Anxiety disorders include panic disorder (PD), generalized anxiety disorder (GAD), social anxiety disorder (SAD), and specific phobic disorders. Until the publication of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) were classified as anxiety disorders. Now, OCD and PTSD are separate from anxiety disorders; however, they will be discussed in this chapter for completion. Specific phobias will not be addressed in this chapter, because pharmacotherapy has a limited role in phobia treatment. For patients to be diagnosed with anxiety disorder, the symptoms must cause significant impairment in social or occupational functioning and cannot be related to a general medical condition or substance.
Panic disorder is characterized by recurrent unexpected panic attacks with associated anticipatory anxiety for at least 1 month. PD may be associated with agoraphobia, the fear of being in a place or situation where escape may be difficult. A panic attack is characterized by somatic or cognitive symptoms such as chest pain, palpitations, sweating, shortness of breath, fear of dying, dizziness, or hot flashes. These symptoms appear suddenly and last about 10 minutes. Patients can have multiple panic attacks in their lifetime; therefore, panic attacks alone do not constitute a diagnosis of PD.
Generalized Anxiety Disorder
Generalized anxiety disorder is characterized by chronic excessive worry and anxiety about life events. Additional symptoms include feeling restless, difficulty concentrating, muscle tension or sleep disturbance, and easy fatigability. A high incidence of comorbidity exists with major depressive disorder.
Patients with OCD have either obsessions, compulsions, or both. Obsessions are marked by recurrent and persistent thoughts that are inappropriate and cause significant anxiety. Compulsions are characterized by repetitive behaviors that a person feels driven to perform. Adults who have either obsessions or compulsions recognize that these feelings are excessive, but they are unable to control these thoughts or actions. These behaviors generally consume more than 1 hour per day.
Post-Traumatic Stress Disorder
Post-traumatic stress disorder is characterized by a collection of symptoms that occur after exposure to a traumatic event such as military combat or violent personal attack. Symptoms must be present for 1 month and include the following types of indicators: re-experiencing (flashbacks, dreams), avoidance (of activities or people associated with the trauma), and increased arousal (sleep disturbance, exaggerated startle response). Comorbidity with another psychiatric illness such as major depressive disorder is common among patients with PTSD. Most symptoms of PTSD occur within 3 months of exposure to the trauma, but they can appear at any time during a patient’s lifetime.
Patients with SAD have a persistent fear of at least one or more social or performance situations. The fear is usually of embarrassment, scrutiny, or humiliation. They may ...