Anxiety disorders

Abstract

Anxiety disorders are characterized by an excessive fear response; these disorders are extremely prevalent among the general population and have a 2:1 female predilection [1]. Functional impairment is common with these disorders and, along with depression, is among the leading causes of disability and work-related absences. As such, it is postulated that the economic burden of anxiety disorders is greater than any other psychiatric disorder, due to the high prevalence and cost of medical and psychiatric treatment [2]. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), defines fear as “the emotional response to real or perceived imminent threat” and anxiety as “anticipation of future threat.” Fear typically induces surges of autonomic arousal and thoughts of immediate danger and escape, whereas anxiety typically manifests as muscular tension and avoidant behaviors. The anxiety disorders listed in the DSM-5 tend to be highly comorbid with other psychiatric conditions [1]. The DSM-5 chapter on Anxiety Disorders no longer includes obsessive-compulsive disorders, post-traumatic stress disorder, or acute stress disorder, which had been included in this section in the DSM-IV/DSM-IV-TR. Due to their relevance, these associated disorders will be discussed briefly in this chapter. Relevant changes to anxiety disorders in the DSM-5 are outlined in Table 1. Of note, the DSM-5 requires a minimum of 6-month duration of symptoms that are not attributable to another medical condition and mental disorder or induced by a substance or medication to meet diagnostic criteria for anxiety disorders. An exception is noted in symptom duration for children with separation anxiety disorder and selective mutism, with a required duration of 4 weeks and 1 month, respectively. Panic disorder and agoraphobia have been unlinked in the DSM-5, and panic attacks can now be listed as a specifier, applicable to all DSM-5 disorders [1]. Many anxiety disorders develop in early childhood and typically persist into adulthood if not adequately treated. These disorders differ from developmentally normative fear or anxiety in magnitude of reaction and/or persistence beyond developmentally appropriate periods. A thorough grasp of a proper differential diagnosis and treatment of anxiety disorders can be daunting; however, it may be easier to conceptualize various anxiety disorders from the perspective of the developmental spectrum, using age of onset to help guide a differential [1, 3].