焦虑障碍的七种类型 - 焦虑课程第6天

欢迎回到《治疗简述》播客的又一期节目。

Welcome back to another episode of the Therapy in a Nutshell podcast.

我是艾玛·麦卡达姆，一名持证婚姻与家庭治疗师。

I'm Emma McAdam, and I'm a licensed marriage and family therapist.

这个播客致力于将治疗中那些改变人生但通常较为复杂的主题，简化为易于理解的概念，让你能在日常生活中运用。

And this podcast is all about taking the life changing but usually kind of complicated topics of therapy and boiling them down into simple, easy to understand concepts that you can use in your daily life.

如果你觉得今天的节目对你有帮助，请分享给其他可能从中受益的人。

If you find today's episode is helpful to you, please pass it on to someone else who could benefit from it as well.

每一期播客都对应着一个可以在《治疗简述》YouTube频道上找到的视频。

Each podcast episode comes from a corresponding video you can find on the Therapy in a Nutshell YouTube channel.

此外，这些播客内容仅供教育用途，不能替代治疗师或其他医疗专业人员提供的建议或指导。

Also, these podcasts are educational and don't replace the advice or direction you may be receiving from a therapist or other health professionals.

现在，请享受本期节目。

Now please enjoy the episode.

《精神障碍诊断与统计手册》第五版修订版（DSM-5-TR）中列出了七种焦虑障碍。

There are seven types of anxiety disorders listed in the DSM five TR.

这是美国精神健康诊断的权威指南。

This is the bible of mental health diagnoses in The US.

在本视频中，你将了解这七种焦虑障碍，因为当你为某种状况命名时，它能帮助你找到管理和应对它的技巧与资源。

In this video, you'll learn what they are because when you have a name for something, it can help you find the skills and resources to manage it.

如果你患有焦虑障碍，这并不是你的错，但你仍然可以采取行动应对。

Now, if you experience an anxiety disorder, it's not your fault, but there is something you can do about it.

本视频是为期30天的改善你与焦虑关系课程的第六天。

This video is day six of a thirty day course on how to improve your relationship with anxiety.

我正在YouTube上发布这30个主要视频，但如果你想深入了解，付费无广告课程中还包含额外视频、工作簿、与我的问答环节以及更多内容。

I'm publishing the 30 main videos to YouTube, but if you want to learn more, there will be a bonus videos, workbook, q and a's with me, and extra content in the ad free course.

我还会在完整课程中提供一些免费的焦虑筛查测试链接。

I'm also going to link some free anxiety screening tests in the full course.

好的。

Okay.

在我们进入七种焦虑障碍之前，我能提醒一下吗？自我诊断通常存在一定风险。

So before we jump into the seven types of anxiety disorders, can I just mention that it's generally a little risky to self diagnose?

所以心理学课的第一课通常是，当你听到这些障碍时，你会倾向于过度诊断自己，这可能会造成伤害，尤其是当你在没有得到能够教你应对焦虑技巧和资源的人支持的情况下自我诊断时。

So the first lesson in psych class is usually when you hear about these disorders, you'll have a tendency to over diagnose yourself, and this can be harmful, especially if you diagnose yourself without the support of someone who can teach you the skills and resources to overcome anxiety.

这就引出了另一个重大误区，即焦虑障碍是永久性的，是100%遗传的特质，或者是一种性格特征，认为一旦被诊断出焦虑障碍，就会终生携带，这就是你的本质。

And that takes us to the other big myth, which is that an anxiety disorder is permanent, that it's a 100% genetic trait or that it's a character trait, that if you've been diagnosed with an anxiety disorder that you'll have it for the rest of your life, that this is who you are.

好的。

Okay.

这非常重要。

So this is really important.

对吧？

Right?

当人们说‘我有焦虑’时，他们通常想表达的是‘我有问题’。

When people say I have anxiety, what they're usually trying to say is there's something wrong with me.

