View source for Medicine:Anxiety disorder

{{short description|Cognitive disorder with an excessive, irrational dread of everyday situations}}
{{Infobox medical condition (new)
| name          = Anxiety disorder
| image         = The Scream.jpg
| field         = [[Biology:Psychiatry|Psychiatry]], [[Social:Clinical psychology|clinical psychology]]
| symptoms      = Worrying, [[Medicine:Tachycardia|fast heart rate]], shakiness<ref name= DSM5/>
| complications = Depression, [[Medicine:Insomnia|trouble sleeping]], poor quality of life, [[Medicine:Suicide|suicide]]<ref>{{cite web |title=Anxiety disorders – Symptoms and causes |url=https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961 |website=Mayo Clinic |access-date=23 May 2019 |language=en}}</ref>
| onset         = 15–35 years old<ref name=Lancet2016/>
| duration      = > 6 months<ref name= DSM5/><ref name=Lancet2016/>
| causes        = [[Medicine:Genetic disorder|Genetic]], environmental, and psychological factors<ref name=NIH2016>{{cite web|title=Anxiety Disorders|url=http://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml#pub2|website=NIMH|access-date=14 August 2016|date=March 2016|url-status=live|archive-url=https://web.archive.org/web/20160727230427/http://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml#pub2|archive-date=27 July 2016}}</ref>
| risks         = Child abuse, family history, poverty<ref name=Lancet2016/>
| diagnosis     = [[Social:Psychological testing|psychological assessment]]
| differential  = [[Medicine:Hyperthyroidism|Hyperthyroidism]]; heart disease; [[Biology:Caffeine|caffeine]], [[Chemistry:Alcohol (drug)|alcohol]], [[Biology:Cannabis (drug)|cannabis]] use; withdrawal from certain drugs<ref name=Lancet2016/><ref name=Test2013partIII/>
| prevention    = 
| treatment     = Lifestyle changes, [[Medicine:Psychotherapy|counselling]], medications<ref name=Lancet2016/>
| medication    = Antidepressants, anxiolytics, beta blockers<ref name=NIH2016/>
| prognosis     = 
| frequency     = 12% per year<ref name=Lancet2016/><ref name=Kess2007>{{cite journal|last= Kessler | display-authors=0|date=2007 |title= Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization's World Mental Health Survey Initiative |journal= World Psychiatry |volume=6 |issue= 3|pages=168–76|pmid=18188442 |pmc=2174588}}</ref>
| deaths        = 
}}
<!-- Definition and symptoms -->
'''Anxiety disorders''' are a cluster of [[Medicine:Mental disorder|mental disorder]]s characterized by significant and uncontrollable feelings of [[Medicine:Anxiety|anxiety]] and [[Philosophy:Fear|fear]]<ref name= DSM5>{{cite book|title=Diagnostic and Statistical Manual of Mental DisordersAmerican Psychiatric Associati.|year=2013|publisher=American Psychiatric Publishing|location=Arlington|isbn=978-0890425558|pages=[https://archive.org/details/diagnosticstatis0005unse/page/189 189–195]|edition=5th|url=https://archive.org/details/diagnosticstatis0005unse/page/189}}</ref> such that a person's social, occupational, and personal function are significantly impaired. Anxiety is a worry about future events, while fear is a reaction to current events.<ref name= DSM5/> Anxiety may cause physical and cognitive symptoms such as restlessness, irritability, easy fatigability, difficulty concentrating, increased heart rate, chest pain, abdominal pain, and many others.<ref name= DSM5/>  In casual discourse the words ''anxiety'' and ''fear'' are often used interchangeably; in clinical usage, they have distinct meanings: anxiety is defined as an unpleasant emotional state for which the cause is either not readily identified or perceived to be uncontrollable or unavoidable, whereas fear is an emotional and physiological response to a recognized external threat.<ref name="WHO2009">{{cite book|author=World Health Organization|url=http://apps.who.int/iris/bitstream/10665/44095/1/9789241547697_eng.pdf|title=Pharmacological Treatment of Mental Disorders in Primary Health Care|date=2009|isbn=978-92-4-154769-7|location=Geneva|archive-url=https://web.archive.org/web/20161120132530/http://apps.who.int/iris/bitstream/10665/44095/1/9789241547697_eng.pdf|archive-date=20 November 2016|url-status=live}}</ref> The umbrella term ''anxiety disorder'' refers to a number of specific disorders that include fears (phobias) or anxiety symptoms.<ref name="DSM5" />

There are several types of anxiety disorders, including [[Medicine:Generalized anxiety disorder|generalized anxiety disorder]], specific phobia, [[Medicine:Social anxiety disorder|social anxiety disorder]], [[Medicine:Separation anxiety disorder|separation anxiety disorder]], [[Medicine:Agoraphobia|agoraphobia]], [[Medicine:Panic disorder|panic disorder]], and [[Medicine:Selective mutism|selective mutism]].<ref name="DSM5" /> The individual disorder can be diagnosed by the specific and unique symptoms, triggering events, and timing.<ref name="DSM5" /> If a person is diagnosed with an anxiety disorder, a medical professional must have evaluated the person to ensure the anxiety cannot be attributed to a medical illness or mental disorder.<ref name="DSM5" />  It is possible for an individual to have more than one anxiety disorder during their life or at the same time.<ref name="DSM5" />  There are numerous treatments and strategies that can improve a person's mood, behaviors, and functioning in daily life.{{TOC limit}}

==Sub-types==
[[File:A. Morison "Physiognomy of mental diseases", cases Wellcome L0022722 (cropped).jpg|thumb|Facial expression of someone with chronic anxiety]]

=== Generalized anxiety disorder ===
{{Main|Medicine:Generalized anxiety disorder}}
Generalized anxiety disorder (GAD) is a common disorder, characterized by long-lasting anxiety which is not focused on any one object or situation. Those suffering from generalized anxiety disorder experience non-specific persistent fear and worry, and become overly concerned with everyday matters. Generalized anxiety disorder is "characterized by chronic excessive worry accompanied by three or more of the following symptoms: restlessness, fatigue, concentration problems, irritability, muscle tension, and sleep disturbance".<ref>Schacter, D. L., Gilbert, D. T., & Wegner, D.M. (2011). ''Psychology: Second Edition''. New York, NY: Worth.</ref> Generalized anxiety disorder is the most common anxiety disorder to affect older adults.<ref name="Calleo">{{Cite journal |vauthors=Calleo J, Stanley M |title=Anxiety Disorders in Later Life: Differentiated Diagnosis and Treatment Strategies |journal=Psychiatric Times |volume=26 |issue=8 |year=2008 |url=http://www.psychiatrictimes.com/display/article/10168/1166976 |url-status=live |archive-url=https://web.archive.org/web/20090904032148/http://www.psychiatrictimes.com/display/article/10168/1166976 |archive-date=4 September 2009}}</ref> Anxiety can be a symptom of a medical or [[Medicine:Substance use disorder|substance use disorder]] problem, and medical professionals must be aware of this. A diagnosis of GAD is made when a person has been excessively worried about an everyday problem for six months or more.<ref name="Barker2003">{{cite book|author=Phil Barker|title=Psychiatric and mental health nursing: the craft of caring|url=https://books.google.com/books?id=6qdoQgAACAAJ|access-date=17 December 2010|date=7 October 2003|publisher=Arnold|location=London|isbn=978-0-340-81026-2|url-status=live|archive-url=https://web.archive.org/web/20130527071117/http://books.google.com/books?id=6qdoQgAACAAJ|archive-date=27 May 2013}}</ref>  These stresses can include family life, work, social life, or their own health. A person may find that they have problems making daily decisions and remembering commitments as a result of lack of concentration and/or preoccupation with worry.<ref>''Psychology'', Michael Passer, Ronald Smith, Nigel Holt, Andy Bremner, Ed Sutherland, Michael Vliek (2009) McGrath Hill Education, UK: McGrath Hill Companies Inc. p 790</ref> A symptom can be a strained appearance, with increased sweating from the hands, feet, and axillae,<ref>{{cite web |url=http://www.webmd.com/anxiety-panic/guide/mental-health-anxiety-disorders |title=All About Anxiety Disorders: From Causes to Treatment and Prevention |access-date=2016-02-18 |url-status=live |archive-url=https://web.archive.org/web/20160217225046/http://www.webmd.com/anxiety-panic/guide/mental-health-anxiety-disorders |archive-date=17 February 2016}}</ref> and they may be tearful, which can suggest depression.<ref name=Gelder2005>''Psychiatry'', Michael Gelder, Richard Mayou, John Geddes 3rd ed. Oxford; New York: Oxford University Press, c 2005 p. 75</ref> Before a diagnosis of anxiety disorder is made, physicians must rule out drug-induced anxiety and other medical causes.<ref>Varcarolis. E (2010). ''Manual of Psychiatric Nursing Care Planning: Assessment Guides, Diagnoses and Psychopharmacology''. 4th ed. New York: Saunders Elsevier. p 109.</ref>

