View source for Anxiety disorder

{{Short description|Cognitive disorder with an excessive, irrational dread of everyday situations}}
{{cs1 config|name-list-style=vanc|display-authors=6}}
{{Use dmy dates|date=September 2020}}
{{Infobox medical condition
| name = Anxiety disorder
| field = [[Psychiatry]], [[clinical psychology]]
| symptoms = Worrying, [[tachycardia|fast heart rate]], shakiness<ref name= DSM5/>
| complications = [[major depressive disorder|Depression]], [[insomnia|trouble sleeping]], poor [[quality of life]], [[substance use disorder]], [[Alcoholism|alcohol use disorder]], [[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 = Over 6 months<ref name= DSM5/><ref name=Lancet2016/>
| causes = [[Genetic disorder|Genetic]], [[Environmental factor|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 |access-date=14 August 2016|date=March 2016|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 | work = National Institute of Mental Health (NIMH) | publisher = U.S. National Institutes of Health }}</ref>
| risks = [[Child abuse]], [[Family history (medicine)|family history]], [[poverty]]<ref name=Lancet2016/>
| diagnosis = [[psychological testing|Psychological assessment]]
| differential = [[Hyperthyroidism]]; [[heart disease]]; [[caffeine]], [[alcohol (drug)|alcohol]], [[cannabis (drug)|cannabis]] use; withdrawal from certain drugs<ref name=Lancet2016/><ref name=Test2013partIII/>
| prevention = 
| treatment = Lifestyle changes, [[psychotherapy|counselling]], medications<ref name=Lancet2016/>
| medication = [[SSRI]]s and [[SNRI]]s are first line,<ref name="Szuhany 2022">{{cite journal |last1=Szuhany |first1=Kristin L. |last2=Simon |first2=Naomi M. |title=Anxiety Disorders: A Review |journal=JAMA |date=27 December 2022 |volume=328 |issue=24 |pages=2431–2445 |doi=10.1001/jama.2022.22744|pmid=36573969 }}</ref> other options include: [[tricyclic antidepressants]], [[benzodiazepines]], [[beta blockers]]<ref name=NIH2016/>
| prognosis = 
| frequency = 12% per year<ref name=Lancet2016/><ref name=Kess2007>{{cite journal | vauthors = Kessler RC, Angermeyer M, Anthony JC, DE Graaf R, Demyttenaere K, Gasquet I, DE Girolamo G, Gluzman S, Gureje O, Haro JM, Kawakami N, Karam A, Levinson D, Medina Mora ME, Oakley Browne MA, Posada-Villa J, Stein DJ, Adley Tsang CH, Aguilar-Gaxiola S, Alonso J, Lee S, Heeringa S, Pennell BE, Berglund P, Gruber MJ, Petukhova M, Chatterji S, Ustün TB | 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 = 168–176 | date = October 2007 | pmid = 18188442 | pmc = 2174588 }}</ref>
| deaths = 
}}
<!-- Definition and symptoms -->

'''Anxiety disorders''' are a group of [[mental disorder]]s characterized by significant and uncontrollable feelings of [[anxiety]] and [[fear]] such that a person's social, occupational, and personal functions are significantly impaired.<ref name="DSM5">{{cite book |title=Diagnostic and statistical manual of mental disorders 5th edition: [[DSM-5]] |publisher=American Psychiatric Association |year=2013 |isbn=978-0-89042-555-8 |publication-place=Arlington, VA Washington, D.C. |page=[https://archive.org/details/diagnosticstatis0005unse/page/189 189–195] |oclc=830807378}}</ref> Anxiety may cause physical and cognitive symptoms, such as a sense of impending doom, restlessness, irritability, easy fatigue, difficulty concentrating, increased heart rate, chest pain, abdominal pain, and a variety of other symptoms that vary based on the individual.<ref name="DSM5" />

In casual discourse, the words ''anxiety'' and ''fear'' are often used interchangeably. In clinical usage, they have distinct meanings; anxiety is clinically 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 clinically defined as an emotional and physiological response to a recognized external threat.<ref name="WHO2009">{{cite book |title=Pharmacological treatment of mental disorders in primary health care |date=2009 |publisher=World Health Organization |hdl=10665/44095 |hdl-access=free |isbn=978-92-4-154769-7 }}{{page needed|date=July 2023}}</ref> The umbrella term 'anxiety disorder' refers to a number of specific disorders that include fears (phobias) and/or anxiety symptoms.<ref name="DSM5" />

There are several types of anxiety disorders, including [[generalized anxiety disorder]], [[hypochondriasis]], [[specific phobia]], [[social anxiety disorder]], [[separation anxiety disorder]], [[agoraphobia]], [[panic disorder]], and [[selective mutism]].<ref name="DSM5" /> Individual disorders can be diagnosed using the specific and unique symptoms, triggering events, and timing.<ref name="DSM5" /> A medical professional must evaluate a person before diagnosing them with an anxiety disorder to ensure that their anxiety cannot be attributed to another 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 to have more than one anxiety disorder at the same time.<ref name="DSM5"/> Comorbid mental disorders or substance use disorders are common in those with anxiety. Comorbid depression (lifetime prevalence) is seen in 20–70% of those with social anxiety disorder, 50% of those with panic disorder and 43% of those with general anxiety disorder. The 12 month prevalence of alcohol or substance use disorders in those with anxiety disorders is 16.5%.<ref name="Szuhany 2022" />