但正如你在上一部分学到的，感到焦虑是生活正常、自然且健康的一部分。

But as you learned in the last segment, having anxiety is a normal, natural, and healthy part of life.

我们本就应该有焦虑。

We're supposed to have anxiety.

那么，经历焦虑和患有焦虑症之间有什么区别呢？

So what's the difference between experiencing anxiety and having an anxiety disorder?

人们的第一反应通常是认为严重程度不同。

Now, people's first guess is severity.

如果你有很高的焦虑水平，那一定就是焦虑症了，对吧？

If you have high levels of anxiety, that must be disordered, right?

同样，不是这样的。

Again, no.

在重要表演前、等待亲人从手术中出来时，或面临生命威胁的情况下，感到高度焦虑是正常、自然且健康的。

It's normal, natural, and healthy to have high levels of anxiety before a big performance or while waiting for a loved one to come out of surgery or when facing a life threatening experience.

所以，问题不在于焦虑的程度。

So it's not the level of anxiety.

那到底是什么呢？

So then what is it, right?

第一，你对焦虑的反应会干扰你的正常功能。

Number one, your response to anxiety interferes with your functioning.

这意味着，逃避焦虑正在阻止你过上你想要的生活。

So what that really means is that avoidance of the anxiety is stopping you from living the life that you want to.

其次，焦虑会引起临床上显著的痛苦。

And then number two, the anxiety causes clinically significant distress.

与焦虑相关的感受、身体反应和想法对你来说似乎难以承受。

The feelings and sensations and thoughts related to anxiety seem unbearable to you.

当我们把焦虑障碍理解为主要是回避行为以及缺乏应对情绪的技能时，这种理解方式让我们看到焦虑障碍其实是可以治疗的。

So when we come to understand anxiety disorders as being primarily about avoidance and a lack of skills knowing how to experience our feelings, When we understand anxiety this way, it opens the door to seeing how treatable they are.

另外需要注意的是，焦虑障碍并不是非黑即白的开关。

The other thing to know is that anxiety disorders aren't an on off switch.

症状存在于一个连续谱上，因此焦虑评估有临床分界点。

The symptoms occur on a spectrum, so anxiety assessments have a clinical cutoff.

在接受治疗后，当你提升了与情绪互动的能力，你可能会达到不再符合诊断标准的阶段，因为症状不再困扰你。

So when treated, when you improve your abilities to interact with your emotions, you can get to the point where you don't meet the criteria anymore because the symptoms don't bother you.

它们得到了控制。

They're managed.

焦虑障碍并不一定是永久的。

An anxiety disorder does not have to be permanent.

它并非100%由基因决定，也不一定就是你的本质。

It's not 100% genetic, it's not necessarily who you are.

这其中涉及很多因素，在下一个视频中我们会讨论焦虑的一些生物学因素，但我们也会在未来的视频中探讨，心理健康诊断与大众普遍理解的有很大不同。

There's a lot of factors that go into that, and in the next video we'll talk about some of the biological factors of anxiety, but we're also going to talk about, in a future video, about how mental health diagnoses are quite different from what the general public understands.

好的。

Okay.

哇，这开场可真够长的。

Whew, that's a long intro.

所以我教你们七种焦虑障碍类型的目标，是让你们能为自己的体验命名，我希望你们对这些自我标签保持开放的态度。

So my goal in teaching you about the seven types of anxiety disorders is for you to have a name for what you're experiencing, and I want you to just hold any of these self labels loosely.

当它们有帮助时就使用，但不要过于固执地坚持，以免限制了你的选择。

Use them when they're helpful, but don't hold them so rigidly that they limit your options.

不要过于僵化地给自己贴标签，以免阻碍了成长的空间。

Don't label yourself so rigidly that you don't have room for growth.

好的。

Okay.

话虽如此，我们先从第一种开始，广泛性焦虑障碍。

So that being said, let's start with number one, generalized anxiety disorder.

