Anxiety Disorder

Anxiety disorders are a group of mental disorders characterised by significant and uncontrollable feelings of anxiety and fear, affecting an individual's social, occupational, and personal functioning. These disorders may cause both physical and cognitive symptoms, including restlessness, irritability, fatigue, difficulty concentrating, increased heart rate, and various other symptoms that vary by individual.

Types

Generalised Anxiety Disorder (GAD)

GAD is characterised by persistent, excessive worry about various everyday matters, not focused on any specific object or situation. Symptoms include restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbances.

GAD often begins around the age of 8-9 years and is the most common anxiety disorder in older adults.

Specific Phobias

This category involves intense, irrational fears of specific objects or situations, such as flying, heights, or animals. Exposure to the phobic stimulus can trigger significant anxiety responses like trembling and shortness of breath.

Specific phobias affect 5-12% of the global population.

Panic Disorder

Panic disorder is marked by recurrent, unexpected panic attacks—brief episodes of intense fear and physical symptoms like trembling, dizziness, and difficulty breathing. These attacks can occur without a clear trigger and lead to chronic worry about future attacks and changes in behaviour to avoid them.

Agoraphobia

Agoraphobia involves anxiety about being in situations where escape might be difficult or help unavailable, often linked to the fear of having a panic attack. This can lead to avoidance behaviours, significantly limiting daily activities and sometimes causing individuals to become housebound.

Social Anxiety Disorder (SAD)

SAD, or social phobia, is the fear of negative evaluation or embarrassment in social situations. Symptoms include blushing, sweating, rapid heart rate, and difficulty speaking.

This disorder can lead to avoidance of social interactions and significant impairment in social and professional life.

Post-Traumatic Stress Disorder (PTSD)

PTSD develops after exposure to a traumatic event, resulting in symptoms like flashbacks, hypervigilance, and avoidant behaviours. It affects approximately 3.5% of U.S.

adults annually and can lead to significant distress and impairment.

Separation Anxiety Disorder

This disorder involves excessive fear or anxiety about being separated from attachment figures. It is more severe in children but can affect adults as well, leading to panic and distress even with brief separations.

Obsessive-Compulsive Disorder (OCD)

Previously classified under anxiety disorders, OCD involves obsessions (persistent intrusive thoughts) and compulsions (repetitive behaviours) that cause significant anxiety and distress. It affects 1-2% of adults and up to 3% of children and adolescents.

Selective Mutism

Selective mutism is characterised by the inability to speak in specific social situations despite being able to speak in others, often coexisting with social anxiety. It affects about 0.8% of individuals at some point in their lives.

Diagnosis

Diagnosis is based on symptoms, triggers, and personal and family histories. No objective biomarkers or laboratory tests can diagnose anxiety.

Various questionnaires, like the State-Trait Anxiety Inventory (STAI) and the Generalised Anxiety Disorder 7 (GAD-7), help in clinical assessment. Symptoms must persist for at least six months and significantly impair daily functioning.

Treatment

Psychological Techniques

Cognitive behavioural therapy (CBT) is the first-line treatment for anxiety disorders, effective in both face-to-face and internet-based formats. Exposure and response prevention (ERP) is also beneficial for specific conditions like PTSD, phobias, and OCD.

Mindfulness-based programmes and meditation can help manage anxiety symptoms.

Medications

First-line medications include SSRIs and SNRIs. Buspirone and pregabalin are second-line treatments.

Benzodiazepines may be used for acute episodes of anxiety. Medications should be used cautiously in older adults due to potential side effects.

Lifestyle and Diet

Lifestyle changes, such as regular exercise, sleep pattern regulation, reduced caffeine intake, and smoking cessation, can help manage anxiety. Omega-3 polyunsaturated fatty acids have shown some benefit in reducing anxiety.

Epidemiology

Anxiety disorders are the most common mental disorders, affecting nearly 30% of adults at some point. They are more prevalent in women (5.2%) than men (2.8%) and have a lifetime prevalence of about 29% in the U.S.

Anxiety disorders are also common in children, with 10-20% developing a full-fledged disorder before age 18.

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Self-assessment MCQs (single best answer)

Which of the following is a characteristic symptom of Generalised Anxiety Disorder (GAD)?

Panic Disorder is best characterised by:

Which anxiety disorder involves a fear of being in situations where escape might be difficult?

A child who refuses to speak in certain social situations but speaks normally at home might be diagnosed with:

Which treatment is considered first-line for most anxiety disorders?

Which symptom is NOT typically associated with anxiety disorders?

Obsessive-Compulsive Disorder (OCD) was previously classified under which category?

Which medication class is commonly used as a second-line treatment for anxiety disorders when SSRIs or SNRIs are ineffective?

Social Anxiety Disorder is characterised by:

Which lifestyle change is recommended to help manage anxiety disorders?