Worldwide, anxiety disorders are the second most common type of mental disorders after depressive disorders.<ref name="Vos 2017">{{cite journal |last1=Vos |first1=Theo |last2=Abajobir |first2=Amanuel Alemu |last3=Abate |first3=Kalkidan Hassen |title=Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016 |journal=The Lancet |date=September 2017 |volume=390 |issue=10100 |pages=1211–1259 |doi=10.1016/S0140-6736(17)32154-2|pmid=28919117 |pmc=5605509 }}</ref> Anxiety disorders affect nearly 30% of adults at some point in their lives, with an estimated 4% of the global population currently experiencing an anxiety disorder. However, anxiety disorders are treatable, and a number of effective treatments are available.<ref>{{cite web |title=Anxiety disorders |url=https://www.who.int/news-room/fact-sheets/detail/anxiety-disorders |access-date=16 March 2024 |website=World Health Organization}}</ref> Most people are able to lead normal, productive lives with some form of treatment.<ref>{{cite web |title=What are Anxiety Disorders? |url=https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders |access-date=8 September 2022 |website=[[American Psychiatric Association]]}}</ref>{{TOC limit}}

==Types==
=== Generalized anxiety disorder ===
{{Main|Generalized anxiety disorder}}
Generalized anxiety disorder (GAD) is a common disorder characterized by long-lasting anxiety that is not focused on any one object or situation. Those with 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>{{cite book | vauthors = Schacter DL, Gilbert DT, Wegner DM |title=Psychology |date=2011 |publisher=Macmillan |isbn=978-1-4292-3719-2 }}{{page needed|date=July 2023}}</ref> Generalized anxiety disorder is the most common anxiety disorder to affect older adults.<ref name="Calleo">{{cite journal |id={{Gale|CA181302423}} | vauthors = Calleo J, Stanley M |title=Anxiety disorders in later life: differentiated diagnosis and treatment strategies |journal=Psychiatric Times |date=1 July 2008 |volume=25 |issue=8 |page=24 }}</ref> Anxiety can be a symptom of a medical or [[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 | vauthors = Barker P |title=Psychiatric and Mental Health Nursing: The Craft of Caring |date=2003 |publisher=Taylor & Francis |isbn=978-0-340-81026-2 }}{{page needed|date=July 2023}}</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 a lack of concentration and/or preoccupation with worry.<ref>{{cite book | vauthors = Passer MW, Bremner A, Smith RE, Holt N, Vliek M, Sutherland E |title=Psychology: The Science of Mind and Behaviour |date=2009 |publisher=McGraw-Hill Higher Education |isbn=978-0-07-711836-5 |page=790 }}</ref> A symptom can be a strained appearance, with increased sweating from the hands, feet, and axillae,<ref>{{cite web | veditors = Bhandari S | date = 7 January 2023 | work = WebMD |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> along with tearfulness, which can suggest depression.<ref name=Gelder2005>{{cite book | vauthors = Gelder MG, Mayou R, Geddes J |title=Psychiatry |date=2005 |publisher=Oxford University Press |isbn=978-0-19-852863-0 |page=75 }}</ref> Before a diagnosis of anxiety disorder is made, physicians must rule out drug-induced anxiety and other medical causes.<ref>{{cite book | vauthors = Varcarolis EM |title=Manual of Psychiatric Nursing Care Planning |date=2010 |publisher=Elsevier Health Sciences |isbn=978-1-4377-1783-9 |page=109 }}</ref>

In children, GAD may be associated with headaches, restlessness, abdominal pain, and [[Palpitations|heart palpitations]].<ref name=PedGAD2009>{{cite journal | vauthors = Keeton CP, Kolos AC, Walkup JT | title = Pediatric generalized anxiety disorder: epidemiology, diagnosis, and management | journal = Paediatric Drugs | volume = 11 | issue = 3 | pages = 171–183 | year = 2009 | pmid = 19445546 | doi = 10.2165/00148581-200911030-00003 }}</ref> Typically, it begins around eight to nine years of age.<ref name=PedGAD2009/>

===Specific phobias===
{{Main|Specific phobias}}

The 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 has 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|archive-url=https://web.archive.org/web/20070919014740/http://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml|archive-date=19 September 2007|access-date=2020-11-16 | work = National Institute of Mental Health (NIMH) | publisher = U.S. National Institutes of Health }}</ref> Individuals with a phobia 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 [[List of phobias|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| work = U.S. Department of Health & Human Services|date=2017 |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}}</ref> People with specific phobias often go to extreme lengths to avoid encountering their phobia. People with specific phobias understand that their fear is not proportional to the actual potential danger, but they can still become overwhelmed by it.<ref>{{cite book | vauthors = Bremner A, Holt N, Passer M, Smith R, Sutherland E, Vliek M | title = Psychology: The Science of Mind and Behaviour. | location = Berkshire UK | publisher = McGraw-Hill | date = 2009 | isbn = 978-0-07-711836-5 }}</ref>

===Panic disorder===
{{Main|Panic disorder}}

With panic disorder, a person has brief attacks of intense terror and apprehension, often marked by trembling, shaking, confusion, dizziness, or difficulty breathing. These [[panic attacks]] are defined by the [[American Psychiatric Association|APA]] as fear or discomfort that abruptly arises and peaks in less than ten minutes but 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, fear of the unknown, or even when engaging in exercise. However, sometimes the trigger is unclear, and 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 and 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 with panic disorder experience symptoms even outside of specific panic episodes. Often, normal changes in heartbeat are noticed, 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 ([[hypervigilance]]) of body functioning occurs during panic attacks, wherein any perceived physiological change is interpreted as a possible life-threatening illness (i.e., extreme [[hypochondriasis]]).

