Anxiety disorders, phobias and stress-related disorders: Pathology Review

19 year old Anastasia comes to the emergency department convinced that she’s about to die from a heart attack.

It all started as soon as she entered the lecture hall to take her final exam for college, when she began sweating and feeling light-headed.

Within 5 minutes, this quickly progressed to being unable to breathe and experiencing a stabbing chest pain.

She denies the use of illicit substances or alcohol and has no personal or family history of cardiovascular or pulmonary disease.

Her mother, who’s by her side, mentions that Anastasia has had five similar episodes in the past six months, all while preparing for her exams.

Anastasia adds that she wants to quit college, because she is afraid an attack will happen again and she won’t be able to make it.

Upon examination, her ECG is normal, and on a blood test, D-dimer is negative, and cardiac enzymes remain normal after 6 hours.

The next day, you see 43 year old Olivia, who is brought to office by her husband, who thinks she needs help.

They constantly get into fights because Olivia wants everything in the house to be sparkling-clean and organized in a very specific way.

She always blames him for leaving contaminated fingerprints around the house and moving items from their proper place.

She then goes on to clean up for hours and even loses sleep over it

When you ask Olivia about these behaviors, she says that she understands they are irrational and wishes she could stop them, but she just can’t.

Okay, based on the initial presentation, both Anastasia and Olivia seem to have some form of anxiety or obsessive-compulsive disorder.

Many of us experience fear or anxiety during stressful times, which is perfectly normal and can actually be beneficial, since it helps set the body on high-alert.

Now, fear is the emotional response to an imminent threat or danger, and can cause a fight or flight response when your life is threatened.

For your exams, make sure you can differentiate fear from anxiety, which is the anticipation of a future threat or stressful situation with an uncertain outcome, and is often associated with feelings of worry and nervousness, which causes avoidant behaviors.

Now, it’s important to keep in mind that fear and anxiety can be experienced at the same time.

For example, you may fear a particularly tough exam, while feeling anxious about an uncertain outcome like passing it!

So, normally, fear and anxiety occur in response to a real threat, but normally shouldn’t cause any excessive physical or psychological manifestations, other than perhaps, mild insomnia before an important event, like the night before your test!