Spiraling out of control: one case of pathologic anxiety as a response to a genetic risk of cancer.
The threat of cancer can result in an existential crisis characterized by feelings of uncertainty and fear. Anxiety, the most common response to the threat of cancer, may be expressed in ways as varied as individual personalities and circumstances. It is a normal response to the threat of cancer, but in some it may deteriorate to pathologic anxiety and manifest somatic or avoidant patterns. Members of families diagnosed with genetic mutations that predispose to cancer are unique in that they experience a complex chain of life events. People affected with genetic mutations that increase the risk for the development of cancer may be at greater risk of manifesting abnormal anxiety. Little research exists that can guide the health professional in meeting the needs of these individuals, which leads health practitioners to approach their needs on the basis of combined theoretical assumptions about the needs of people with cancer, people who have family members with cancer, and people with recurrent cancer. Some factors may be assessed by the health professional as an aid in identifying an individual at increased risk of developing a psychopathology. These factors include age and developmental level, existence of a previous psychologic disorder, and family integrity. Advanced practice nurses may effectively intervene in the care of these patients by (a) accurately assessing the risk for and extent of the anxiety reaction in individuals and family members; (b) developing management plans that include ongoing support, education, psychotherapy, and pharmacotherapeutics for the individual; and (c) support and psychotherapy for the family. In this article, the pathologic anxiety experienced by one adolescent girl diagnosed with a genetic mutation that caused multiple endocrine neoplasia 2a is addressed, along with the treatment of her avoidant anxiety disorder--trichotillomania.
Giarelli
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University of Pennsylvania School of Nursing, Center for Advancing Care in Serious Illness, Philadelphia 19104, USA.
D000223:Adaptation, Psychological; D000293:Adolescent; D001008:Anxiety Disorders / Q000523:psychology* / Q000628:therapy; D001521:Behavior Therapy; D005260:Female; D006801:Humans; D009377:Multiple Endocrine Neoplasia / Q000235:genetics / Q000451:nursing / Q000523:psychology*; D009730:Nursing Assessment; D014256:Trichotillomania / Q000523:psychology* / Q000628:therapy