Panic disorder is commonly comorbid with anxiety due to the consistent fight or flight response that one's brain is being put under at such a high repetitive rate. Another one of the very big leading causes of someone developing a panic disorder has a lot to do with one's childhood. The article{{?}} provides knowledge on a positive trend in children who experience abuse and have low self-esteem to later on develop disorders such as generalized anxiety disorder and panic disorder.<ref>{{cite journal |last1=Sarkar |first1=Nilakshi |last2=Zainal |first2=Nur Hani |last3=Newman |first3=Michelle G. |title=Self-esteem mediates child abuse predicting adulthood anxiety, depression, and substance use symptoms 18 years later |journal=Journal of Affective Disorders |date=November 2024 |volume=365 |pages=542–552 |doi=10.1016/j.jad.2024.08.107 |pmc=11415822 |pmid=39178955 }}</ref>

===Agoraphobia===
{{Main|Agoraphobia}}

Agoraphobia is a specific anxiety disorder wherein an individual is afraid of being in a place or situation where escape is difficult or embarrassing or where help may be unavailable.<ref>{{cite book |doi=10.1016/B978-0-08-044032-3.X5000-X |title=Origins of Phobias and Anxiety Disorders |year=2003 |isbn=978-0-08-044032-3 | vauthors = Craske MG }}{{page needed|date=July 2023}}</ref> Agoraphobia is strongly linked with [[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 [[agoraphobia]] is often used to refer to avoidance behaviors that individuals often develop.<ref>{{cite book | vauthors = Hazlett-Stevens H | chapter = Agoraphobia | pages = 24–34 | veditors = Fisher JE, O'Donohue WT |title= Practitioner's Guide to Evidence-Based Psychotherapy |year=2006 | location = Boston, MA | publisher = Springer |doi=10.1007/978-0-387-28370-8_2  |isbn=978-0-387-28369-2 }}</ref> For example, following a panic attack while driving, someone with agoraphobia may develop anxiety over driving and will therefore avoid driving. These avoidance behaviors can have serious consequences and often reinforce the fear they are caused by. In a severe case of agoraphobia, the person may never leave their home.

===Social anxiety disorder===
{{Main|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 [[fear]] can be specific to particular social situations (such as public speaking) or it can be experienced in most or all social situations. 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://mhanational.org/conditions/social-anxiety-disorder/ |access-date=16 November 2020 |website=Mental Health America}}</ref> [[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|access-date=2020-12-01| work = National Institute of Mental Health (NIMH) | publisher = U.S. National Institutes of Health }}</ref> As with all phobic disorders, those with social anxiety often attempt to avoid the source of their anxiety; in the case of social anxiety, this is particularly problematic, and in severe cases, it can lead to complete social isolation.

Children are also affected by social anxiety disorder, although their associated symptoms are different from those of teenagers and adults. They may experience difficulty 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 sub-type of social anxiety involving concern over the evaluation of one's body by others.<ref>{{cite book | vauthors = Ginis KM, Bassett-Gunter RL, Conlin C | chapter = Body image and exercise | veditors = Acevedo EO |title=The Oxford Handbook of Exercise Psychology|date=2012 |publisher=Oxford University Press |isbn=978-0-19-993074-6 |pages=55–75 (56) | chapter-url = https://books.google.com/books?id=VR1pAgAAQBAJ&pg=PA56}}</ref> SPA is common among adolescents, especially females.

===Post-traumatic stress disorder===
{{Main|Post-traumatic stress disorder}}

Post-traumatic stress disorder (PTSD) was once an anxiety disorder (now moved to ''trauma- and stressor-related disorders'' in the DSM-5) 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=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 (PTSD) and the Family: For Parents with Young Children |date=2006 |publisher=Veterans Affairs Canada |isbn=978-0-662-42627-1 |url=https://www.veterans.gc.ca/public/pages/publications/system-pdfs/pstd_families_e.pdf |archive-date=6 March 2024 |access-date=3 July 2023 |archive-url=https://web.archive.org/web/20240306063922/https://www.veterans.gc.ca/public/pages/publications/system-pdfs/pstd_families_e.pdf }}</ref> for example, soldiers who endure individual battles but cannot [[coping (psychology)|cope]] with continuous combat. Common symptoms include [[hypervigilance]], [[Flashback (psychological phenomenon)|flashbacks]], avoidant behaviors, anxiety, anger, and depression.<ref name="psycho-prat">{{cite web | url = http://www.psycho-prat.fr/index.php?module=webuploads&func=download&fileId=2963_0 | title = Psychological Disorders | archive-url = https://web.archive.org/web/20081204123458/http://www.psycho-prat.fr/index.php?module=webuploads&func=download&fileId=2963_0 | archive-date=4 December 2008 | work = Psychologie Anglophone, Cours de Madame Lacroix }}{{unreliable source?|date=July 2023}}</ref> In addition, individuals may experience sleep disturbances.<ref>{{cite journal | vauthors = Shalev A, Liberzon I, Marmar C | title = Post-Traumatic Stress Disorder | journal = The New England Journal of Medicine | volume = 376 | issue = 25 | pages = 2459–2469 | date = June 2017 | pmid = 28636846 | doi = 10.1056/NEJMra1612499 }}</ref> People who have 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 with PTSD; such treatments include [[cognitive behavioral therapy]] (CBT), prolonged exposure therapy, stress inoculation therapy, medication, psychotherapy, and support from family and friends.<ref name="Barker2003"/>

