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].
References
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Association; 2013. p. 607–913.
Garakani A, Murrough J, Iosifescu D. Advances in psychopharmacology for anxiety disorders. Focus. 2014;XII(2):152–62.
Allgulander C. Morbid anxiety as a risk factor in patients with somatic diseases: a review of recent findings. Mind Brain. 2010; 1–9.
Wong P. Selective mutism: a review of etiology, comorbidities, and treatment. Psychiatry. 2010;7(3):23–31.
Wittchen HU, Jacobi F, Rehm J, et al. The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol. 2011;21:655.
Lenze EJ. Anxiety disorders in the elderly. In: Stein DJ, Hollander E, Rothbaum BO, editors. Textbook of anxiety disorders, vol. 2. Washington, DC: American Psychiatric Publishing; 2010. p. 651.
Scneider F, Milrod B. Gabbard’s treatments of psychiatric disorders. 5th ed. American Psychiatric Publishing, Arlington; 2014.
Grant JE, Odlaug BA, Won KS. N-Acetylcysteine, a glutamate modulator, in the treatment of Trichotillomania. Arch Gen Psychiatry. 2009;66(7):756–63.
Koran LM, Simpson HB. Guideline watch: practice guidelines for the treatment of patients with obsessive-compulsive disorder. APA Pract Guidel. 2013; 1–22.
Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol. 1959;32:50–5.
Koerner N, Antony M, Dugas M. Limitations of the Hamilton Anxiety Rating Scale as a primary outcome measure in randomized, controlled trials of treatments for generalized anxiety disorder. Am J Psychiatry. 2010;167(1):103–4.
Spitzer RL, Kroenke K, Willimas JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7.
Cupp M. Pharmacotherapy of anxiety disorders. Prescriber’s Lett. 2014; PL Detail-Doc #301006: 1–5.
Finley PR, Lee KC. Mood disorders 1: major depressive disorders. In: Alldredge BK, Corelli RL, Ernst ME, et al., editors. Koda-Kimble and Young’s applied therapeutics; the clinical use of drugs. 10th ed. Philadelphia: Lippincott Williams & Wilkins; 2013. p. 1949–82.
American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder. 3rd ed. Arlington: American Psychiatric Association Publishing; 2010.
Sarris J, Stough C, Bousman C. Kava in the treatment of generalized anxiety disorder: a double-blind, randomized, placebo-controlled study. J Clin Psychopharmacol. 2013;33(5):643–8.
Sharma M. Yoga as an alternative and complementary approach for stress management: a systematic review. J Evid Based Complementary Altern Med. 2014;19:59–67.
Salmon P. Effects of physical exercise on anxiety, depression, and sensitivity to stress: a unifying theory. Clin Psychol Rev. 2001;21(1):33–61.
Bazzan A, Zabrecky G, Monti D, Newberg A. Current evidence regarding the management of mood and anxiety disorders using complementary and alternative medicine. Neurotherapeutics. 2014;14(4):411–23.
Sharma M, Rush SE. Mindfulness-based stress reduction as a stress management intervention for healthy individuals: a systematic review. J Evid Based Complementary Altern Med. 2014;19(4):271–86.
Morgan LP, Graham JR, Hayes-Skelton SA, Orsillo SM, Roemer L. Relationships between amount of post-intervention of mindfulness practice and follow-up outcome variables in an acceptance-based behavior therapy for generalized anxiety disorder: the importance of informal practice. J Contextual Behav Sci. 2014;3(3):173–6.
Kessler RC, Gruber M, Hettma JM, et al. Co-morbid major depression and generalized anxiety disorders in the National Comorbidity Survey Follow-up. Psychol Med. 2008;38:365.
Cuijpers P, Sijbrandij M, Koole S, Andersson G, Beekman A, Reynolds C. Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis. Focus. 2014;XII(3):347–58.
Hoepner C. OTC Agents for depression, anxiety, and insomnia. Carlat Rep Psychiatr 2013; 11(7):1–3.
Mohatt J, Bennett S, Walkup J. Treatment of separation, generalized, and social anxiety disorders in youths. Am J Psychiatry. 2014;171:7.
Bezchlibnyk-Butler K, Jeffries J, Procyshyn R, Virani A. Anxiolytic agents. In: Clinical handbook of psychotropic drugs. 20th ed. 2014. Boston: Hogrefe Publishing, pp. 196–212.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer International Publishing Switzerland (outside the USA)
About this entry
Cite this entry
MacGilvray, P., Williams, R., Dambro, A. (2015). Anxiety Disorders. In: Paulman, P., Taylor, R. (eds) Family Medicine. Springer, Cham. https://doi.org/10.1007/978-1-4939-0779-3_32-1
Download citation
DOI: https://doi.org/10.1007/978-1-4939-0779-3_32-1
Received:
Accepted:
Published:
Publisher Name: Springer, Cham
Online ISBN: 978-1-4939-0779-3
eBook Packages: Springer Reference MedicineReference Module Medicine