In children GAD may be associated with headaches, restlessness, abdominal pain, and heart palpitations.<ref name=PedGAD2009>{{cite journal|last=Keeton|first=CP|author2=Kolos, AC|author3= Walkup, JT|title=Pediatric generalized anxiety disorder: epidemiology, diagnosis, and management.|journal=Paediatric Drugs|year=2009|volume=11|issue=3|pages=171–83|pmid=19445546|doi=10.2165/00148581-200911030-00003|s2cid=39870253}}</ref> Typically it begins around 8 to 9 years of age.<ref name=PedGAD2009/>

===Specific phobias===
The single largest category of anxiety disorders is that of specific phobias which includes all cases in which fear and anxiety are triggered by a specific stimulus or situation. Between 5% and 12% of the population worldwide suffer from specific phobias.<ref name="Barker2003"/> According to the National Institute of Mental Health, a phobia is an intense fear of- or aversion to- specific objects or situations.<ref>{{Cite web|title=NIMH » Anxiety Disorders|url=https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml|access-date=2020-11-16|website=www.nimh.nih.gov}}</ref> Sufferers typically anticipate terrifying consequences from encountering the object of their fear, which can be anything from an animal to a location to a bodily fluid to a particular situation. Common phobias are flying, blood, water, highway driving, and tunnels. When people are exposed to their phobia, they may experience trembling, shortness of breath, or rapid heartbeat.<ref>{{Cite web|url=https://www.mentalhealth.gov/what-to-look-for/anxiety-disorders/phobias/index.html|title=Phobias|last=U.S. Department of Health & Human Services|date=2017|website=www.mentalhealth.gov|language=en-us|access-date=2017-12-01|archive-url=https://web.archive.org/web/20170513022004/https://www.mentalhealth.gov/what-to-look-for/anxiety-disorders/phobias/index.html|archive-date=13 May 2017|url-status=dead}}</ref>  Thus meaning that people with specific phobias often go out of their way to avoid encountering their phobia. People understand that their fear is not proportional to the actual potential danger but still are overwhelmed by it.<ref>''Psychology''. Michael Passer, Ronald Smith, Nigel Holt, Andy Bremner, Ed Sutherland, Michael Vliek. (2009) McGrath Hill Higher Education; UK: McGrath Hill companies Inc.</ref>

===Panic disorder===
{{Main|Medicine:Panic disorder}}
With panic disorder, a person has brief attacks of intense terror and apprehension, often marked by trembling, shaking, confusion, dizziness, nausea, and/or difficulty breathing. These panic attacks, defined by the APA as fear or discomfort that abruptly arises and peaks in less than ten minutes, can last for several hours.<ref>{{cite web|title=Panic Disorder|url=https://www.med.upenn.edu/ctsa/panic_symptoms.html|website=Center for the Treatment and Study of Anxiety, University of Pennsylvania|url-status=live|archive-url=https://web.archive.org/web/20150527074826/http://www.med.upenn.edu/ctsa/panic_symptoms.html|archive-date=27 May 2015}}</ref> Attacks can be triggered by stress, irrational thoughts, general fear or fear of the unknown, or even exercise. However, sometimes the trigger is unclear and the attacks can arise without warning. To help prevent an attack one can avoid the trigger. This can mean avoiding places, people, types of behaviors, or certain situations that have been known to cause a panic attack. This being said not all attacks can be prevented.

In addition to recurrent unexpected panic attacks, a diagnosis of panic disorder requires that said attacks have chronic consequences: either worry over the attacks' potential implications, persistent fear of future attacks, or significant changes in behavior related to the attacks. As such, those suffering from panic disorder experience symptoms even outside specific panic episodes. Often, normal changes in heartbeat are noticed by a panic sufferer, leading them to think something is wrong with their heart or they are about to have another panic attack. In some cases, a heightened awareness ([[Medicine:Hypervigilance|hypervigilance]]) of body functioning occurs during panic attacks, wherein any perceived physiological change is interpreted as a possible life-threatening illness (i.e., extreme [[Medicine:Hypochondriasis|hypochondriasis]]).

===Agoraphobia===
{{Main|Medicine:Agoraphobia}}
Agoraphobia is the specific anxiety about being in a place or situation where escape is difficult or embarrassing or where help may be unavailable.<ref>{{harvnb|Craske|2003}} Gorman, 2000</ref> Agoraphobia is strongly linked with [[Medicine:Panic disorder|panic disorder]] and is often precipitated by the fear of having a panic attack. A common manifestation involves needing to be in constant view of a door or other escape route. In addition to the fears themselves, the term [[Medicine:Agoraphobia|agoraphobia]] is often used to refer to avoidance behaviors that sufferers often develop.<ref>{{cite book |author1= Jane E. Fisher |author2= William T. O'Donohue |title= Practitioner's Guide to Evidence-Based Psychotherapy |url= https://archive.org/details/practitionersgui00fish |url-access= limited |date= 27 July 2006 |publisher= Springer |isbn= 978-0387283692 |pages= [https://archive.org/details/practitionersgui00fish/page/n759 754]}}</ref> For example, following a panic attack while driving, someone suffering from agoraphobia may develop anxiety over driving and will therefore avoid driving. These avoidance behaviors can often have serious consequences and often reinforce the fear they are caused by. In a severe case of someone with Agoraphobia, they may never leave their home.

===Social anxiety disorder===
{{Main|Medicine:Social anxiety disorder}}
[[Medicine:Social anxiety disorder|Social anxiety disorder]] (SAD; also known as social phobia) describes an intense fear and avoidance of negative public scrutiny, public embarrassment, humiliation, or social interaction. This [[Philosophy:Fear|fear]] can be specific to particular social situations (such as public speaking) or, more typically, is experienced in most (or all) social interactions. Roughly 7%. of American adults have Social anxiety disorder, and more than 75% of people experience their first symptoms in their childhood or early teenage years.<ref>{{Cite web|title=Social Anxiety Disorder|url=https://www.mhanational.org/conditions/social-anxiety-disorder|access-date=2020-11-16|website=Mental Health America|language=en}}</ref> [[Medicine:Social anxiety|Social anxiety]] often manifests specific physical symptoms, including blushing, sweating, rapid heart rate, and difficulty speaking.<ref>{{Cite web|title=NIMH » Social Anxiety Disorder: More Than Just Shyness|url=https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness/index.shtml#pub3|access-date=2020-12-01|website=www.nimh.nih.gov}}</ref> As with all phobic disorders, those suffering from social anxiety often will attempt to avoid the source of their anxiety; in the case of social anxiety this is particularly problematic, and in severe cases can lead to complete social isolation.

It is important to understand that children are also affected by Social anxiety disorder while attending school. Although their symptoms associated with this disorder are different compared to teenagers and adults. Their symptoms can include difficult processing or retrieving information, sleep deprivation, disruptive behaviors in class, and irregular class participation.<ref>{{Cite web|title=Managing Anxiety in the Classroom|url=https://www.mhanational.org/blog/managing-anxiety-classroom|access-date=2020-11-16|website=Mental Health America|language=en}}</ref>

Social physique anxiety (SPA) is a subtype of social anxiety. It is concern over the evaluation of one's body by others.<ref>{{cite book|title=The Oxford Handbook of Exercise Psychology|date=2012|publisher=Oxford University Press|isbn=9780199930746|page=56|url=https://books.google.com/books?id=VR1pAgAAQBAJ&pg=PA56}}</ref> SPA is common among adolescents, especially females.