[[Post-traumatic stress disorder]] research began with US military veterans of the Vietnam War, as well as natural and non-natural disaster victims. Studies have found the degree of exposure to a disaster to be the best predictor of [[Post-traumatic stress disorder|PTSD]].<ref>{{cite book|title = Posttraumatic Stress Disorder|url = https://archive.org/details/posttraumaticstr0000full|url-access = limited| vauthors = Fullerton C |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|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>{{cite book | vauthors = Siegler RS |title=How Children Develop, Exploring Child Develop |date=2006 |publisher=Worth Pub |isbn=978-0-7167-6113-6 }}{{page needed|date=July 2023}}</ref> Separation anxiety disorder affects roughly 7% of adults and 4% of children, but childhood cases tend to be more severe; in some instances, even a brief separation can produce panic.<ref>{{cite journal | vauthors = Arehart-Treichel J |title=Adult Separation Anxiety Often Overlooked Diagnosis |journal=Psychiatric News |date=7 July 2006 |volume=41 |issue=13 |page=30 |doi=10.1176/pn.41.13.0030 }}</ref><ref>{{cite journal | vauthors = Shear K, Jin R, Ruscio AM, Walters EE, Kessler RC | title = Prevalence and correlates of estimated DSM-IV child and adult separation anxiety disorder in the National Comorbidity Survey Replication | journal = The American Journal of Psychiatry | volume = 163 | issue = 6 | pages = 1074–1083 | date = June 2006 | pmid = 16741209 | pmc = 1924723 | doi = 10.1176/ajp.2006.163.6.1074 }}</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 [[Selective serotonin reuptake inhibitor|SSRIs]], can be used to treat separation anxiety.<ref name=Moh2014>{{cite journal | vauthors = Mohatt J, Bennett SM, Walkup JT | title = Treatment of separation, generalized, and social anxiety disorders in youths | journal = The American Journal of Psychiatry | volume = 171 | issue = 7 | pages = 741–748 | date = July 2014 | pmid = 24874020 | doi = 10.1176/appi.ajp.2014.13101337 }}</ref>

===Obsessive–compulsive disorder===
{{Main|Obsessive–compulsive disorder}}

Obsessive–compulsive disorder (OCD) is not an anxiety disorder in the [[DSM-5]] or the [[ICD-11]].<ref name="Marras et al. (2016)">{{cite journal | vauthors = Marras A, Fineberg N, Pallanti S | title = Obsessive compulsive and related disorders: comparing DSM-5 and ICD-11 | journal = CNS Spectrums | volume = 21 | issue = 4 | pages = 324–333 | date = August 2016 | pmid = 27401060 | doi = 10.1017/S1092852916000110 }}</ref> However, it was classified as such in older versions of the DSM-IV and [[ICD-10]]. OCD manifests in the form of [[Fixation (psychology)|obsession]]s (distressing, persistent, and intrusive thoughts or images) and [[Compulsive behavior|compulsions]] (urges to repeatedly perform specific acts or rituals) that are not caused by drugs or physical disorders and which cause anxiety or distress plus (more or less important) functional disabilities.<ref name="NICE-2006">{{cite book |title=Obsessive-Compulsive Disorder: Core Interventions in the Treatment of Obsessive-Compulsive Disorder and Body Dysmorphic Disorder |series=National Institute for Health and Care Excellence: Guidelines |date=2006 |publisher=British Psychological Society |isbn=978-1-85433-430-5 |url=https://www.ncbi.nlm.nih.gov/books/NBK56458/ |pmid=21834191 |author1=National Collaborating Centre for Mental Health (UK) }}{{page needed|date=July 2023}}</ref><ref name="Soomro-2012">{{cite journal | vauthors = Soomro GM | title = Obsessive compulsive disorder | journal = BMJ Clinical Evidence | volume = 2012 | page = 1004 | date = January 2012 | pmid = 22305974 | pmc = 3285220 }}</ref><ref name="Marras et al. (2016)" /><ref>{{cite web |title=6B20 Obsessive-compulsive disorder |url=https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1582741816 |website=ICD-11 for Mortality and Morbidity Statistics |access-date=3 July 2023 |archive-date=15 October 2023 |archive-url=https://web.archive.org/web/20231015122454/https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1582741816 }}</ref> 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 book |title=InformedHealth.org |date=19 October 2017 |publisher=Institute for Quality and Efficiency in Health Care |chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK279562/ |chapter=Obsessive-compulsive disorder: Overview }}</ref> Their symptoms could be related to external events they fear, such as their home burning down because they forgot to turn off the stove, or they could worry that they will behave inappropriately.<ref name="IQWiG-2014" /> The compulsive rituals are personal rules they follow to relieve discomfort, such as needing to verify that the stove is turned off a specific number of times before leaving the house.<ref name="Soomro-2012" />