当大多数人谈论自己有焦虑时，他们指的就是这种。

Now, when most people talk about having anxiety, this is what they're talking about.

医疗专业人员会在你几乎每天都会担忧，且持续至少六个月的情况下，诊断为广泛性焦虑障碍。

Health care providers diagnose generalized anxiety disorder when you're worrying happens on most days and for at least six months.

这是一种对许多事情长期担忧的状态，甚至包括普通或日常事务，而且担忧的程度与实际情况不成比例。

It's being chronically worried about many things, even ordinary or routine issues, and the level of worry is disproportionate to the actual situation.

许多人觉得无法控制自己的焦虑，这种焦虑还会影响他们的身体感受。

Many people feel like they can't control their anxiety, and it affects how they feel physically.

你可能会感到紧张、坐立不安、肠胃不适等等。

You may feel tense, jittery, an upset stomach, etc.

对吧？

Right?

患有广泛性焦虑症的人常常记不起上一次感到放松是什么时候。

And people with general anxiety disorder often struggle to remember the last time they felt relaxed.

一个焦虑的想法刚解决，另一个又出现了。

As soon as one anxious thought is resolved, another appears.

因此，大约百分之六的美国人经历过这种情况。

So around six percent of Americans experience this.

也就是说，每十六个人中就有一个。

That's one in sixteen people.

大多数焦虑症中，女性患者多于男性，最常见的发病年龄是35至55岁。

And with most anxiety disorders, more women are affected than men, and the most common ages are 35 to 55.

而且，你知道，如果不治疗，它可能会变成慢性病。

And, you know, when it's not treated, it can be chronic.

它还会引发其他疾病，如恐慌症、重度抑郁症和物质滥用障碍。

It also contributes to other disorders like panic disorder, major depression, and substance abuse disorders.

广泛性焦虑还会导致频繁且昂贵的医疗需求。

General anxiety also contributes to frequent and costly medical needs.

好的。

Okay.

第二，社交焦虑障碍。

Number two, social anxiety disorder.

同样，这非常常见。

Again, this is very common.

大约百分之十二的人在一生中会经历社交焦虑，当你在社交场合中感到高度焦虑或恐惧时，就是这种情况。

Around twelve percent of people experience social anxiety in their lifetime, and that's when you have high levels of anxiety or fear around social situations.

你担心会被他人评判，或担心自己会做出尴尬的错误。

You worry about being judged by others or about making an embarrassing mistake.

患有社交焦虑的人通常非常在意自己的形象。

People with social anxiety often are very self conscious.

他们难以停止思考自己是如何摆放双手，或是否眼神接触过多。

They struggle to stop thinking about how they're holding their hands or if they're making too much eye contact.

他们可能会对身体症状感到极度焦虑，或者在社交场合中出现诸如脸红、出汗、颤抖、恶心或说话困难等身体反应。

They might feel really anxious about physical symptoms, or they might just have physical symptoms like blushing or sweating or trembling or nausea or difficulty speaking in social situations.

有些人会在社交活动前好几天甚至几周都担心，事后还会反复回想。

And some people worry for days or weeks leading up to a social event, and then they'll ruminate on them afterwards.

另一些人则会经历恐慌发作。

Others experience panic attacks.

女性比男性更可能被诊断出此病，且通常在青春期开始，发病中位年龄为13岁。

And women are more likely to be diagnosed than men, and it often begins in adolescence with the median age of onset being 13 years old.

好的。

Okay.

第三种是恐慌障碍。

Number three is panic disorder.

当你反复出现意外的恐慌发作时，就属于这种情况。

It's when you have recurrent unexpected panic attacks.

这些是短暂、突然且强烈的恐惧感。

These are short, sudden, intense feelings of fear.

它们通常在几分钟内达到高峰，常由身体感觉引发，如胸痛、呼吸急促、心悸或头晕。

They often peak within minutes and are often triggered by physical sensations like chest pain, shortness of breath, fluttering or pounding heart, or dizziness.

