Hamilton Addictions & Mental Health Resource

Anxiety Disorders 

Anxiety is a common emotion but when excessive, it can be a symptom of a mental or physical illness.  When anxiety occurs as part of an “anxiety disorder”, it is characterized as an irrational or excessive fear or apprehension regarding one or more situations.  The fear causes the individual significant difficulty and distress in managing daily tasks, and usually interferes with personal, work, and other socially related activities.  Anxiety that causes difficulty in day-to-day functioning should be assessed and may require treatment.  Anxiety disorders are common: the lifetime prevalence of any anxiety disorder in adults is one in four. In the past year, one in ten adults will have struggled with an anxiety disorder.  It is the number one mental health concern in women, and the second most common mental health concern in men, after substance use disorders. *

Types of Anxiety Disorders and Screening Tools

The main Anxiety Disorders (AD) include panic disorder, agoraphobia, generalized anxiety disorder, social anxiety disorder and specific phobia.  In the latest version of the DSM 5, Obsessive Compulsive (OCD) and Related Disorders, and Trauma (including Post-Traumatic Stress Disorder) and Stress-Related Disorders are listed in separate categories from the AD; for the purpose of this website, and resource finding, these mental health concerns will be included in the page for AD.  When assessing someone for the presence or absence of an anxiety disorder, it is important also to ensure that the anxiety symptoms a person feels are not due to other mental health concerns, (e.g., mood disorders, personality disorders, substance use disorders), or medical problems (e.g., cardio-respiratory, endocrinological, etc.).  Physical examination and laboratory investigations as indicated should be done as part of the assessment of a patient presenting with symptoms of anxiety.

Panic Disorder (PD) and Agoraphobia:
Persons with PD have experienced panic attacks “out of the blue”, and worry that more will follow.  They fear that the panic attacks are a sign of an imminent physical emergency or some other catastrophic outcome.  Some individuals also have agoraphobia, and may engage in avoidance behaviours (e.g., of enclosed spaces, being alone, or standing in a line) or other life-style changes in order to manage their fears of panic, helplessness or embarrassment.

Screening tool for PDA

Social Anxiety Disorder (SAD):
Persons with SAD have excessive fears of humiliating or embarrassing themselves in social situations, or of being judged negatively by others.  They feel panicky in social situations, and may avoid them or participate with a great degree of distress.  Examples include fear or avoidance of giving presentations, attending a party, or making small talk with strangers.

Screening tool for SAD

Generalized Anxiety Disorder (GAD):
Worry is a part of life.  Persons with GAD however, worry excessively and uncontrollably about numerous events, such as finances, health, safety, world events and relationships.  They have a tendency to expect the worst about events that others may routinely perceive as small and insignificant.  Worries in GAD tend to be uncontrollable, linger for months, and cause significant difficulties with sleep, concentration, energy, irritability, restlessness, and muscle tension.

Screening tool for GAD

Specific Phobia (SP):
Persons with SP feel excessive and uncontrollable anxiety when exposed to certain and specific situations or stimuli.  Examples of feared situations may include fears related to heights, flying, animals, medical procedures, and needles.  In such situations, symptoms of a panic attack may be experienced, and avoidance behavior is common.  For some people, the phobia may interfere with necessary activities and treatment may be required.

Obsessive Compulsive Disorder and Related Disorders

Obsessive Compulsive Disorder (OCD):
Persons with OCD struggle with obsessions and/or compulsions.  Obsessions are unwanted, intrusive, and distressing thoughts or urges which tend to pop into someone’s mind and are difficult to let go of.  Examples of obsessions include fears of contamination, need for orderliness or symmetry, aggressive thoughts, and self-doubt.  Most of the time, obsessions lead to, or are accompanied by behaviours (called compulsions) that are intended to decrease, suppress or neutralize an obsession or an unwanted thought.  Examples of compulsions include excessive hand washing, cleaning, organizing, and re-reading/re-writing.  Obsessions and/or compulsions interfere with daily activities and can preoccupy a person with OCD for hours.

Screening tool for OCD  

Hoarding Disorder (HD):
Persons with HD have a difficult time letting go of objects which otherwise have little to no value (e.g., newspapers, plastic bands, etc.).  HD can be associated with OCD, but it can also present on its own, as a disorder separate from OCD.  It is more common in the elderly, and presents a problem when hoarded items increase the risk of fire or other health hazards.

Screening tool for HD

Body Dysmorphic Disorder (BDD):
Persons with BDD are excessively preoccupied with a real or perceived flaw in regard to their appearance (e.g., a crooked nose, lips too big or too small, etc.).  Others rarely appreciate the perceived flaw, but a person with BDD may spend hours each day worrying and trying to “fix” the flaw.

Screening tool for BDD

Trichotillomania (Hair Pulling Disorder):
Persons with trichotillomania have trouble controlling the urge to pull the hair from anywhere on their body, resulting in bare patches.