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, being of a 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|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 [[shyness]] or [[social anxiety]].<ref>{{cite journal | vauthors = Viana AG, Beidel DC, Rabian B | title = Selective mutism: a review and integration of the last 15 years | journal = Clinical Psychology Review | volume = 29 | issue = 1 | pages = 57–67 | date = February 2009 | pmid = 18986742 | doi = 10.1016/j.cpr.2008.09.009 }}</ref> People with selective mutism stay silent even when the consequences of their silence include shame, social ostracism, or even punishment.<ref>{{cite news |last=Brown |first=Harriet |date=12 April 2005 |title=The Child Who Would Not Speak a Word |url=https://www.nytimes.com/2005/04/12/health/psychology/the-child-who-would-not-speak-a-word.html |access-date=30 September 2013 |work=[[The New York Times]] |language=en-US |issn=0362-4331}}</ref> Selective mutism affects about 0.8% of people at some point in their lives.<ref name="Lancet2016">{{cite journal | vauthors = Craske MG, Stein MB | title = Anxiety | journal = Lancet | volume = 388 | issue = 10063 | pages = 3048–3059 | date = December 2016 | pmid = 27349358 | doi = 10.1016/S0140-6736(16)30381-6 }}</ref>

Testing for selective mutism is important because doctors must determine if it is an issue associated with the child's hearing or 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=16 November 2020 |website=American Speech-Language-Hearing Association}}</ref> Generally, [[cognitive behavioral therapy]] (CBT) is the recommended approach for treating selective mutism, but prospective long-term outcome studies are lacking.<ref>{{cite journal | vauthors = Oerbeck B, Overgaard KR, Stein MB, Pripp AH, Kristensen H | title = Treatment of selective mutism: a 5-year follow-up study | journal = European Child & Adolescent Psychiatry | volume = 27 | issue = 8 | pages = 997–1009 | date = August 2018 | pmid = 29357099 | pmc = 6060963 | doi = 10.1007/s00787-018-1110-7 }}</ref>

==Diagnosis==
The diagnosis of anxiety disorders is made by symptoms, triggers, and a person's personal and family histories. There are no objective [[biomarker (medicine)|biomarkers]] or laboratory tests that can diagnose anxiety.<ref name=RoseDevine2014>{{cite journal | vauthors = Rose M, Devine J | title = Assessment of patient-reported symptoms of anxiety | journal = Dialogues in Clinical Neuroscience | volume = 16 | issue = 2 | pages = 197–211 | date = June 2014 | pmid = 25152658 | pmc = 4140513 | doi = 10.31887/DCNS.2014.16.2/mrose }}</ref> It is important for a medical professional to evaluate a person for other medical and mental causes of 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 vary between each sub-type 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; and irritability.<ref name="DSM5" /><ref name="Lancet2016" />

Questionnaires developed for clinical use include the [[State-Trait Anxiety Inventory]] (STAI), the [[Generalized Anxiety Disorder 7]] (GAD-7), the [[Beck Anxiety Inventory]] (BAI), the [[Zung Self-Rating Anxiety Scale]], and the [[Taylor Manifest Anxiety Scale]].<ref name=RoseDevine2014/> Other questionnaires combine anxiety and depression measurements, such as the [[Hamilton Anxiety Rating Scale]], the [[Hospital Anxiety and Depression Scale]] (HADS), the [[Patient Health Questionnaire]] (PHQ), and the [[Patient-Reported Outcomes Measurement Information System]] (PROMIS).<ref name=RoseDevine2014/> Examples of specific anxiety questionnaires include the [[Liebowitz Social Anxiety Scale]] (LSAS), the [[Social Interaction Anxiety Scale]] (SIAS), the [[Social Phobia Inventory]] (SPIN), the Social Phobia Scale (SPS), and the Social Anxiety Questionnaire (SAQ-A30).<ref name=RoseDevine2014/>

The GAD-7 has a sensitivity of 57-94% and a specificity of 82-88% in the diagnosis of general anxiety disorder.<ref name="Szuhany 2022" /> All screening questionnaires, if positive, should be followed by clinical interview including assessment of impairment and distress, avoidance behaviors, symptom history and persistence to definitively diagnose an anxiety disorder.<ref name="Szuhany 2022" /> Some organizations support routinely screening all adults for anxiety disorders, with the US Preventative Services Task Force recommending screening for all adults younger than 65.<ref>{{cite web |title=Recommendation: Anxiety Disorders in Adults: Screening |url=https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/anxiety-adults-screening |access-date=8 October 2024 |website=[[United States Preventive Services Taskforce]]}}</ref>