恐慌障碍的循环发生在人们担心恐慌再次发生，并回避曾经发生或可能发生的场合时。

The cycle of panic disorder happens when people worry about them happening again and avoid situations where they have happened or may happen.

此外，当人们试图压抑或控制自己的恐慌症状时，这也可能加剧恐慌障碍。

Also, when people try to suppress or control their symptoms of panic, that can also contribute to panic disorder.

大约百分之十一的普通人群在一生中至少经历过一次恐慌发作，但据估计，只有百分之四点七的人会发展成恐慌障碍，即反复出现干扰其正常功能的恐慌发作。

Around eleven percent of the general population has had at least one panic attack in their lifetime, but it's estimated that only four point seven percent of people develop panic disorder where they're having repeated panic attacks that are interfering with their functioning.

好的。

Okay.

第四，广场恐惧症。

Number four, agoraphobia.

当人们回避可能感到焦虑、被困、无助或尴尬的场所或情境时，就属于这种情况。

It's when people avoid places or situations where they might feel anxious, trapped, helpless, or embarrassed.

诊断标准要求，你必须对以下两种或以上情境持续感到恐惧或焦虑：公共交通工具、开阔空间如市场或桥梁、封闭空间如剧院、商店、排队或身处人群，或独自外出或在家时。

The criteria says that you need to feel persistent fear or anxiety around two or more of the following: public transportation, open spaces like marketplaces or bridges, enclosed spaces like theaters, shops, standing in line, or being in a crowd, or being outside or in the home alone.

这可能导致安全活动范围逐渐缩小，有些人可能不再离开家，甚至不再离开自己的城市或社区。

Now this can lead to this like slowly shrinking perimeter of safe places, and people maybe won't leave their home or they won't leave their city or their neighborhood.

对一些人来说，广场恐惧症是在恐慌发作之后发展的。

Now, for some people, agoraphobia develops after panic attacks.

它们常常是相关的，美国大约有1.7%的人在一生中会经历广场恐惧症。

They can often be connected, and about one point seven percent of people in The United States experience agoraphobia in their lifetime.

好的。

Okay.

第五，特定恐惧症。

Number five, specific phobias.

这是指对某一特定事物有极度的恐惧，比如蛇、蜘蛛、高处或飞行。

These are when you have an extreme fear about one specific thing, like snakes or spiders or heights or flying.

对吧？

Right?

有些人遇到这些事物时会经历恐慌发作。

Some people have panic attacks when they encounter the thing.

另一些人则会制定复杂的回避行为，以避免接触他们害怕的事物，这显然会妨碍他们过上充实的生活。

Others create elaborate avoidance routines to prevent being exposed to the thing they fear, and this can obviously interfere with their ability to live a full life.

特定恐惧症通常在童年时期发展，可能由创伤性事件引发。

Specific phobias often develop during childhood, and they can be triggered by a traumatic event.

大约百分之十二的人在一生中会经历特定恐惧症，因此相当常见。

About twelve percent of people experience a specific phobia in their life, so pretty common.

好的。

K.

第六，选择性缄默症。

Number six, selective mutism.

这通常发生在儿童身上。

Usually this is in children.

这种症状表现为一个人在某些场合（如学校或在同龄人面前）无法说话，但在其他场合（如家中）却能正常交谈。

This is when a person is unable to speak in certain settings like like school or in front of peers, but they're perfectly capable of speaking in other settings like home.

看起来他们像是拒绝开口，但通常他们感到僵住、被困住，无法说出话来。

It may look like they're refusing to speak up, but often they feel frozen and trapped and, like, unable to make words come out.

据估计，它在普通人群中的发生率约为百分之零点七。

It's estimated that it occurs in about point seven percent of the general population.