===Post-traumatic stress disorder===
{{Main|Medicine:Post-traumatic stress disorder}}
Post-traumatic stress disorder (PTSD) was once an anxiety disorder (now moved to ''trauma- and stressor-related disorders'' in DSM-V) that results from a traumatic experience. PTSD affects approximately 3.5% of U.S. adults every year, and an estimated one in eleven people will be diagnosed with PTSD in their lifetime.<ref>{{Cite web|title=What Is PTSD?|url=https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd|access-date=2020-11-16|website=www.psychiatry.org}}</ref> Post-traumatic stress can result from an extreme situation, such as combat, natural disaster, rape, hostage situations, child abuse, bullying, or even a serious accident. It can also result from long-term (chronic) exposure to a severe stressor--<ref>{{Cite book | title=Post-Traumatic Stress Disorder and the Family | publisher=Veterans Affairs Canada | url=http://www.vac-acc.gc.ca/clients/sub.cfm?source=mhealth/ptsd_families# | isbn=978-0-662-42627-1 | year=2006 | url-status=dead | archive-url=https://web.archive.org/web/20090214122623/http://www.vac-acc.gc.ca/clients/sub.cfm?source=mhealth%2Fptsd_families | archive-date=14 February 2009| access-date=8 September 2017 }}</ref> for example, soldiers who endure individual battles but cannot [[Social:Coping (psychology)|cope]] with continuous combat. Common symptoms include [[Medicine:Hypervigilance|hypervigilance]], flashbacks, avoidant behaviors, anxiety, anger and depression.<ref name="psycho-prat">[http://www.psycho-prat.fr/index.php?module=webuploads&func=download&fileId=2963_0 Psychological Disorders] {{webarchive|url=https://web.archive.org/web/20081204123458/http://www.psycho-prat.fr/index.php?module=webuploads&func=download&fileId=2963_0 |date=4 December 2008 }}, Psychologie Anglophone</ref> In addition, individuals may experience sleep disturbances.<ref>{{cite journal|last1=Shalev|first1=Arieh|last2=Liberzon|first2=Israel|last3=Marmar|first3=Charles|title=Post-Traumatic Stress Disorder|journal=New England Journal of Medicine|volume=376|issue=25|pages=2459–2469|doi=10.1056/nejmra1612499|pmid=28636846|year=2017}}</ref> People who suffer from PTSD often try to detach themselves from their friends and family, and have difficulty maintaining these close relationships. There are a number of treatments that form the basis of the care plan for those suffering with PTSD. Such treatments include [[Medicine:Cognitive behavioral therapy|cognitive behavioral therapy]] (CBT), prolonged exposure therapy, stress inoculation therapy, medication, and psychotherapy and support from family and friends.<ref name="Barker2003"/>

[[Medicine:Post-traumatic stress disorder|Post-traumatic stress disorder]] (PTSD) research began with Vietnam veterans, as well as natural and non-natural disaster victims. Studies have found the degree of exposure to a disaster has been found to be the best predictor of PTSD.<ref>{{Cite book|title = Posttraumatic Stress Disorder|url = https://archive.org/details/posttraumaticstr0000full|url-access = limited|last = Fullerton|first = Carol|publisher = American Psychiatric Press Inc.|year = 1997|isbn = 978-0-88048-751-1|location = Washington, D.C.|pages = [https://archive.org/details/posttraumaticstr0000full/page/8 8]–9}}</ref>

===Separation anxiety disorder===
{{Main|Medicine:Separation anxiety disorder}}
Separation anxiety disorder (SepAD) is the feeling of excessive and inappropriate levels of anxiety over being separated from a person or place. Separation anxiety is a normal part of development in babies or children, and it is only when this feeling is excessive or inappropriate that it can be considered a disorder.<ref>Siegler, Robert (2006). ''How Children Develop, Exploring Child Develop Student Media Tool Kit & Scientific American Reader to Accompany How Children Develop''. New York: Worth Publishers. {{ISBN|0-7167-6113-0}}.</ref> Separation anxiety disorder affects roughly 7% of adults and 4% of children, but the childhood cases tend to be more severe; in some instances, even a brief separation can produce panic.<ref>{{cite journal|title=Adult Separation Anxiety Often Overlooked Diagnosis – Arehart-Treichel 41 (13): 30 – Psychiatr News |journal=Psychiatric News |volume=41 |issue=13 |pages=30 |doi=10.1176/pn.41.13.0030 |year = 2006|last1 = Arehart-Treichel|first1 = Joan}}</ref><ref>{{Cite journal| last1 = Shear | first1 = K. | last2 = Jin | first2 = R. | last3 = Ruscio | first3 = AM. | last4 = Walters | first4 = EE. | last5 = Kessler | first5 = RC. | title = Prevalence and correlates of estimated DSM-IV child and adult separation anxiety disorder in the National Comorbidity Survey Replication | journal = Am J Psychiatry | volume = 163 | issue = 6 | pages = 1074–1083 |date=June 2006 | doi = 10.1176/appi.ajp.163.6.1074 | pmid = 16741209 | pmc = 1924723 }}</ref> Treating a child earlier may prevent problems. This may include training the parents and family on how to deal with it.<!-- <ref name=Moh2014/> --> Often, the parents will reinforce the anxiety because they do not know how to properly work through it with the child.<!-- <ref name=Moh2014/> --> In addition to parent training and family therapy, medication, such as SSRIs, can be used to treat separation anxiety.<ref name=Moh2014>{{Cite journal|last1=Mohatt|first1=Justin|last2=Bennett|first2=Shannon M.|last3=Walkup|first3=John T.|date=2014-07-01|title=Treatment of Separation, Generalized, and Social Anxiety Disorders in Youths|journal=American Journal of Psychiatry|volume=171|issue=7|pages=741–748|doi=10.1176/appi.ajp.2014.13101337|pmid=24874020|issn=0002-953X}}</ref>

===Obsessive–compulsive disorder===
{{Main|Medicine:Obsessive–compulsive disorder}}
Obsessive–compulsive disorder (OCD) is not classified as an anxiety disorder by the DSM-5 but is by the [[Medicine:ICD-10|ICD-10]]. It was previously classified as an anxiety disorder in the DSM-IV. It is a condition where the person has obsessions (distressing, persistent, and intrusive thoughts or images) and [[Medicine:Compulsive behavior|compulsions]] (urges to repeatedly perform specific acts or rituals), that are not caused by drugs or physical disorder, and which cause distress or social dysfunction.<ref name="NICE-2006">{{cite book|last1=National Collaborating Centre for Mental Health|first1=(UK)|title=Obsessive-Compulsive Disorder: Core Interventions in the Treatment of Obsessive-Compulsive Disorder and Body Dysmorphic Disorder|journal=NICE Clinical Guidelines|date=2006|issue=31|pmid=21834191|url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0015812/|access-date=21 November 2015|url-status=live|archive-url=https://web.archive.org/web/20130529141531/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0015812/|archive-date=29 May 2013|isbn=9781854334305}}</ref><ref name="Soomro-2012">{{cite journal|last1=Soomro|first1=GM|title=Obsessive compulsive disorder.|journal=BMJ Clinical Evidence|date=18 January 2012|volume=2012|pmid=22305974|pmc=3285220}}</ref> The compulsive rituals are personal rules followed to relieve the feeling of discomfort.<ref name="Soomro-2012" /> OCD affects roughly 1–⁠2% of adults (somewhat more women than men), and under 3% of children and adolescents.<ref name="NICE-2006" /><ref name="Soomro-2012" />

A person with OCD knows that the symptoms are unreasonable and struggles against both the thoughts and the behavior.<ref name="NICE-2006" /><ref name="IQWiG-2014">{{cite web|last1=Institute for Quality and Efficiency in Health Care (IQWiG)|title=Obsessive-compulsive disorder: overview|url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072746/|website=PubMed Health|publisher=Institute for Quality and Efficiency in Health Care (IQWiG)|access-date=21 November 2015}}</ref> Their symptoms could be related to external events they fear (such as their home burning down because they forget to turn off the stove) or worry that they will behave inappropriately.<ref name="IQWiG-2014" />

It is not certain why some people have OCD, but behavioral, cognitive, genetic, and neurobiological factors may be involved.<ref name="Soomro-2012" /> Risk factors include family history, being single (although that may result from the disorder), and higher socioeconomic class or not being in paid employment.<ref name="Soomro-2012" /> Of those with OCD about 20% of people will overcome it, and symptoms will at least reduce over time for most people (a further 50%).<ref name="NICE-2006" />

