; mixing PTSD with adjustment disorder.
- Forgetting that trauma-focused psychological therapy is first-line for PTSD, not routine benzodiazepines.
Rule of thumb
For anxiety, OCD and PTSD, psychological therapy (CBT/ERP/trauma-focused) is first-line; SSRIs are first-line pharmacotherapy; benzodiazepines are short-term only and avoided in PTSD.