这种病症在儿童中比在成人中更常见，且常与社交焦虑或分离焦虑障碍共存。

It's much more common in children than adults, and it often co occurs with social anxiety or separation anxiety disorder.

接下来是第七种，这也是另一种儿童期障碍——分离焦虑。

And that takes us to number seven, which is another childhood disorder, separation anxiety.

当孩子对离开父母或家庭产生过度焦虑时，就属于这种情况。

It's when a child has excessive anxiety about being away from their parents or their home.

大约百分之四的普通人群会经历这种症状，而且它也常与广泛性焦虑障碍或社交焦虑障碍共存。

About four percent of the general population experiences this, and, again, it often co occurs with generalized anxiety disorder or social anxiety disorder.

以上就是七种焦虑障碍。

Those are the seven anxiety disorders.

现在还有一些其他相关的障碍，我个人将它们归入更广泛的焦虑类别，尽管它们在特征和成因上是独立的。

Now there's a couple of other relevant disorders that I personally group into this kind of broader anxiety category even though they are distinct in their features and causes.

强迫症最初被归类为焦虑障碍，但在2013年，它被重新划分为独立的一类。

So OCD was originally classified as an anxiety disorder, but in 2013, it was reclassified in its own category.

焦虑是强迫症的常见特征，但它们在大脑化学物质和功能上存在差异。

Anxiety is a common feature of OCD, but they have differences in brain chemistry and function.

它们对不同的治疗方法反应最好。

They respond best to different treatments.

例如，强迫症对暴露与反应预防疗法反应更好，而广泛性焦虑则对认知行为疗法（CBT）反应更佳。

So, for example, OCD responds better to exposure response prevention, where generalized anxiety responds better to, like, CBT.

强迫症通常需要有行为症状，即你正在从事某种行为，而焦虑障碍则不需要；焦虑障碍常伴有身体症状，比如你感到胃部不适，但这并不是强迫症的必要特征。

OCD usually requires a behavioral symptom, some kind of action you're engaging in, where anxiety disorders don't, and anxiety disorders often include a physical component like, you know, you're upset to your stomach or something, and that's not a physical and that's not a requirement for OCD.

举个例子，治疗方式的另一个区别是，强迫症患者常常寻求保证，比如：‘你生我气了吗？’

And, you know, for example, another difference in approaches in treatment is like with OCD, someone's frequently seeking reassurance like, Oh, are you mad at me?

你生我气了吗？

Are you mad at me?

你生我气了吗？

Are you mad at me?

对吧？

Right?

但寻求保证实际上会加重强迫症，而对焦虑症而言，恰当的保证有时反而有帮助。

But reassurance can actually make the OCD worse, whereas with anxiety, the right kind of reassurance can actually sometimes be helpful.

对于焦虑症，有时你可以审视并挑战某些思维模式，但对于强迫症，如果过度关注侵入性思维或强迫性想法，反而可能陷入非常无益的循环。

With anxiety, sometimes you can, like, examine and challenge certain thinking types, where with OCD it can actually lead to really unhelpful loops if you engage too much with intrusive thoughts or, you know, obsessive thoughts.

创伤后应激障碍。

PTSD.

它与焦虑症有许多相似症状，但可以认为创伤后应激障碍是一种心理创伤，而不是心理疾病。

It shares a lot of symptoms with anxiety disorders, but it could be considered that PTSD is a mental injury, not a mental illness.

创伤后应激障碍由创伤性事件引发，但许多经历过创伤事件的人并不会发展出创伤后应激障碍。

PTSD is triggered by a traumatic event, but a lot of people experience traumatic events without developing PTSD.

所以，创伤后应激障碍本质上是你的神经系统陷入过度活跃状态，被困在持续的警觉、紧张和恐惧中，或者陷入麻木。

So PTSD is basically when your nervous system gets stuck in hyperdrive, being trapped in a state of constant vigilance, tension, and fear or shutting down.

对吧？

Right?

