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Dr. Sonia Melville

Clinical Psychologist and Mental Health

Since one year ago, Luisa, a 40-year old woman, does not leave her house for fear to cross the streets, even those with little traffic as those in her neighborhood. When she does go out, she feels oppression in her chest, tachycardia, difficulty breathing, dizziness and fear of fainting in the middle of the street, so she opts for staying at home.

Miguel does not dare express, not even to his wife, that some months ago he began feeling a peculiar fear. While he is driving his car, he starts wondering if he has run over a person or animal. Although he is sure no accident has happened, he somehow feels compelled to return and verify no accident has happened. Sometimes he has had to do it two or three times. Miguel is beginning to think he may be going crazy.

Javier’s boss asked him to prepare for next week a presentation about his work. At that moment, Javier began to sweat and feel extremely nervous. Although Javier is a very capable computer engineer and recognizes his fear is irrational, that night he thought maybe it would be better to quit his job.

Julia is an 8 year old girl who does not want to go to school. She fears if she leaves her house, her mother might die.

Luisa, Miguel, Javier and Julia are persons that present anxiety.



Anxiety must be differentiated from fear or dread. Fear is a feeling of danger, of threat linked to an external object or situation. It is precise, specific and generally falls into the barriers of possibility. One can fear being rejected by a person we want to please, not being able to pay the bills, failing a test. On the other hand, the focus of anxiety is rather internal. It is a response to a vague, distant and often unrecognizable danger. Anxiety affects a person as a whole, producing physiologic, psychological and behavior reaction. At physiology level, anxiety produces body reactions such as fast heartbeat, muscular tension, dry mouth, abundant perspiration, a choking sensation and dizziness, among other symptoms. Behaviorally, anxiety can sabotage the ability of a person to act, express herself or face daily life situations. At psychological level the person feels a state of unease, apprehension and intense fear. In its extreme form it can produce a feeling of depersonalization, fear of dying or going crazy, symptoms that  manifest themselves during an anxiety crisis or panic attack.

The Johns Hopkins White Papers, Depression and Anxiety, 2002, states that when anxiety is out of control and interferes with the normal functioning of a person, as in the aforementioned cases, we can talk about an Anxiety Disorder.

The Diagnostic and Statistical Manual of Mental Disorders, DSM-IV-TR, describes the following anxiety disorders:  anguish disorders with or without agoraphobia; agoraphobia without a history of anguish disorder; specific phobia; social phobia; compulsive obsessive disorder; post-traumatic stress; acute stress disorders; general anxiety disorder; anxiety disorder due to disease; anxiety disorder induced by substances and non-specified anxiety disorder.

This article not present each anxiety disorder in detail due to space limitation, although for better understanding we can describe some terms. The essential characteristic of agoraphobia is the appearance of anxiety when a person is in situations where escape may be difficult or embarrassing or where in case of a crisis of anguish no help can be found. The specific phobia appears as a response to exposure to specific feared situations or objects, which creates behaviors of avoidance. Such is Luisa’s case: here anxiety refers to a specific situation, crossing a street. Social phobia, as Javier presents it, is a marked and persisting fear due to one or more social situations or interventions in public in which the person is exposed to a possible evaluation, thus avoiding those situations. The compulsive obsessive disorder includes recurring obsessions or compulsions that are experimented as inadequate. Miguel tries to suppress intrusive thoughts going back to the site one or more times to ensure he has not caused an accident.  After an extremely traumatic event in which someone is involved in an event that presents real danger for his/her life or physical integrity (kidnapping, serious accident, war and natural disasters, among others) that person may suffer post-traumatic stress disorder with persistent re-experimenting of the traumatic event and significant deterioration in important areas of activity, such as studies, work, social and family life.

The aforementioned disorders can also happen in children, as well as the anxiety due to separation disorder. Children with that disorder can feel excessively ill when separated from their home or persons closes to them; generally, that anxiety appears after a stressful situation. Such is Julia’s case: she fears that if she goes to school, something bad can happen to her mother.

Some anxiety symptoms can be the product of medical conditions and due to use of certain substances. They include hyperventilation syndrome, hypoglycemia, hyperthyroidism, prolapse of the mitral valve, alcohol or tranquilizer pill  abstinence, asthma, heart attack, use of bronchodilators, psycho-stimulants, thyroid hormone and others.

Anxiety disorders are frequent. The study executed in 2005 by the National Comorbidity Survey of the United States indicates that generally speaking, anxiety disorders have high prevalence. Three out of every ten US citizens will suffer an anxiety disorder at some point in life; it is the most frequent mental disorder group in the population. Recovered from El Blog de CentroIMA.

The Epidemiology Study of Mental Disorders in Guatemala, Metropolitan Region,  2011 (ETMEGUA) indicates that the most prevalent mental disorders in the total sample, throughout life (13.95%), during the past 12 months (6.73%) and during the past 30 days (4.71%) were those related to anxiety, presenting a clear and consistent pattern of more prevalence in youth throughout their life. The study also presents more prevalence of anxiety disorders, especially social phobia and agoraphobia, in places with more violence and more comorbidity. It found that some of those disorders appeared at an early age, for example specific phobia (8 years of age) and social phobia (12 years of age).  The highest risk event to develop post-traumatic stress, for the total sample, was intra-family violence.  Although anxiety disorders were the most prevalent, persons that suffered that type of disorder were the ones that reported the lowest use of any health care service during the past 12 months (doctor, psychiatrist or psychologist).

Bourne (2001), states that several causes contribute to generate an anxiety disorder; they can be genetic factors, imbalance in brain chemistry, deprivation during childhood, traumatic events and stress accumulation. There are also causes that maintain it: thought distortions, irrational beliefs, anxious self-dialogue, catastrophic thoughts, feelings of inadequacy, low self-esteem, avoidance phobic situations, poor nutrition, muscular stress and superficial breathing.

As causes of anxiety are diverse and factors that maintain it are several, it can be said its treatment is not unique. Some therapists still treat anxiety disorders only as a psychiatric condition that can be “cured” medicine, or as a childhood or behavioral problem. The current approach to treat anxiety is directed to interventions at the different levels that may originate or maintain such anxiety. Thus, it is necessary to work with different techniques at physical, emotional, behavioral, mental, interpersonal, self-esteem, existential and spiritual levels of the anxious person that they must reflect the unique and individual problems of each person, as in the case of Luisa, Miguel, Javier or Julia.


American Psychiatric Association (2005). Diagnostic and statistical manual of mental disorders DSM-IV-TR. Reviewed text. Masson, S.A.

Bourne, E., (2001). The Anxiety & Phobia Workbook. Third Edition. New Harbinger Publications, Inc.

Margolis, S. y Swartz, K. (2002), Depression and Anxiety. The Johns Hopkins White Papers. The Johns Hopkins Medical Institutions, Baltimore, Maryland.

Pereira, M., Donado, M., Melville, S. Barco, B., Sánchez, M., Paiz, L. (2012). Estudio Epidemiológico de Trastornos Mentales en Guatemala, Región Metropolitana, 2011. Universidad Mariano Gálvez de Guatemala, Guatemala.