===Differential diagnosis===
Anxiety disorders differ from developmentally normal [[fear]] or [[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 | title = Psychiatric emergencies (part III): psychiatric symptoms resulting from organic diseases | journal = European Review for Medical and Pharmacological Sciences | volume = 17 | issue = Suppl 1 | pages = 86–99 | date = February 2013 | pmid = 23436670 | url = https://www.europeanreview.org/wp/wp-content/uploads/86-99.pdf }}</ref><ref name=WHO2009 /> Diseases that may present similar to an anxiety disorder include certain endocrine diseases ([[Hypothyroidism|hypo-]] and [[hyperthyroidism]], [[hyperprolactinemia]]),<ref name=Lancet2016 /><ref name="Test2013partIII" /><ref name=Samuels2008>{{cite journal | vauthors = Samuels MH | title = Cognitive function in untreated hypothyroidism and hyperthyroidism | journal = Current Opinion in Endocrinology, Diabetes, and Obesity | volume = 15 | issue = 5 | pages = 429–433 | date = October 2008 | pmid = 18769215 | doi = 10.1097/MED.0b013e32830eb84c | type = Review }}</ref> metabolic disorders ([[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 = Journal of Psychosomatic Research | volume = 53 | issue = 6 | pages = 1053–1060 | date = December 2002 | pmid = 12479986 | doi = 10.1016/S0022-3999(02)00417-8 | type = Systematic Review }}</ref> deficiency states (low levels of [[vitamin D]], [[Riboflavin|B2]], [[vitamin B12|B12]], [[folic acid]]),<ref name="Test2013partIII" /> gastrointestinal diseases ([[celiac disease]], [[non-celiac gluten sensitivity]], [[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 Gastroenterology Journal | volume = 3 | issue = 2 | pages = 136–145 | date = April 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 = Alimentary Pharmacology & Therapeutics | volume = 41 | issue = 9 | pages = 807–820 | date = May 2015 | pmid = 25753138 | doi = 10.1111/apt.13155 | 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 = Journal of Psychosomatic Research | volume = 87 | pages = 70–80 | date = August 2016 | pmid = 27411754 | doi = 10.1016/j.jpsychores.2016.06.001 | type = Systematic Review }}</ref> heart diseases,<ref name=Lancet2016 /><ref name="Test2013partIII" /> blood diseases ([[anemia]]),<ref name="Test2013partIII" /> and brain degenerative diseases ([[Parkinson's disease]], [[dementia]], [[multiple sclerosis]], [[Huntington's disease]]).<ref name="Test2013partIII" /><ref name=ZhaoTan2016>{{cite journal | vauthors = Zhao QF, Tan L, Wang HF, Jiang T, Tan MS, Tan L, Xu W, Li JQ, Wang J, Lai TJ, Yu JT | title = The prevalence of neuropsychiatric symptoms in Alzheimer's disease: Systematic review and meta-analysis | journal = Journal of Affective Disorders | volume = 190 | pages = 264–271 | date = January 2016 | pmid = 26540080 | doi = 10.1016/j.jad.2015.09.069 | type = Systematic Review }}</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 = European Journal of Neurology | volume = 23 | issue = 6 | pages = 1001–1019 | date = June 2016 | pmid = 27141858 | pmc = 5084819 | doi = 10.1111/ene.13002 | type = Review }}</ref><ref name=MarrieReingold2015>{{cite journal | vauthors = Marrie RA, Reingold S, Cohen J, Stuve O, Trojano M, Sorensen PS, Cutter G, Reider N | title = The incidence and prevalence of psychiatric disorders in multiple sclerosis: a systematic review | journal = Multiple Sclerosis | volume = 21 | issue = 3 | pages = 305–317 | date = March 2015 | pmid = 25583845 | pmc = 4429164 | doi = 10.1177/1352458514564487 | type = Systematic Review }}</ref> Anxiety and panic disorders as well as other neuropsychiatric disorders can be a symptom of [[mast cell activation syndrome|mast cell activation syndrome (MCAS)]].<ref name="PMID38003876">{{cite journal |vauthors=Weinstock LB, Nelson RM, Blitshteyn S |title=Neuropsychiatric Manifestations of Mast Cell Activation Syndrome and Response to Mast-Cell-Directed Treatment: A Case Series |journal= J Pers Med |volume=13 |issue=11 |date=2023-10-31 |page=1562 |doi=10.3390/jpm13111562 |pmc=10672129 |pmid=38003876 |url=|doi-access=free}}</ref><ref name="PMID26162709">{{cite journal |vauthors=Afrin LB, Pöhlau D, Raithel M, Haenisch B, Dumoulin FL, Homann J, Mauer UM, Harzer S, Moderings J |title=Mast cell activation disease: An underappreciated cause of neurologic and psychiatric symptoms and diseases |journal=Brain Behav Immun |volume=50 |date=November 2015 |doi=10.1016/j.bbi.2015.07.002 |pmid=26162709 |pages=314–321}}</ref><ref name="PMID28262205">{{cite journal |vauthors=Afrin LB, Self S, Menk J, Lazarchick J |title=Characterization of Mast Cell Activation Syndrome |journal=The American Journal of the Medical Science |volume=353 |issue=3 |date=2016-12-16 |pages=207–215 |doi=10.1016/j.amjms.2016.12.013 |pmc=5341697 |pmid=28262205|url=|doi-access=free}}</ref>