===Selective mutism===
{{Main|Medicine:Selective mutism}}
Selective mutism (SM) is a disorder in which a person who is normally capable of speech does not speak in specific situations or to specific people. Selective mutism usually co-exists with [[Social:Shyness|shyness]] or [[Medicine:Social anxiety|social anxiety]].<ref>{{Cite journal | last1 = Viana | first1 = A. G. | last2 = Beidel | first2 = D. C. | last3 = Rabian | first3 = B. | doi = 10.1016/j.cpr.2008.09.009 | title = Selective mutism: A review and integration of the last 15 years | journal = Clinical Psychology Review | volume = 29 | issue = 1 | pages = 57–67 | year = 2009 | pmid = 18986742 }}</ref> People with selective mutism stay silent even when the consequences of their silence include shame, social ostracism or even punishment.<ref>[https://www.nytimes.com/2005/04/12/health/psychology/12mute.html "The Child Who Would Not Speak a Word"] {{webarchive|url=https://web.archive.org/web/20150403040319/http://www.nytimes.com/2005/04/12/health/psychology/12mute.html |date=3 April 2015 }}</ref> Selective mutism affects about 0.8% of people at some point in their life.<ref name="Lancet2016">{{cite journal|last1=Craske|first1=MG|last2=Stein|first2=MB|date=24 June 2016|title=Anxiety.|journal=Lancet|volume=388|issue=10063|pages=3048–3059|doi=10.1016/S0140-6736(16)30381-6|pmid=27349358|s2cid=208789585}}</ref>

Testing for selective mutism is important because doctors must determine if it is an issue associated with the child's hearing, movements associated with the jaw or tongue, and if the child can understand when others are speaking to them.<ref>{{Cite web|title=Selective Mutism|url=https://www.asha.org/public/speech/disorders/selective-mutism/|access-date=2020-11-16|website=American Speech-Language-Hearing Association}}</ref>

==Diagnosis==
The diagnosis of anxiety disorders is made by symptoms, triggers, and a person's personal and family histories.  There are no objective [[Medicine:Biomarker|biomarkers]] or laboratory tests that can diagnose anxiety.<ref name="RoseDevine2014table1">{{cite journal| vauthors=Rose M, Devine J| title=Assessment of patient-reported symptoms of anxiety | journal=Dialogues Clin Neurosci | year= 2014 | volume= 16 | issue= 2 | pages= 197–211 (Table 1) | doi=10.31887/DCNS.2014.16.2/mrose | pmid=25152658 | pmc=4140513 |type= Review }}{{open access}}</ref>  It is important for a medical professional to evaluate a person for other medical and mental causes for prolonged anxiety because treatments will vary considerably.<ref name="DSM5" />

Numerous questionnaires have been developed for clinical use and can be used for an objective scoring system. Symptoms may be vary between each subtype of generalized anxiety disorder.  Generally, symptoms must be present for at least six months, occur more days than not, and significantly impair a person's ability to function in daily life.  Symptoms may include: feeling nervous, anxious, or on edge; worrying excessively; difficulty concentrating; restlessness; irritability.<ref name="DSM5" /><ref name="Lancet2016" />

Questionnaires developed for clinical use include the State-Trait Anxiety Inventory (STAI), the [[Social:Generalized Anxiety Disorder 7|Generalized Anxiety Disorder 7]] (GAD-7), the [[Medicine:Beck Anxiety Inventory|Beck Anxiety Inventory]] (BAI), the [[Social:Zung Self-Rating Anxiety Scale|Zung Self-Rating Anxiety Scale]], and the [[Social:Taylor Manifest Anxiety Scale|Taylor Manifest Anxiety Scale]].<ref name=RoseDevine2014table1/> Other questionnaires combine anxiety and depression measurement, such as the Hamilton Anxiety Rating Scale, the [[Medicine:Hospital Anxiety and Depression Scale|Hospital Anxiety and Depression Scale]] (HADS), the [[Medicine:Patient Health Questionnaire|Patient Health Questionnaire]] (PHQ), and the [[Medicine:Patient-Reported Outcomes Measurement Information System|Patient-Reported Outcomes Measurement Information System]] (PROMIS).<ref name=RoseDevine2014table1 /> Examples of specific anxiety questionnaires include the Liebowitz Social Anxiety Scale (LSAS), the [[Medicine:Social Interaction Anxiety Scale|Social Interaction Anxiety Scale]] (SIAS), the [[Social:Social Phobia Inventory|Social Phobia Inventory]] (SPIN), the Social Phobia Scale (SPS), and the Social Anxiety Questionnaire (SAQ-A30).<ref name=RoseDevine2014table2>{{cite journal| vauthors=Rose M, Devine J| title=Assessment of patient-reported symptoms of anxiety | journal=Dialogues Clin Neurosci | year= 2014 | volume= 16 | issue= 2 | pages= 197–211 (Table 2) | doi=10.31887/DCNS.2014.16.2/mrose | pmid=25152658 | pmc=4140513 |type= Review }}{{open access}}</ref>

===Differential diagnosis===
Anxiety disorders differ from developmentally normal [[Philosophy:Fear|fear]] or [[Medicine:Anxiety|anxiety]] by being excessive or persisting beyond developmentally appropriate periods. They differ from transient fear or anxiety, often stress-induced, by being persistent (e.g., typically lasting 6 months or more), although the criterion for duration is intended as a general guide with allowance for some degree of flexibility and is sometimes of shorter duration in children.<ref name= DSM5/>

The diagnosis of an anxiety disorder requires first ruling out an underlying medical cause.<ref name="Test2013partIII">{{cite journal|vauthors=Testa A, Giannuzzi R, Daini S, Bernardini L, Petrongolo L, Gentiloni Silveri N|year=2013|title=Psychiatric emergencies (part III): psychiatric symptoms resulting from organic diseases|url=http://www.europeanreview.org/wp/wp-content/uploads/86-99.pdf|url-status=live|journal=Eur Rev Med Pharmacol Sci|type=Review|volume=17 Suppl 1|pages=86–99|pmid=23436670|archive-url=https://web.archive.org/web/20160310035445/http://www.europeanreview.org/wp/wp-content/uploads/86-99.pdf|archive-date=10 March 2016}}{{open access}}</ref><ref name=WHO2009 /> Diseases that may present similar to an anxiety disorder, including certain endocrine diseases ([[Medicine:Hypothyroidism|hypo-]] and [[Medicine:Hyperthyroidism|hyperthyroidism]], hyperprolactinemia),<ref name=Lancet2016 /><ref name="Test2013partIII" /><ref name=WHO2009 /><ref name=Samuels2008>{{cite journal| author=Samuels MH| title=Cognitive function in untreated hypothyroidism and hyperthyroidism | journal=Curr Opin Endocrinol Diabetes Obes | year= 2008 | volume= 15 | issue= 5 | pages= 429–33 | pmid=18769215 | doi=10.1097/MED.0b013e32830eb84c | s2cid=27235034 | type= Review }}</ref> metabolic disorders ([[Medicine:Diabetes mellitus|diabetes]]),<ref name="Test2013partIII" /><ref name=GrigsbyAnderson2002>{{cite journal|vauthors=Grigsby AB, Anderson RJ, Freedland KE, Clouse RE, Lustman PJ | title=Prevalence of anxiety in adults with diabetes: a systematic review | journal=J Psychosom Res | year= 2002 | volume= 53 | issue= 6 | pages= 1053–60 | pmid=12479986 | type= Systematic Review | doi=10.1016/S0022-3999(02)00417-8 }}</ref> deficiency states (low levels of [[Chemistry:Vitamin D|vitamin D]], [[Biology:Riboflavin|B2]], [[Biology:Vitamin B12|B12]], folic acid),<ref name="Test2013partIII" /> gastrointestinal diseases (celiac disease, non-celiac gluten sensitivity, [[Medicine:Inflammatory bowel disease|inflammatory bowel disease]]),<ref name=ZingoneSwift2015>{{cite journal|vauthors=Zingone F, Swift GL, Card TR, Sanders DS, Ludvigsson JF, Bai JC|title=Psychological morbidity of celiac disease: A review of the literature|journal=United European Gastroenterol J|volume=3|issue=2|pages=136–45|date=Apr 2015|pmid=25922673|pmc=4406898|doi=10.1177/2050640614560786|type=Review}}</ref><ref name=MolinaInfanteSantolaria2015SystematicReview>{{cite journal|vauthors=Molina-Infante J, Santolaria S, Sanders DS, Fernández-Bañares F|title=Systematic review: noncoeliac gluten sensitivity| journal=Aliment Pharmacol Ther|volume=41|issue=9|pages=807–20|date=May 2015|pmid=25753138|doi=10.1111/apt.13155|s2cid=207050854|type=Systematic Review|doi-access=free}}</ref><ref name=NeuendorfHarding2016>{{cite journal| vauthors=Neuendorf R, Harding A, Stello N, Hanes D, Wahbeh H| title=Depression and anxiety in patients with Inflammatory Bowel Disease: A systematic review | journal=J Psychosom Res | year= 2016 | volume= 87 | pages= 70–80 | pmid=27411754 | doi=10.1016/j.jpsychores.2016.06.001 | type= Systematic Review }}</ref> heart diseases,<ref name=Lancet2016 /><ref name="Test2013partIII" /> blood diseases ([[Medicine:Anemia|anemia]]),<ref name="Test2013partIII" /> and brain degenerative diseases ([[Medicine:Parkinson's disease|Parkinson's disease]], [[Medicine:Dementia|dementia]], multiple sclerosis, [[Medicine:Huntington's disease|Huntington's disease]]).<ref name="Test2013partIII" /><ref name=ZhaoTan2016>{{cite journal| vauthors=Zhao QF, Tan L, Wang HF, Jiang T, Tan MS, Tan L ''et al.''| title=The prevalence of neuropsychiatric symptoms in Alzheimer's disease: Systematic review and meta-analysis | journal=J Affect Disord | year= 2016 | volume= 190 | pages= 264–71 | pmid=26540080 | type= Systematic Review | doi=10.1016/j.jad.2015.09.069}}</ref><ref name=WenChan2016>{{cite journal| vauthors=Wen MC, Chan LL, Tan LC, Tan EK| title=Depression, anxiety, and apathy in Parkinson's disease: insights from neuroimaging studies | journal=Eur J Neurol | year= 2016 | volume= 23 | issue= 6 | pages= 1001–19 | pmid=27141858 | doi=10.1111/ene.13002 | pmc=5084819 | type= Review }}</ref><ref name=MarrieReingold2015>{{cite journal| vauthors=Marrie RA, Reingold S, Cohen J, Stuve O, Trojano M, Sorensen PS ''et al.''| title=The incidence and prevalence of psychiatric disorders in multiple sclerosis: a systematic review | journal=Mult Scler | year= 2015 | volume= 21 | issue= 3 | pages= 305–17 | pmid=25583845 | doi=10.1177/1352458514564487 | pmc=4429164 | type= Systematic Review }}</ref>

