Reference
Guide | Reference

24  Anxiety, Threat, and Bodily Alarm

24.1 Summary

  • Heightened threat anticipation with bodily alarm and avoidance that feels out of proportion or hard to control.

24.2 Patient-Language Phrases

  • “I feel on edge all the time.”
  • “My heart races and I can’t catch my breath.”
  • “I keep thinking something bad will happen.”
  • “I avoid places because I might panic.”

24.3 Core Features

  • Persistent sense of threat or danger.
  • Bodily arousal (racing heart, tight chest, trembling).
  • Avoidance or safety behaviors.

24.4 Boundary Markers

  • What it is: threat-focused worry or fear that dominates attention.
  • What it is not: expected stress responses to clear, time-limited threats.

24.5 Variants / Spectrum

  • Worry-dominant tension.
  • Panic surges with intense bodily alarm.
  • Specific fears or phobic avoidance.
  • Social or performance-related threat.
  • Health-focused threat and scanning.

24.6 Severity Anchors (0-4)

  • 0: No significant threat anticipation.
  • 1: Mild, situational, manageable.
  • 2: Moderate, recurring, interferes with focus or sleep.
  • 3: Severe, frequent avoidance or panic.
  • 4: Extreme, disabling or unsafe.

24.7 Time-Course Patterns

  • Acute spikes tied to triggers.
  • Episodic panic with inter-episode worry.
  • Chronic, diffuse tension.
  • Fluctuating with stress load.

24.8 Functional Impact

  • Work/school: reduced concentration or avoidance.
  • Relationships: withdrawal or reassurance seeking.
  • Self-care: disrupted routines or sleep.

24.9 Common Mimics / Differential

  • Trauma-related hypervigilance.
  • Obsessional intrusive fears.
  • Mood dysregulation with agitation.

24.10 Medical / Substance Rule-Outs

  • Stimulants or caffeine effects.
  • Withdrawal states.
  • Thyroid or cardiopulmonary contributors.

24.11 Developmental Expression

  • Early childhood: separation fears, somatic complaints.
  • School age: school refusal, performance anxiety.
  • Adolescence: social threat, panic, avoidance.
  • Late life: health or safety-focused threat.

24.12 Cultural / Context Notes

  • May present as somatic distress or spiritual framing.
  • Threat meaning is shaped by environment and exposure.

24.13 Measurement Prompts

  • Brief anxiety measure.
  • Panic frequency or trigger log.

24.15 Documentation Snippet (1-2 lines)

  • “Reports persistent threat anticipation with episodic bodily alarm and avoidance; Threat 3, Arousal 2; episodic course.”