Several drugs can also cause or worsen anxiety, whether through intoxication, withdrawal, or chronic use. These include [[alcohol (drug)|alcohol]], tobacco, cannabis, [[sedative]]s (including prescription [[Benzodiazepine|benzodiazepines]]), [[opioid]]s (including prescription painkillers and illicit drugs like heroin), [[stimulant]]s (such as caffeine, cocaine, and amphetamines), [[hallucinogen]]s, and [[inhalants]].<ref name=Lancet2016/><ref name= DSM5 />

== Causes ==

=== Evolutionary Perspectives ===
Evolutionary psychiatry interprets anxiety as part of an evolved defensive system calibrated to potential threat. According to the “smoke-alarm principle,” anxiety mechanisms are expected to err on the side of false alarms because the cost of unnecessary fear is typically lower than the cost of failing to detect genuine danger.<ref>{{Cite journal |last1=Marks |first1=Isaac fM. |last2=Nesse |first2=Randolph M. |date=September 1994 |title=Fear and fitness: An evolutionary analysis of anxiety disorders |url=https://linkinghub.elsevier.com/retrieve/pii/0162309594900027 |journal=Ethology and Sociobiology |language=en |volume=15 |issue=5–6 |pages=247–261 |doi=10.1016/0162-3095(94)90002-7|hdl=2027.42/31354 |hdl-access=free }}</ref> This framework has been extended to modern settings, where mismatch between ancestral and contemporary threat profiles may contribute to chronic or generalised anxiety.<ref>{{Cite journal |last=Nesse |first=Randolph M. |date=June 2023 |title=Evolutionary psychiatry: foundations, progress and challenges |journal=World Psychiatry |language=en |volume=22 |issue=2 |pages=177–202 |doi=10.1002/wps.21072 |issn=1723-8617 |pmc=10168175 |pmid=37159362}}</ref>

==Prevention==
Focus is increasing on the prevention of anxiety disorders.<ref name=Bien2007>{{cite journal | vauthors = Bienvenu OJ, Ginsburg GS | title = Prevention of anxiety disorders | journal = International Review of Psychiatry | volume = 19 | issue = 6 | pages = 647–654 | date = December 2007 | pmid = 18092242 | doi = 10.1080/09540260701797837 | publication-place = Abingdon, England }}</ref> There is tentative evidence to support the use of [[cognitive behavioral therapy]]<ref name=Bien2007/> and [[mindfulness]] therapy.<ref name= Khoury>{{cite journal | vauthors = Khoury B, Lecomte T, Fortin G, Masse M, Therien P, Bouchard V, Chapleau MA, Paquin K, Hofmann SG | title = Mindfulness-based therapy: a comprehensive meta-analysis | journal = Clinical Psychology Review | volume = 33 | issue = 6 | pages = 763–771 | date = August 2013 | 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 = Journal of Evidence-Based Complementary & Alternative Medicine | volume = 19 | issue = 4 | pages = 271–286 | date = October 2014 | pmid = 25053754 | doi = 10.1177/2156587214543143 | doi-access = free }}</ref> A 2013 review found no effective measures to prevent GAD in adults.<ref>{{cite journal | vauthors = Patel G, Fancher TL | title = In the clinic. Generalized anxiety disorder | journal = Annals of Internal Medicine | 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 | date = December 2013 | pmid = 24297210 | doi = 10.7326/0003-4819-159-11-201312030-01006 }}</ref> A 2017 review found that psychological and educational interventions had a small benefit for the prevention of anxiety.<ref>{{cite journal | vauthors = Moreno-Peral P, Conejo-Cerón S, Rubio-Valera M, Fernández A, Navas-Campaña D, Rodríguez-Morejón A, Motrico E, Rigabert A, Luna JD, Martín-Pérez C, Rodríguez-Bayón A, Ballesta-Rodríguez MI, Luciano JV, Bellón 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 | volume = 74 | issue = 10 | pages = 1021–1029 | date = October 2017 | pmid = 28877316 | pmc = 5710546 | doi = 10.1001/jamapsychiatry.2017.2509 }}</ref><ref>{{cite book |doi=10.1016/B978-0-12-813495-5.00008-5 |chapter=Targeting anxiety sensitivity as a prevention strategy |title=The Clinician's Guide to Anxiety Sensitivity Treatment and Assessment |year=2019 | vauthors = Schmidt NB, Allan NP, Knapp AA, Capron D |pages=145–178 |isbn=978-0-12-813495-5 }}</ref> Research indicates that predictors of the emergence of anxiety disorders partly differ from the factors that predict their persistence.<ref name="Lancet2021">{{cite journal | vauthors = Hovenkamp-Hermelink JH, Jeronimus BF, Myroniuk S, Riese H, Schoevers RA | title = Predictors of persistence of anxiety disorders across the lifespan: a systematic review | journal = The Lancet. Psychiatry | volume = 8 | issue = 5 | pages = 428–443 | date = May 2021 | pmid = 33581052 | doi = 10.1016/S2215-0366(20)30433-8 | url = https://pure.rug.nl/ws/files/177228875/Predictors_of_persistence_of_anxiety_disorders_across_the_lifespan_a_systematic_review.pdf }}</ref>