Also, several drugs can cause or worsen anxiety, whether in intoxication, withdrawal, or from chronic use. These include alcohol, tobacco, cannabis, [[Chemistry:Sedative|sedative]]s (including prescription benzodiazepines), [[Chemistry:Opioid|opioid]]s (including prescription pain killers and illicit drugs like heroin), [[Chemistry:Stimulant|stimulant]]s (such as caffeine, cocaine and amphetamines), [[Unsolved:Hallucinogen|hallucinogen]]s, and inhalants.<ref name=Lancet2016/><ref name=":0">{{Cite book|title = Diagnostic and statistical manual of mental disorders, fifth edition.|last = American Psychiatric Association|publisher = American Psychiatric Association|year = 2013|isbn = 978-0890425558|location = Arlington, VA|url-access = registration|url = https://archive.org/details/diagnosticstatis0005unse}}</ref>

==Prevention==
Focus is increasing on prevention of anxiety disorders.<ref name=Bien2007>{{cite journal|last=Bienvenu|first=OJ|author2=Ginsburg, GS|title=Prevention of anxiety disorders|journal=International Review of Psychiatry (Abingdon, England)|date=December 2007|volume=19|issue=6|pages=647–54|pmid=18092242|doi=10.1080/09540260701797837|s2cid=95140}}</ref> There is tentative evidence to support the use of [[Medicine:Cognitive behavioral therapy|cognitive behavioral therapy]]<ref name=Bien2007/> and [[Philosophy:Mindfulness|mindfulness]] therapy.<ref name= Khoury>{{cite journal |vauthors=Khoury B, Lecomte T, Fortin G |title= Mindfulness-based therapy: a comprehensive meta-analysis |journal= Clin Psychol Rev |volume=33 |issue=6 |pages=763–71 |date=Aug 2013|display-authors=0|pmid= 23796855 |doi= 10.1016/j.cpr.2013.05.005 }}</ref><ref name=Sharma>{{cite journal |vauthors=Sharma M, Rush SE |title= Mindfulness-based stress reduction as a stress management intervention for healthy individuals: a systematic review |journal= J Evid Based Complementary Altern Med |volume=19 |issue=4 |pages=271–86 |date=Jul 2014 | doi=10.1177/2156587214543143 |pmid=25053754|doi-access=free }}</ref> A 2013 review found no effective measures to prevent GAD in adults.<ref>{{cite journal|last1=Patel|first1=G|last2=Fancher|first2=TL|title=In the clinic. Generalized anxiety disorder.|journal=Annals of Internal Medicine|date=3 December 2013|volume=159|issue=11|pages=ITC6–1, ITC6–2, ITC6–3, ITC6–4, ITC6–5, ITC6–6, ITC6–7, ITC6–8, ITC6–9, ITC6–10, ITC6–11; quiz ITC6–12|pmid=24297210|url=http://cwrumedicine.org/images/current_residents/gad.pdf|quote=currently there is no evidence on the effectiveness of preventive measures for GAD in adult|doi=10.7326/0003-4819-159-11-201312030-01006|s2cid=42889106|url-status=live|archive-url=https://web.archive.org/web/20150104200159/http://cwrumedicine.org/images/current_residents/gad.pdf|archive-date=4 January 2015}}</ref> A 2017 review found that psychological and educational interventions had a small benefit for the prevention of anxiety.<ref>{{cite journal |last1=Moreno-Peral |first1=P |last2=Conejo-Cerón |first2=S |last3=Rubio-Valera |first3=M |last4=Fernández |first4=A |last5=Navas-Campaña |first5=D |last6=Rodríguez-Morejón |first6=A |last7=Motrico |first7=E |last8=Rigabert |first8=A |last9=Luna |first9=JD |last10=Martín-Pérez |first10=C |last11=Rodríguez-Bayón |first11=A |last12=Ballesta-Rodríguez |first12=MI |last13=Luciano |first13=JV |last14=Bellón |first14=JÁ |title=Effectiveness of Psychological and/or Educational Interventions in the Prevention of Anxiety: A Systematic Review, Meta-analysis, and Meta-regression. |journal=JAMA Psychiatry |date=1 October 2017 |volume=74 |issue=10 |pages=1021–1029 |doi=10.1001/jamapsychiatry.2017.2509 |pmid=28877316|pmc=5710546 }}</ref><ref>{{cite book |last1=Schmidt |first1=Norman B. |last2=Allan |first2=Nicholas P. |last3=Knapp |first3=Ashley A. |last4=Capron |first4=Dan |title=The Clinician's Guide to Anxiety Sensitivity Treatment and Assessment |date=2019 |publisher=Academic Press |isbn=978-0-12-813495-5 |pages=145–178 |chapter-url=https://www.sciencedirect.com/science/article/pii/B9780128134955000085 |chapter=8 - Targeting anxiety sensitivity as a prevention strategy}}</ref>

==Treatment==
Treatment options include lifestyle changes, [[Medicine:Psychotherapy|therapy]], and medications. There is no clear evidence as to whether therapy or medication is most effective; the specific medication decision can be made by a doctor and patient with consideration to the patient's specific circumstances and symptoms.<ref name=NEJM2015>{{cite journal|last1=Stein|first1=MB|last2=Sareen|first2=J|title=Clinical Practice: Generalized Anxiety Disorder.|journal=The New England Journal of Medicine|date=19 November 2015|volume=373|issue=21|pages=2059–68|pmid=26580998|doi=10.1056/nejmcp1502514}}</ref> If while on treatment with a chosen medication, the person does not improve with his or her anxiety, another medication may be offered.<ref name=NEJM2015/> Specific treatments will vary by subtype of anxiety disorder, a person's other medical conditions, and medications.

