Anxiety Disorders

Primer

Anxiety Disorders are a group of mental disorders characterized by significant feelings of anxiety and fear, including generalized anxiety disorders, specific phobias, panic disorder, and posttraumatic stress disorder. Anxiety is a worry about future events, and fear is a reaction to current events. These feelings may cause significant somatic symptoms as well.

Epidemiology
  • The lifetime prevalence rates of anxiety disorders is as high as 31%.[1]
Prognosis
  • Anxiety disorders can cause substantial functional impairment, quality of life issues, decreased work productivity, and a significant economic impact.[2]
Comorbidity
Risk Factors
  • A family history of anxiety disorders, personal history of stressful life events
  • Women have higher rates for most anxiety disorders compared to men.[3]

Average Age of Onset

The average age of onset varies greatly between anxiety disorders.[4]

Average Age of Onset

Adapted from: Lijster, J. M et al. (2017). The Age of Onset of Anxiety Disorders. Canadian journal of psychiatry. 62(4), 237–246.
Average age Range
Separation anxiety disorder 11 years 6 to 14
Specific phobia 11 years 8 to 14
Social anxiety disorder (social phobia) 14 years 13 to 15
Agoraphobia without panic disorder 21 years 17 to 25
Obsessive-compulsive disorder 24 years 19 to 29
Posttraumatic stress disorder 27 years 22 to 31
Panic disorder 30 years 26 to 35
Generalized anxiety disorder 35 years 31 to 39

Changes in anxiety disorder presentation across the lifespan. (Dialogues Clin Neurosci. 2011 Dec; 13(4): 381–399.) Fig. 1

Older Adults

  • Late onset anxiety disorders are relatively unusual. Thus, older patients with new onset anxiety symptoms should always have a thorough investigation for other etiologies including physical illness and medication side effects.[5]

Treatment

  • The treatment of most anxiety disorders can broadly be divided into pharmacological and psychological therapies.
    • Cognitive behavioural therapy is the primary treatment modality, with some modifications for specific disorders.
  • Regardless of whether one takes a medication, guidelines recommend that gradual exposure to fears should be done (i.e. - exposure to decreased avoidance behaviours).[6]

Resources

For Providers

References

1) Katzman, M. A., Bleau, P., Blier, P., Chokka, P., Kjernisted, K., & Van Ameringen, M. (2014). Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC psychiatry, 14(1), 1-83.
2) MacQueen, G. M., Frey, B. N., Ismail, Z., Jaworska, N., Steiner, M., Lieshout, R. J., Kennedy, S. H., Lam, R. W., Milev, R. V., Parikh, S. V., Ravindran, A. V., & CANMAT Depression Work Group (2016). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 6. Special Populations: Youth, Women, and the Elderly. Canadian journal of psychiatry, 61(9), 588–603.
3) Katzman, M. A., Bleau, P., Blier, P., Chokka, P., Kjernisted, K., & Van Ameringen, M. (2014). Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC psychiatry, 14(1), 1-83.
4) Lijster, J. M., Dierckx, B., Utens, E. M., Verhulst, F. C., Zieldorff, C., Dieleman, G. C., & Legerstee, J. S. (2017). The Age of Onset of Anxiety Disorders. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 62(4), 237–246.
5) Katzman, M. A., Bleau, P., Blier, P., Chokka, P., Kjernisted, K., & Van Ameringen, M. (2014). Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC psychiatry, 14(1), 1-83.
6) Katzman, M. A., Bleau, P., Blier, P., Chokka, P., Kjernisted, K., & Van Ameringen, M. (2014). Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC psychiatry, 14(1), 1-83.