Screening tool for Trichotillomania

Excoriation (Skin Picking) Disorder:
Persons with excoriation disorder have trouble controlling the urge to pick, rub, scratch or dig into the skin on their body, including around the skin around nail beds.

Trauma and Stress-Related Disorders

Post-Traumatic Stress Disorder  (PTSD):
Persons with PTSD have been exposed to, or witnessed a traumatic event (e.g., car crash, assault) and develop nightmares, flashbacks, and physiological and psychological distress (e.g., when reminded of the traumatic event).   Persons with PTSD also exhibit avoidance behavior and difficulty with other symptoms such as hyper-vigilance, self-blame, and concentration and memory difficulties.  These symptoms can be highly intrusive and interfere with daily functioning.

Screening Tool for PTSD (still needed)

Other Anxiety-Related Mental Health Concerns

Illness Anxiety Disorder (Hypochondria) (IAD):
Persons with IAD worry excessively and uncontrollably about becoming ill or having an illness.  As a result, they engage in checking behaviour (e.g., of their body for signs of illness), surfing of health-based websites, and visits to numerous health care providers to be reassured that they are well or to have their fears confirmed.

Separation Anxiety Disorder:
Seen primarily in children and adolescents, this mental health concern involves a significant fear of being apart from someone with whom the person has a strong connection or attachment, or a fear of being away from home.

Hospital (St. Joseph’s Healthcare Hamilton) Based Resources

Anxiety Treatment and Research Clinic (ATRC)

ATRC provides psychiatric assessment and pharmacotherapy, as well as cognitive behaviour therapy for patients with the following conditions:

  • Panic Disorder
  • Agoraphobia
  • Social Anxiety Disorder
  • Generalized Anxiety Disorder
  • Specific Phobias
  • Obsessive Compulsive Disorder
  • Post-Traumatic Stress Disorder (limited resources)
  • Illness Anxiety Disorder (limited resources)

The clinic does not provide assessment or treatment for individuals with primary diagnoses of depression or mood disorders, substance use disorders, psychotic disorders, or eating disorders.  Limited resources are available for individuals with post-traumatic stress disorder and illness anxiety disorder.

The clinic’s services are catchmented; please see referral form, or contact Ms. Judy Odom for additional information if your patient does not live in the Hamilton area.

Referral Form: Coming soon

Contact: Ms. Judy Odom
Tel: (905) 522-1155, ext. 33697
Fax: (905) 521-6120

Community Psychiatry Clinic and East Region Mental Health Centre 

These general psychiatry outpatient clinics also see people with anxiety disorders and other difficulties such as mood symptoms and personality disorders. The clinics include a Rapid Assessment Clinic that provides treatment recommendations to the referring physician but no further follow-up.  Clinics are catchmented.

Contact:  Debbie Casperson for additional information and to make a referral.
Tel:  905-522-1155 x33954

Community-based Counseling (Group or Individual) and Resources for Anxiety Disorders in Hamilton

Growing Together Hamilton Summarizes many groups and programs offered in Hamilton.
Find the document on the “News & Events” page and search for programs on “anxiety.”  Many of the programs are for children and youth.

Catholic Family Services Hamilton (for short-term individual, couple and family counseling for a number of mental health concerns, including certain anxiety disorders, and hoarding in the elderly)
Cost is based on a sliding scale.  People self-refer.

Sexual Assault Centre of Hamilton (for counseling related to sexual trauma and  PTSD)

Hamilton Family Health Team
For patients of family physicians who are part of the HFHT, please see resources listed on the HFHT website

General Online Patient Information on Anxiety Disorders

website focused on all types of anxiety and self-help strategies.

Anxiety Canada
website focused on anxiety disorders.

Center for Addiction and Mental Health
website provides information on all mental health concerns.

Mind Your Mind
A Canadian website providing information to teens/young adults.

Help Guide
An ad-free, U.S. based website from Harvard Health Publications, provides self-help information on numerous mental health concerns.

Disorder Specific Online Patient Information

www.paniccenter.net (for panic disorder)

https://ecouch.anu.edu.au (for depression, generalized anxiety disorder and social anxiety disorder)

www.stoppulling.ca (for hair pulling)

www.trich.org (for hair pulling)

www.stoppicking.ca (for skin picking)

App Store:  MindShift (free app from www.anxietybc.com, focused on relaxation and mindfulness based exercises for individuals with symptoms of anxiety focused on perfectionism, social situations, and excessive worrying)

Online Resources for Physicians

Clinical Treatment Guidelines for Anxiety Disorders (includes screening questions for anxiety disorders)

Anxiety Disorders Association of Ontario

Anxiety Disorders Association of Canada

*Adapted from Anxiety Disorders: An Information Guide, 2009 Centre for Addiction and Mental Health, and as per the Anxiety Treatment and Research Clinic, St. Joseph’s Healthcare Hamilton.

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