===Lifestyle and diet===
Lifestyle changes include exercise, for which there is moderate evidence for some improvement, regularizing sleep patterns, reducing caffeine intake, and stopping smoking.<ref name=NEJM2015/> Stopping smoking has benefits in anxiety as large as or larger than those of medications.<ref>{{cite journal|last=Taylor|first=G.|author2=McNeill, A.|author3= Girling, A.|author4= Farley, A.|author5= Lindson-Hawley, N.|author6= Aveyard, P.|title=Change in mental health after smoking cessation: systematic review and meta-analysis|journal=BMJ|date=13 February 2014|volume=348|issue=feb13 1|pages=g1151|doi=10.1136/bmj.g1151|pmid=24524926|pmc=3923980}}</ref> Omega-3 polyunsaturated fatty acids, such as fish oil, may reduce anxiety, particularly in those with more significant symptoms.<ref name="SuTseng2018">{{cite journal|last1=Su|first1=Kuan-Pin|last2=Tseng|first2=Ping-Tao|last3=Lin|first3=Pao-Yen|last4=Okubo|first4=Ryo|last5=Chen|first5=Tien-Yu|last6=Chen|first6=Yen-Wen|last7=Matsuoka|first7=Yutaka J.|title=Association of Use of Omega-3 Polyunsaturated Fatty Acids With Changes in Severity of Anxiety Symptoms|journal=JAMA Network Open|volume=1|issue=5|year=2018|pages=e182327|issn=2574-3805|doi=10.1001/jamanetworkopen.2018.2327|pmid=30646157|pmc=6324500}}</ref>

===Psychotherapy===
[[Medicine:Cognitive behavioral therapy|Cognitive behavioral therapy]] (CBT) is effective for anxiety disorders and is a first line treatment.<ref name=NEJM2015/><ref>{{cite journal|last=Cuijpers|first=P|author2=Sijbrandij, M|author3= Koole, S|author4= Huibers, M|author5= Berking, M|author6= Andersson, G|title=Psychological treatment of generalized anxiety disorder: A meta-analysis.|journal=Clinical Psychology Review|date=Mar 2014|volume=34|issue=2|pages=130–140|pmid=24487344|doi=10.1016/j.cpr.2014.01.002}}</ref><ref>{{cite journal|last=Otte|first=C|title=Cognitive behavioral therapy in anxiety disorders: current state of the evidence.|journal=Dialogues in Clinical Neuroscience|year=2011|volume=13|issue=4|pages=413–21|doi=10.31887/DCNS.2011.13.4/cotte|pmid=22275847|pmc=3263389}}</ref><ref>{{cite journal|last1=Pompoli|first1=A|last2=Furukawa|first2=TA|last3=Imai|first3=H|last4=Tajika|first4=A|last5=Efthimiou|first5=O|last6=Salanti|first6=G|title=Psychological therapies for panic disorder with or without agoraphobia in adults: a network meta-analysis.|journal=The Cochrane Database of Systematic Reviews|date=13 April 2016|volume=4|pages=CD011004|pmid=27071857|doi=10.1002/14651858.CD011004.pub2|pmc=7104662|url=https://boris.unibe.ch/81165/1/Pompoli%20CochraneDatabaseSystRev%202016.pdf}}</ref><ref name=Ol2016>{{cite journal|last1=Olthuis|first1=JV|last2=Watt|first2=MC|last3=Bailey|first3=K|last4=Hayden|first4=JA|last5=Stewart|first5=SH|title=Therapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults.|journal=The Cochrane Database of Systematic Reviews|date=12 March 2016|volume=2016|issue=3|pages=CD011565|doi=10.1002/14651858.cd011565.pub2|pmid=26968204|pmc=7077612}}</ref> CBT appears to be equally effective when carried out via the internet compared to sessions completed face to face.<ref name=Ol2016/><ref>{{Cite journal|title=Media-delivered Cognitive Behavioural Therapy and Behavioural Therapy (Self-Help) for Anxiety Disorders in Adults|last1=E|first1=Mayo-Wilson|last2=P|first2=Montgomery|journal=The Cochrane Database of Systematic Reviews|date=2013-09-09|issue=9|pages=CD005330|doi=10.1002/14651858.CD005330.pub4|language=en|pmid=24018460}}</ref>

[[Philosophy:Mindfulness|Mindfulness]] based programs also appear to be effective for managing anxiety disorders.<ref name=Roemer>{{cite journal |vauthors=Roemer L, Williston SK, Eustis EH |title= Mindfulness and acceptance-based behavioral therapies for anxiety disorders |journal= Curr Psychiatry Rep |volume=15 |issue=11 |pages=410 |date=Nov 2013 | doi=10.1007/s11920-013-0410-3|pmid= 24078067 |s2cid= 23278447 }}</ref><ref name=Lang>{{cite journal |author= Lang AJ |title= What mindfulness brings to psychotherapy for anxiety and depression |journal= Depress Anxiety |volume=30 |issue=5 |pages=409–12 |date=May 2013 | doi=10.1002/da.22081|pmid= 23423991 |s2cid= 25705284 |doi-access=free }}</ref> It is unclear if meditation has an effect on anxiety and transcendental meditation appears to be no different than other types of meditation.<ref>{{cite journal|last1=Krisanaprakornkit|first1=T|last2=Krisanaprakornkit|first2=W|last3=Piyavhatkul|first3=N|last4=Laopaiboon|first4=M|title=Meditation therapy for anxiety disorders.|journal=The Cochrane Database of Systematic Reviews|date=25 January 2006|issue=1|pages=CD004998|pmid=16437509|doi=10.1002/14651858.CD004998.pub2}}</ref>

A 2015 Cochrane review of [[Medicine:Morita therapy|Morita therapy]] for anxiety disorder in adults found not enough evidence to draw a conclusion.<ref>{{cite journal |last1=Wu |first1=Hui |last2=Yu |first2=Dehua |last3=He |first3=Yanling |last4=Wang |first4=Jijun |last5=Xiao |first5=Zeping |last6=Li |first6=Chunbo |title=Morita therapy for anxiety disorders in adults |journal=Cochrane Database of Systematic Reviews |issue=2 |pages=CD008619 |date=19 February 2015 |doi=10.1002/14651858.CD008619.pub2|pmid=25695214 }}</ref>

===Medications===
First line choices for medications include [[Chemistry:Selective serotonin reuptake inhibitor|SSRIs]] or [[Chemistry:Serotonin–norepinephrine reuptake inhibitor|SNRIs]] to treat generalized anxiety disorder.<ref name=NEJM2015/><ref name=Bald2005/> There is no good evidence supporting which specific medication in the SSRI or SNRI is best for treating anxiety, so cost often drives drug choice.<ref name=NEJM2015/><ref name=Bald2005>{{Cite journal|last1=Baldwin|first1=David S|last2=Anderson|first2=Ian M|last3=Nutt|first3=David J|last4=Allgulander|first4=Christer|last5=Bandelow|first5=Borwin|last6=Boer|first6=Johan A den|last7=Christmas|first7=David M|last8=Davies|first8=Simon|last9=Fineberg|first9=Naomi|date=2014-04-08|title=Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: A revision of the 2005 guidelines from the British Association for Psychopharmacology|journal=Journal of Psychopharmacology|language=en|volume=28|issue=5|pages=403–439|doi=10.1177/0269881114525674|pmid=24713617|s2cid=28893331|url=https://eprints.soton.ac.uk/367917/1/AnxietyGuidelines2014%255B1%255D.pdf}}</ref> If they are effective, it is recommended that they are continued for at least a year.<ref>{{cite journal|last1=Batelaan|first1=Neeltje M|last2=Bosman|first2=Renske C|last3=Muntingh|first3=Anna|last4=Scholten|first4=Willemijn D|last5=Huijbregts|first5=Klaas M|last6=van Balkom|first6=Anton J L M|title=Risk of relapse after antidepressant discontinuation in anxiety disorders, obsessive-compulsive disorder, and post-traumatic stress disorder: systematic review and meta-analysis of relapse prevention trials|journal=BMJ|volume=358|date=13 September 2017|pages=j3927|doi=10.1136/bmj.j3927|pmid=28903922|pmc=5596392}}</ref> Stopping these medications results in a greater risk of relapse.<ref>{{cite journal|last1=Batelaan|first1=NM|last2=Bosman|first2=RC|last3=Muntingh|first3=A|last4=Scholten|first4=WD|last5=Huijbregts|first5=KM|last6=van Balkom|first6=AJLM|title=Risk of relapse after antidepressant discontinuation in anxiety disorders, obsessive-compulsive disorder, and post-traumatic stress disorder: systematic review and meta-analysis of relapse prevention trials.|journal=BMJ (Clinical Research Ed.)|date=13 September 2017|volume=358|pages=j3927|pmid=28903922|pmc=5596392|doi=10.1136/bmj.j3927}}</ref>

[[Chemistry:Buspirone|Buspirone]] and [[Chemistry:Pregabalin|pregabalin]] are second-line treatments for people who do not respond to SSRIs or SNRIs; there is also evidence that benzodiazepines including [[Chemistry:Diazepam|diazepam]] and [[Chemistry:Clonazepam|clonazepam]] are effective.<ref name=NEJM2015/>

