Other Anxiety Related Disorders: Part II
To complicate things further, sometimes two separate disorders may be present at the same time. Thus, it is quite possible to have both an eating disorder and an anxiety disorder. The term "co-occurring disorders" (or "comorbid" disorders) is used when two or more disorders occur at the same time. In this section we will review some of the other psychiatric disorders where anxiety is a prominent feature, as well as disorders which frequently co-occur with anxiety disorders.
Anxiety and personality disorders
Personality disorders are a category of disorders that are distinct from many other disorders listed in the DSM. Personality disorders refer to a chronic, inflexible, and maladaptive pattern of relating to the world. This maladaptive pattern is evident in the way the person thinks, feels, behaves, and most importantly, how they relate interpersonally to other people. It is quite possible to have both a personality disorder and an anxiety disorder. However, several personality disorders appear very similar to certain anxiety disorders and it is important to distinguish between them. For more information about personality disorders please refer to our article entitled "Understanding Personality Disorders" (coming soon!).
There is an entire group of personality disorders, labeled the anxious-fearful Cluster C personality disorders which include the Avoidant Personality Disorder, the Dependent Personality Disorder, and the Obsessive-Compulsive Personality Disorder. We will discuss two of these Cluster C Personality disorders to distinguish them from anxiety disorders with similar symptoms: the Obsessive-Compulsive Personality Disorder and the Avoidant Personality Disorder.
The DSM lists two different disorders with very similar names: 1) the Obsessive-Compulsive Disorder (OCD), an anxiety disorder; and 2) the Obsessive-Compulsive Personality Disorder (OCDP), a personality disorder. Despite the similarity in names, the connection between OCD and OCPD is weak. OCPD is defined as the preoccupation with perfectionism, orderliness, and control. Individuals with OCPD tend to be inflexible and rigid. They pay extreme attention to details and rules so much so that it can interfere with their ability to complete a task. They become so excessively devoted to work and being productive, that they neglect their friends and family, and have no free time for pleasurable or leisurely pursuits. People with OCPD may experience functional impairment at work because they cannot complete projects as they get lost in the details, and fail to see the big picture. They also experience functional impairment because they have no social life as a result of their excessive devotion to work and "productivity." Although these two disorders may share some related features, OCD and OCPD are two distinct disorders. The primary distinction between these two disorders is the presence of obsessions and compulsions, as in OCD; or the absence them, as in OCPD. Research indicates that most individuals with OCD do not have OCPD (Baer & Jenike, 1992).
Another set of disorders that are similar are Social Phobia (an anxiety disorder) and Avoidant Personality Disorder (a personality disorder). The Avoidant Personality Disorder is characterized by feelings of inadequacy, being socially reserved, and extreme sensitivity to negative criticism. People with this disorder believe they are socially inept, personally unappealing or inferior to others, and they are afraid they will be embarrassed or ridiculed in social situations. Because of the parallels between these two disorders, some research has suggested that Avoidant Personality Disorder is merely a more severe form of Social Phobia. The comorbidity between Social Phobia and Avoidant Personality Disorder has ranged from 21% to 89% (Ralevski et al., 2005). Despite this evidence, others continue to assert these are two separate and distinct disorders. Some studies have shown that people with Avoidant Personality Disorder have more difficulty forming intimate relationships, have more severe social phobia, and poorer social skills, when compared to people with Social Phobia. Other studies have indicated that people with both disorders (Social Phobia and Avoidant Personality Disorder) display more anxiety, depression, and impairment in functioning, when compared to people with either disorder alone. (Chambless, Fydrich, & Rodebaugh, 2008; Tillfors, Furmark, Ekselius, & Fredrikson, 2004). Research will continue to explore the similarities and differences between these two disorders.
Anxiety and Depression
Anxiety and depression commonly occur together with a comorbidity rate of 50% (Hubert, 2009). Depression is a psychiatric disorder that is characterized by significant changes in mood. People will often say, "I feel depressed" to describe a deep feeling of sadness. This everyday usage of the term "depression" must be distinguished from the clinical usage of the term. People with clinical depression have a depressed mood almost every day, for most of the day, for at least two weeks. Depressed mood can be experienced as profound feelings of sadness, but depression can also be expressed as irritability or agitation. In children and teens, depression is often displayed as an irritable mood. Another important symptom of clinical depression is anhedonia, which means a lack of interest or pleasure in most activities. Additional symptoms of depression include significant weight loss or gain, insomnia or hypersomnia (i.e., too little or too much sleep), psychomotor agitation or retardation, fatigue, feelings of worthlessness or guilt, decreased ability to concentrate, and suicidal ideation (thoughts of suicide).
It may be difficult to separate anxiety from depression when both disorders co-occur because the symptoms of one disorder, might disguise the symptoms of the other disorder, due to symptom overlap. Depressive disorders and anxiety disorders both include symptoms of psychomotor agitation, difficulties with concentration, changes in appetite, and sleep disturbances. However, individuals with both anxiety and depression tend to have more severe and chronic depressive and anxious symptoms when compared to individuals with either disorder alone. This increased severity of symptoms refers to increased chronicity, increased recurrence, greater negative impact on quality of life measures, increased risk of suicide, and more frequent use of health care services such as visits to primary care providers (Huppert, 2009). Anxiety and depression are suspected of sharing a genetic pathway.
Anxiety and Schizophrenia
Schizophrenia spectrum disorders (SSDs) are disorders which are characterized by perceptual and cognitive difficulties (e.g., hallucinations and delusions) that result in an impaired ability to distinguish between what is real, and what is not (called impaired reality-testing) This group of disorders includes: Schizophrenia, Schizoaffective Disorder, Schizophreniform Disorder, Delusional Disorder, and Psychotic Disorder Not Otherwise Specified. There is a comorbid association between these SSDs and anxiety disorders. In fact, comorbid anxiety disorders and SSDs are rather commonplace, with an average comorbidity estimated at 50% (Pokos & Castle, 2006). However, the effect of having both an anxiety disorder and SSD is uncertain. Some studies suggest that having both disorders has no significant effect, while other research points to poorer outcomes when both disorders are present (Pokos & Castle, 2006).