经历创伤后应激障碍的人还经常出现闪回、不想要的或扭曲的记忆，这些症状会干扰他们正常生活和享受生活的能力。

People experiencing PTSD also frequently have flashbacks, unwanted or distorted memories, and these symptoms interfere with their ability to function and enjoy life.

还有很多其他状况与焦虑直接相关。

There's also a lot of other conditions that are directly connected to anxiety.

他们要么表现出一些焦虑症状，要么焦虑会导致这些障碍。

They either have some symptoms of anxiety or anxiety can lead to these disorders.

例如，抑郁症通常 preceded 一段强烈的压力和焦虑期。

So, for example, depression is often preceded by a period of intense stress and anxiety.

物质滥用障碍可能源于试图用药物来调节焦虑或创伤后应激障碍。

Substance abuse disorders may come from an attempt to regulate anxiety or PTSD with drugs.

疾病焦虑或健康焦虑（以前称为疑病症）与强迫症有关，囤积障碍、皮肤搔抓和拔毛障碍也是如此。

Illness anxiety or health anxiety, which was previously called hypochondria, is connected to OCD and as is hoarding disorder and skin picking and hair pulling disorders.

厌食症常与焦虑和恐惧相关，而在DSM中的许多其他障碍症状中，也容易发现焦虑的存在。

Anorexia is commonly associated with anxiety and fears, and it's easy to find anxiety around many of the symptoms in many of the other disorders in the DSM.

因此，在本系列的下一个视频中，我们将讨论诊断的真相：它们并不像你想象的那样永久，你有很多方法可以促进心理健康，甚至解决焦虑障碍，使你不再患有它们。

So in the next video in this series, we're going to talk about the truth about diagnoses, how they aren't as permanent as you may think, how there's a lot you can do to promote your mental wellness and even resolve anxiety disorders so that you no longer have them.

总之，当焦虑干扰了你的工作、人际关系或其他生活方面，当你难以控制担忧或恐惧，或者有自杀念头时，建议你与个体化的专业人士（如你的治疗师或医生）合作。

When it comes down to it, it's recommended that you work with an individualized provider like your therapist or doctor when your anxiety is interfering with your work, your relationships, or other parts of your life, when it's hard to control your worry or fears, or if you have suicidal thoughts.

如果你没有管理焦虑的技能，焦虑症状通常不会自行消失，越早治疗焦虑就越容易。

Now if you don't have the skills to manage your anxiety, the symptoms of anxiety usually don't just go away on their own, and it's easier to treat anxiety sooner rather than later.

因此，我当然鼓励你与专业的个体提供者合作，同时我也知道本课程中的技巧也会对你有所帮助。

So, of of course, I encourage you to work with an individual provider, and I also know that the skills in this course are going to help you too.

好的。

Okay.

对于参加完整课程的朋友们，请花些时间查看工作簿，探索这些标签对你而言是有帮助还是没有帮助。

For those of you in the full course, make sure to take time, check out the workbook, and explore how these labels are helpful, not helpful for you.

好的。

Okay.

感谢观看，保重。

Thanks for watching, and take care.

希望你喜欢这一集，并找到一些可以融入日常生活的技巧，让生活变得更好一点点。

I hope you enjoyed this episode and found something you can add to your daily routine that makes your life just a little bit better.

如果你想了解更多关于如何处理艰难情绪、改变大脑、建立更健康的人际关系，或支持身边患有心理疾病的人，欢迎访问我的课程网站 therapyinanutshell.com。

If you want to learn more about topics like how to process tough emotions, how to change your brain, how to build better relationships, or support someone you know with a mental illness, then check out my classes at therapyinanutshell.com.

如果你觉得这些播客对你有帮助，请留下评分，让更多人能轻松找到这些内容。

And if you feel like these podcasts have been a benefit to you, please leave a rating so others can more easily find this content.

非常感谢，祝你今天愉快。

Thank you so much, and have a great day.