Medications need to be used with care among older adults, who are more likely to have side effects because of coexisting physical disorders. Adherence problems are more likely among older people, who may have difficulty understanding, seeing, or remembering instructions.<ref name="Calleo" />

In general medications are not seen as helpful in specific phobia but a benzodiazepine is sometimes used to help resolve acute episodes; as 2007 data were sparse for efficacy of any drug.<ref>{{cite journal|last1=Choy|first1=Y|last2=Fyer|first2=AJ|last3=Lipsitz|first3=JD|title=Treatment of specific phobia in adults.|journal=Clinical Psychology Review|date=April 2007|volume=27|issue=3|pages=266–86|pmid=17112646|doi=10.1016/j.cpr.2006.10.002}}</ref>

===Alternative medicine===
Other remedies have been used or are under research for treating anxiety disorders. As of 2019, there is little evidence for [[Biology:Cannabis|cannabis]] in anxiety disorders.<ref>{{cite journal |last1=Black |first1=Nicola |last2=Stockings |first2=Emily |last3=Campbell |first3=Gabrielle |last4=Tran |first4=Lucy T |last5=Zagic |first5=Dino |last6=Hall |first6=Wayne D |last7=Farrell |first7=Michael |last8=Degenhardt |first8=Louisa |title=Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: a systematic review and meta-analysis |journal=The Lancet Psychiatry |volume=6 |issue=12 |pages=995–1010 |date=October 2019 |doi=10.1016/S2215-0366(19)30401-8|pmid=31672337 |pmc=6949116 }}</ref> [[Biology:Kava|Kava]] is under preliminary research for its potential in short-term use by people with mild to moderate anxiety.<ref>{{Cite journal|vauthors=Pittler MH, Ernst E |title=Kava extract for treating anxiety |journal=Cochrane Database of Systematic Reviews |issue=1 |pages=CD003383 |year=2003 |pmid=12535473 |doi=10.1002/14651858.CD003383|editor1-last=Pittler|editor1-first=Max H|pmc=6999799 }}</ref><ref>{{Cite journal|vauthors=Witte S, Loew D, Gaus W |title=Meta-analysis of the efficacy of the acetonic kava-kava extract WS1490 in patients with non-psychotic anxiety disorders |journal=Phytother Res |volume=19 |issue=3 |pages=183–188 |date=March 2005 |pmid=15934028 |doi=10.1002/ptr.1609|s2cid=39260703 }}</ref> The American Academy of Family Physicians recommends use of kava for mild to moderate anxiety disorders in people not using alcohol or taking other medicines metabolized by the liver, while preferring remedies thought to be natural.<ref name=AFP2007/> [[Chemistry:Inositol|Inositol]] has been found to have modest effects in people with panic disorder or obsessive-compulsive disorder.<ref name=AFP2007>{{cite journal|last=Saeed|first=SA|author2=Bloch, RM|author3= Antonacci, DJ|title=Herbal and dietary supplements for treatment of anxiety disorders|journal=American Family Physician|date=15 August 2007|volume=76|issue=4|pages=549–56|pmid=17853630}}</ref> There is insufficient evidence to support the use of St. John's wort, [[Biology:Valerian (herb)|valerian]] or passionflower.<ref name=AFP2007/>

[https://isnr.org/what-is-neurofeedback Neurofeedback training (NFT)] training is another form of alternative medicine, where practitioners use monitoring devices to see moment to moment information in relation to the nervous system and the brain. Sensors are placed along the scalp, and the brain responses are recorded and amplified in association with specific brain activity. The practitioners then discuss the responses associated with the client, in an attempt to determine different principles of learning, and practitioner guidance to create changes in brain patterns.<ref>{{Cite web|date=2019-06-08|title=What Is NeuroregulationTraining?|url=https://isnr.org/what-is-neurofeedback|access-date=2020-11-16|website=ISNR|language=en-US}}</ref>

===Children===
Both therapy and a number of medications have been found to be useful for treating childhood anxiety disorders.<ref name=Wang2017>{{cite journal|last1=Wang|first1=Zhen|last2=Whiteside|first2=Stephen P. H.|last3=Sim|first3=Leslie|last4=Farah|first4=Wigdan|last5=Morrow|first5=Allison S.|last6=Alsawas|first6=Mouaz|last7=Barrionuevo|first7=Patricia|last8=Tello|first8=Mouaffaa|last9=Asi|first9=Noor|last10=Beuschel|first10=Bradley|last11=Daraz|first11=Lubna|last12=Almasri|first12=Jehad|last13=Zaiem|first13=Feras|last14=Larrea-Mantilla|first14=Laura|last15=Ponce|first15=Oscar J.|last16=LeBlanc|first16=Annie|last17=Prokop|first17=Larry J.|last18=Murad|first18=Mohammad Hassan|title=Comparative Effectiveness and Safety of Cognitive Behavioral Therapy and Pharmacotherapy for Childhood Anxiety Disorders|journal=JAMA Pediatrics|volume=171|issue=11|pages=1049–1056|date=31 August 2017|doi=10.1001/jamapediatrics.2017.3036|pmid=28859190|pmc=5710373}}</ref> Therapy is generally preferred to medication.<ref name="Higa-McMillan"/>

[[Medicine:Cognitive behavioral therapy|Cognitive behavioral therapy]] (CBT) is a good first therapy approach.<ref name="Higa-McMillan">{{cite journal|last1=Higa-McMillan|first1=CK|last2=Francis|first2=SE|last3=Rith-Najarian|first3=L|last4=Chorpita|first4=BF|title=Evidence Base Update: 50 Years of Research on Treatment for Child and Adolescent Anxiety.|journal=Journal of Clinical Child and Adolescent Psychology|volume=45|issue=2|date=18 June 2015|pages=91–113|pmid=26087438|doi=10.1080/15374416.2015.1046177|doi-access=free}}</ref> Studies have gathered substantial evidence for treatments that are not CBT based as being effective forms of treatment, expanding treatment options for those who do not respond to CBT.<ref name="Higa-McMillan" /> Although studies have demonstrated the effectiveness of CBT for anxiety disorders in children and adolescents, evidence that it is more effective than [[Standard treatment|treatment as usual]], medication, or [[Wait list control group|wait list controls]] is inconclusive.<ref>{{Cite journal|last1=James|first1=Anthony C.|last2=James|first2=Georgina|last3=Cowdrey|first3=Felicity A.|last4=Soler|first4=Angela|last5=Choke|first5=Aislinn|date=2015-02-18|title=Cognitive behavioural therapy for anxiety disorders in children and adolescents|journal=The Cochrane Database of Systematic Reviews|issue=2|pages=CD004690|doi=10.1002/14651858.CD004690.pub4|issn=1469-493X|pmc=6491167|pmid=25692403}}</ref> Like adults, children may undergo psychotherapy, cognitive-behavioral therapy, or counseling. [[Family therapy]] is a form of treatment in which the child meets with a therapist together with the primary guardians and siblings.<ref name=CRD2017/> Each family member may attend individual therapy, but family therapy is typically a form of group therapy. Art and play therapy are also used. [[Medicine:Art therapy|Art therapy]] is most commonly used when the child will not or cannot verbally communicate, due to trauma or a disability in which they are nonverbal. Participating in art activities allows the child to express what they otherwise may not be able to communicate to others.<ref>{{cite journal |author1=Kozlowska K. |author2=Hanney L. | year = 1999 | title = Family assessment and intervention using an interactive are exercise | journal = Australian and New Zealand Journal of Family Therapy | volume = 20 | issue = 2| pages = 61–69 | doi=10.1002/j.1467-8438.1999.tb00358.x}}</ref> In play therapy, the child is allowed to play however they please as a therapist observes them. The therapist may intercede from time to time with a question, comment, or suggestion. This is often most effective when the family of the child plays a role in the treatment.<ref name=CRD2017>{{Cite journal|last1=Creswell|first1=Cathy|last2=Cruddace|first2=Susan|last3=Gerry|first3=Stephen|last4=Gitau|first4=Rachel|last5=McIntosh|first5=Emma|last6=Mollison|first6=Jill|last7=Murray|first7=Lynne|author7-link=Lynne Murray|last8=Shafran|first8=Rosamund|last9=Stein|first9=Alan|title=Treatment of childhood anxiety disorder in the context of maternal anxiety disorder: a randomised controlled trial and economic analysis|journal=Health Technology Assessment|language=EN|volume=19|issue=38|pages=1–184|doi=10.3310/hta19380|pmc=4781330|pmid=26004142|date=2015-05-25}}</ref><ref>Bratton, S.C., & Ray, D. (2002). Humanistic play therapy. In D.J. Cain (Ed.), ''Humanistic psychotherapies: Handbook of research and practice'' (pp. 369-402). Washington, DC: American Psychological Association.</ref>

