Anxiety Disorders ____________________________________________________________________________
Agoraphobia Around two-thirds of patients with panic disorder develop agoraphobia, defined as fear or avoidance of places or situations from which escape might be difficult or where help might not be available in the event of a panic attack [3]. These places or situations can include crowds, public transportation, or being alone outside of the home [2]. Social Anxiety Disorder Social anxiety disorder (SAD) is characterized by excessive worry and apprehension in anticipation of social interactions and situations, specifically a fear of being negatively evaluated/ judged by others (resulting in embarrassment or humiliation) in social group settings [3]. It is associated with physical and psychologic anxiety symptoms. Specific Phobia Specific, simple, or isolated phobia is excessive and unreason- able fear/avoidance of specific objects or situations such as animals (e.g., snakes, insects); the natural environment (e.g., heights, storms); closed spaces (e.g., elevators, caves); or proce- dures (e.g., venipuncture, dental examination) [3]. Individuals with specific phobia disorder recognize that their specific fear/ avoidance reaction is unreasonable but find it intensely dis- tressing or interfering with everyday life. The most common phobias reported by adults involve animals, heights, and flying. Separation Anxiety Disorder Adult separation anxiety disorder (SEPAD) is characterized by fear or anxiety concerning separation from those to whom an individual is attached. Common features include excessive distress when experiencing or anticipating separation from home and persistent and excessive worries about potential harms to attachment figures or untoward events that might result in separation [3]. Post-Traumatic Stress Disorder PTSD is the persistent fear or episodic severe emotional dis- tress that follows actual or threatened death, serious injury, or psychological shock to the physical integrity of self or oth- ers (the trauma), with ongoing intrusive symptoms related to the traumatic event. Exacerbations are often triggered by recollections, flashbacks, or dreams; manifestations include avoidance symptoms (e.g., efforts to avoid activities or thoughts associated with the trauma), negative alterations in cognition and mood, and hyper-arousal symptoms (e.g., disturbed sleep, hypervigilance, exaggerated startle response) [2]. Obsessive-Compulsive Disorder OCD is characterized by recurrent uncontrollable thoughts and ruminations (obsessions) that lead to restlessness and anxi- ety, followed by impulsive/repetitive physical or mental rituals (compulsions) to alleviate distress. The obsessive-compulsive behaviors are destressing and time-consuming, which impedes normal social and occupational function. Common obses- sions relate to fear of personal contamination, accidents, and
religious or sexual matters; common rituals include washing, checking, cleaning, counting, and touching [3]. Illness Anxiety Disorder Illness anxiety disorder is a somatic-symptom related disorder characterized by excessive or disproportionate preoccupations with having or acquiring a serious illness. This includes exces- sive health-related behaviors and high levels of alarm about personal health status [3]. OVERALL PREVALENCE, RISK FACTORS, AND CLINICAL COURSE Taken together, anxiety disorders (DSM-5 plus PTSD and OCD) have a 12-month prevalence of approximately 19% in the United States, and a lifetime prevalence of approximately 29% [4; 5]. The pattern of sex distribution is consistent among anxiety disorders, and the prevalence of any anxiety disorder is higher for girls/women (23%) than for boys/men (14%) [5; 6]. Anxiety disorder is more prevalent among adolescents 13 to18 years of age (32%) but less severe, with only 8% having experienced severe impairment. The prevalence of anxiety dis- order gradually declines with age, from a high of 23% among all persons 30 to 44 years of age to 9% among those older than 60 years of age. Among surveyed adults having any anxiety disorder, the proportional severity of impairment associated with symptomatic episodes occurring in the previous year was 43% mild, 34% moderate, and 23% serious [5]. PAST YEAR AND LIFETIME PREVALENCE The reported data on anxiety disorders in the United States include 12-month prevalence, lifetime prevalence, and lifetime morbid risk ( Table 1 ). The two lifetime measures differ. Life- time prevalence measures the proportion of the population currently or previously diagnosed with the disorder, while lifetime morbid risk measures the proportion who may develop the disorder at some point, independent of their lifetime history at the time of assessment. By including future cases, lifetime morbid risk is believed to be more accurate. Lifetime prevalence and lifetime morbid risk are usually equivalent for disorders with early-life onset, but diverge for disorders with increasingly later onset. The ratio of lifetime prevalence to lifetime morbidity risk falls below 1.0 in disorders with increasingly later onset; the further the ratio values fall below 1.0, the later the median age of onset [7]. Anxiety disorders with earlier median age of onset are phobias and separation anxiety disorder (15 to 17 years of age), and those with latest age of onset are panic disorder and general- ized anxiety disorder (23 to 30 years of age). Lifetime morbid risk is considerably higher than lifetime prevalence for most anxiety disorders, with magnitude of difference much higher for disorders with later than earlier age of onset. Also, the ratio of 12-month to lifetime prevalence roughly reflects persistence but varies meaningfully in ways consistent with differential persistence of these disorders [7].
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