Anxiety Disorders Health Article

Definition

The anxiety disorders are a group of mental disturbances characterized by anxiety as a central or core symptom. Although anxiety is a commonplace experience, not everyone who experiences it has an anxiety disorder. Anxiety is associated with a wide range of physical illnesses, medication side effects, and other psychiatric disorders.

The revisions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) that took place after 1980 brought major changes in the classification of the anxiety disorders. Prior to 1980, psychiatrists classified patients on the basis of a theory of causality that defined anxiety as the outcome of unconscious conflicts in the patient's mind. DSM-III (1980), DSM-III-R (1987), and DSM-IV (1994) introduced and refined a new classification that took into consideration recent discoveries about the biochemical and post-traumatic origins of some types of anxiety. The present definitions are based on the external and reported symptom patterns of the disorders rather than on theories about their origins.

Description

Anxiety disorders are the most common form of mental disturbance in the United States population. It is estimated that 28 million persons suffer from an anxiety disorder every year. These disorders are a serious problem for the entire society because of their interference with patients' work, schooling, and family life. They also contribute to the high rates of alcohol and substance abuse in the United States. Anxiety disorders are an additional problem for health professionals because the physical symptoms of anxiety frequently bring people to primary care doctors or emergency rooms.

DSM-IV defines twelve types of anxiety disorders in the adult population. They can be grouped under seven headings:

• Panic disorders with or without agoraphobia. The chief characteristic of panic disorder is the occurrence of panic attacks coupled with fear of their recurrence. In clinical settings, agoraphobia is usually not a disorder by itself, but is typically associated with some form of panic disorder. Patients with agoraphobia are afraid of places or situations in which they might have a panic attack and be unable to leave or to find help. About 25% of patients with panic disorder develop obsessive-compulsive disorder (OCD).
• Phobias. These include specific phobias and social phobia. A phobia is an intense irrational fear of a specific object or situation that compels the patient to avoid it. Some phobias concern activities or objects that involve some risk (for example, flying or driving) but many are focused on harmless animals or other objects. Social phobia involves a fear of being humiliated, judged, or scrutinized. It manifests itself as a fear of performing certain functions in the presence of others, such as public speaking or using public lavatories.
• Obsessive-compulsive disorder (OCD). This disorder is marked by unwanted, intrusive, persistent thoughts or repetitive behaviors that reflect the patient's anxiety or attempts to control it. It affects between 2-3% of the population and is much more common than was previously thought.
• Stress disorders. These include post-traumatic stress disorder (PTSD) and acute stress disorder. Stress disorders are symptomatic reactions to traumatic events in the patient's life.
• Generalized anxiety disorder (GAD). GAD is the most commonly diagnosed anxiety disorder and occurs most frequently in young adults.
• Anxiety disorders due to known physical causes. These include general medical conditions or substance abuse.
• Anxiety disorder not otherwise specified. This last category is not a separate type of disorder, but is included to cover symptoms that do not meet the specific DSM-IV criteria for other anxiety disorders.

All DSM-IV anxiety disorder diagnoses include a criterion of severity. The anxiety must be severe enough to interfere significantly with the patient's occupational or educational functioning, social activities or close relationships, and other customary activities.

The anxiety disorders vary widely in their frequency of occurrence in the general population, age of onset, family patterns, and gender distribution. The stress disorders and anxiety disorders caused by medical conditions or substance abuse are less age-and gender-specific. Whereas OCD affects males and females equally, GAD, panic disorder, and specific phobias all affect women more frequently than men. GAD and panic disorders are more likely to develop in young adults, while phobias and OCD can begin in childhood.

Anxiety disorders in children and adolescents

DSM-IV defines one anxiety disorder as specific to children, namely, separation anxiety disorder. This disorder is defined as anxiety regarding separation from home or family that is excessive or inappropriate for the child's age. In some children, separation anxiety takes the form of school avoidance.

Children and adolescents can also be diagnosed with panic disorder, phobias, generalized anxiety disorder, and the post-traumatic stress syndromes.