If a medication option is warranted, antidepressants such as SSRIs and SNRIs can be effective.<ref name=Wang2017/> Minor side effects with medications, however, are common.<ref name=Wang2017/>

==Epidemiology==
Globally as of 2010 approximately 273&nbsp;million (4.5% of the population) had an anxiety disorder.<ref name=LancetEpi2012>{{cite journal|last1=Vos|first1=T|title=Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010|journal=Lancet|date=15 December 2012|volume=380|issue=9859|pages=2163–96|pmid=23245607|pmc=6350784|doi=10.1016/S0140-6736(12)61729-2|last2=Flaxman|first2=AD|last3=Naghavi|first3=M|last4=Lozano|first4=R|last5=Michaud|first5=C|last6=Ezzati|first6=M|last7=Shibuya|first7=K|last8=Salomon|first8=JA|last9=Abdalla|first9=S|display-authors=0}}</ref> It is more common in females (5.2%) than males (2.8%).<ref name=LancetEpi2012/>

In Europe, Africa and Asia, lifetime rates of anxiety disorders are between 9 and 16%, and yearly rates are between 4 and 7%.<ref name=Helen2010/> In the United States, the lifetime prevalence of anxiety disorders is about 29%<ref>{{Cite journal|vauthors=Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE |title=Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication |journal=Arch. Gen. Psychiatry |volume=62|issue=6 |pages=593–602 |date=June 2005 |pmid=15939837 |doi=10.1001/archpsyc.62.6.593 |doi-access=free }}</ref> and between 11 and 18% of adults have the condition in a given year.<ref name=Helen2010>{{cite book|editor-first=Helen Blair|editor-last=Simpson|title=Anxiety disorders : theory, research, and clinical perspectives|year=2010|publisher=Cambridge University Press|location=Cambridge, UK|isbn=978-0-521-51557-3|page=7|url=https://books.google.com/books?id=s_z03KmH8QoC&pg=PA7|edition=1. publ.|url-status=live|archive-url=https://web.archive.org/web/20160506171238/https://books.google.com/books?id=s_z03KmH8QoC&pg=PA7|archive-date=6 May 2016}}</ref> This difference is affected by the range of ways in which different cultures interpret anxiety symptoms and what they consider to be normative behavior.<ref>{{cite book|last1=Brockveld|first1=Kelia C.|last2=Perini|first2=Sarah J.|last3=Rapee|first3=Ronald M.|year=2014|chapter=6|doi=10.1016/B978-0-12-394427-6.00006-6|editor1-last=Hofmann|editor1-first=Stefan G.|editor2-last=DiBartolo|editor2-first=Patricia M.|title=Social Anxiety: Clinical, Developmental, and Social Perspectives|edition=3|publisher=Elsevier|isbn=978-0-12-394427-6}}</ref><ref name=Hofmann2010>{{cite journal|last1=Hofmann|first1=Stefan G.|last2=Asnaani|first2=Anu|date=December 2010|title=Cultural Aspects in Social Anxiety and Social Anxiety Disorder|journal=Depress Anxiety|volume=27|issue=12|doi=10.1002/da.20759|pmid=21132847|pmc=3075954|pages=1117–1127}}</ref> In general, anxiety disorders represent the most prevalent psychiatric condition in the United States, outside of [[Medicine:Substance use disorder|substance use disorder]].<ref name="nejm 2014 on generalized anxiety">{{cite journal|last1=Fricchione|first1=Gregory|title=Generalized Anxiety Disorder|journal=New England Journal of Medicine|date=12 August 2004|volume=351|issue=7|pages=675–682|doi=10.1056/NEJMcp022342|pmid=15306669}}</ref>

Like adults, children can experience anxiety disorders; between 10 and 20 percent of all children will develop a full-fledged anxiety disorder prior to the age of 18,<ref>{{cite book|last1=Essau|first1=Cecilia A.|title=Child and Adolescent Psychopathology: Theoretical and Clinical Implications|date=2006|publisher=Routledge|location=27 church road, Hove, East Sussex|page=79}}</ref> making anxiety the most common mental health issue in young people. Anxiety disorders in children are often more challenging to identify than their adult counterparts owing to the difficulty many parents face in discerning them from normal childhood fears. Likewise, anxiety in children is sometimes misdiagnosed as an attention deficit disorder or, due to the tendency of children to interpret their emotions physically (as stomach aches, head aches, etc.), anxiety disorders may initially be confused with physical ailments.<ref name="GENERALIZED ANXIETY">{{cite web|last1=AnxietyBC|title=GENERALIZED ANXIETY|url=http://www.anxietybc.com/parent/generalized.php|website=AnxietyBC|publisher=AnxietyBC|access-date=11 June 2015|url-status=dead|archive-url=https://web.archive.org/web/20150612075631/http://www.anxietybc.com/parent/generalized.php|archive-date=12 June 2015|date=2014-11-14}}</ref>

Anxiety in children has a variety of causes; sometimes anxiety is rooted in biology, and may be a product of another existing condition, such as [[Medicine:Autism|autism]] or Asperger's disorder.<ref>{{cite web|last1=Merrill|first1=Anna|title=Anxiety and Autism Spectrum Disorders|url=http://www.iidc.indiana.edu/?pageId=3616|website=Indiana Resource Center for Autism|publisher=Indiana Resource Center for Autism|access-date=10 June 2015|url-status=live|archive-url=https://web.archive.org/web/20150611094817/http://www.iidc.indiana.edu/?pageId=3616|archive-date=11 June 2015}}</ref> Gifted children are also often more prone to excessive anxiety than non-gifted children.<ref>{{cite journal|last1=Guignard|first1=Jacques-Henri|last2=Jacquet|first2=Anne-Yvonne|last3=Lubart|first3=Todd I.|title=Perfectionism and Anxiety: A Paradox in Intellectual Giftedness?|journal=PLOS ONE|pmc=3408483|pmid=22859964|doi=10.1371/journal.pone.0041043|volume=7|issue=7|pages=e41043|year=2012|bibcode=2012PLoSO...741043G|doi-access=free}}</ref> Other cases of anxiety arise from the child having experienced a traumatic event of some kind, and in some cases, the cause of the child's anxiety cannot be pinpointed.<ref>{{cite web|last1=Rapee |first1=Ronald M. |last2=Schniering |first2=Carolyn A. |last3=Hudson |first3=Jennifer L. |title=Anxiety Disorders During Childhood and Adolescence: Origins and Treatment |url=http://www2.sd45.bc.ca/schools/ridgeview/Parents/Education/Article/Anxiety%20Presentation/Anxiety%20Presentation%20-%20Rapee%202009%20review%20of%20child%20anxiety.pdf |publisher=Annual Review of Clinical Psychology |url-status=dead |archive-url=https://web.archive.org/web/20150611160953/http://www2.sd45.bc.ca/schools/ridgeview/Parents/Education/Article/Anxiety%20Presentation/Anxiety%20Presentation%20-%20Rapee%202009%20review%20of%20child%20anxiety.pdf |archive-date=11 June 2015 }}</ref>

Anxiety in children tends to manifest along age-appropriate themes, such as fear of going to school (not related to bullying) or not performing well enough at school, fear of social rejection, fear of something happening to loved ones, etc. What separates disordered anxiety from normal childhood anxiety is the duration and intensity of the fears involved.<ref name="GENERALIZED ANXIETY"/>

==See also==
* List of people with an anxiety disorder
* Exposure Therapy

==References==
{{Reflist}}

==External links==
{{Medical condition classification and resources
| DiseasesDB = 787
| ICD10 = {{ICD10|F|40||f|40}}-{{ICD10|F|42||f|40}}
| ICD9 = {{ICD9|300}}
| ICDO =
| OMIM =
| MedlinePlus =
| eMedicineSubj = med
| eMedicineTopic = 152
| MeshID = D001008
}}
* {{curlie|Health/Mental_Health/Disorders/Anxiety/Social_Anxiety/Support_Groups/ Support Group Providers for }}

{{Mental and behavioral disorders|selected = neurotic}}


[[Category:Abnormal psychology]]
[[Category:Anxiety disorders| ]]
[[Category:Psychiatric diagnosis]]
[[Category:Wikipedia medicine articles ready to translate]]

{{Sourceattribution|Anxiety disorder}}