A big factor that goes into anxiety disorder prevention starts in childhood. Based on the cited article, parents have a big part in whether or not their child will develop anxiety in their future. Specific interventions have been tested to educate parents with young children on how to care and prevent a disorder like anxiety from becoming a bigger issue in their child's teen to adult life. The study also shared that since it is such a new intervention that there is not much information on long term results, however it does seem to be looking in a positive direction.<ref>{{cite journal |last1=Lal |first1=Anita |last2=Le |first2=Long Khanh-Dao |last3=Engel |first3=Lidia |last4=Lee |first4=Yong Yi |last5=Mihalopoulos |first5=Cathrine |title=Modelled cost-effectiveness of a parent education program for the prevention of anxiety in children |journal=Mental Health & Prevention |date=December 2021 |volume=24 |article-number=200219 |doi=10.1016/j.mhp.2021.200219 }}</ref>

== Perception and discrimination ==

=== Stigma ===
People with an anxiety disorder may be challenged by prejudices and stereotypes held by other people, most likely as a result of misconceptions around anxiety and anxiety disorders.<ref name="Corrigan 67–73">{{cite journal | vauthors = Corrigan PW | title = Lessons learned from unintended consequences about erasing the stigma of mental illness | journal = World Psychiatry | volume = 15 | issue = 1 | pages = 67–73 | date = February 2016 | pmid = 26833611 | pmc = 4780288 | doi = 10.1002/wps.20295 }}</ref> Misconceptions found in a data analysis from the National Survey of Mental Health Literacy and Stigma include: (1) many people believe anxiety is not a real medical illness; and (2) many people believe that people with anxiety could turn it off if they wanted to.<ref name="beyondblue">{{cite web |title=Stigma relating to anxiety |url=https://www.beyondblue.org.au/mental-health/anxiety/stigma-relating-to-anxiety |website=Beyond Blue |access-date=3 July 2023 |archive-date=23 March 2024 |archive-url=https://web.archive.org/web/20240323041317/https://www.beyondblue.org.au/mental-health/anxiety/stigma-relating-to-anxiety }}</ref> For people experiencing the physical and mental symptoms of an anxiety disorder, stigma and negative social perception can make an individual less likely to seek treatment.<ref name="beyondblue"/>

Prejudice that some people with mental illness turn against themselves is called self-stigma.<ref name="Corrigan 67–73" />

There is no explicit evidence for the exact cause of stigma towards anxiety. Stigma can be divided by social scale, into the macro, intermediate, and micro levels. The macro-level marks society as a whole with the influence of mass media. The intermediate level includes healthcare professionals and their perspectives. The micro-level details the individual's contributions to the process through self-stigmatization.<ref name="Rossler 2016">{{cite journal | vauthors = Rössler W | title = The stigma of mental disorders: A millennia-long history of social exclusion and prejudices | journal = EMBO Reports | volume = 17 | issue = 9 | pages = 1250–1253 | date = September 2016 | pmid = 27470237 | pmc = 5007563 | doi = 10.15252/embr.201643041 }}</ref>

It has become very prevalent that many college students undergo some sort of mental disorder in their early adulthood. Anxiety has become one of the main ones that has grown in prevalence over time. This is due to many issues such as different social pressures, school, career worries, etc. This has not only affected a lot of the youth in today's world but their overall quality of life. However, it is important to bring this issue to light since there is such a negative stigma when it comes to mental health; but rather than ignoring it and letting the issue grow exponentially larger, it is important to recognize ways that it can be lessened for future generations.<ref>{{cite journal |last1=Baik |first1=Seung Yeon |last2=Shin |first2=Ki Eun |last3=Fitzsimmons-Craft |first3=Ellen E. |last4=Eisenberg |first4=Daniel |last5=Wilfley |first5=Denise E. |last6=Taylor |first6=C. Barr |last7=Newman |first7=Michelle G. |title=The relationship of race, ethnicity, gender identity, sex assigned at birth, sexual orientation, parental education, financial hardship and comorbid mental disorders with quality of life in college students with anxiety, depression or eating disorders |journal=Journal of Affective Disorders |date=December 2024 |volume=366 |pages=335–344 |doi=10.1016/j.jad.2024.08.098 |pmid=39173926 |pmc=11444337 }}</ref>

Stigma can be described in three conceptual ways: cognitive, emotional, and behavioral. This allows for differentiation between stereotypes, prejudice, and discrimination.<ref name="Rossler 2016"/>

==Treatment==
Treatment options include [[psychotherapy]], medications and lifestyle changes. There is no clear evidence as to whether psychotherapy or medication is more effective; the specific medication decision can be made by a doctor and patient with consideration for the patient's specific circumstances and symptoms.<ref name="NEJM20152">{{cite journal | vauthors = Stein MB, Sareen J | title = CLINICAL PRACTICE. Generalized Anxiety Disorder | journal = The New England Journal of Medicine | volume = 373 | issue = 21 | pages = 2059–2068 | date = November 2015 | pmid = 26580998 | doi = 10.1056/nejmcp1502514 }}</ref> If, while on treatment with a chosen medication, the person's anxiety does not improve, another medication may be offered.<ref name="NEJM20152"/> Specific treatments will vary by sub-type of anxiety disorder, a person's other medical conditions, and medications.

===Psychological techniques===
[[Cognitive behavioral therapy]] (CBT) is effective for anxiety disorders and is a first-line treatment.<ref name="NEJM20152"/><ref>{{cite journal | vauthors = Cuijpers P, Sijbrandij M, Koole S, Huibers M, Berking M, Andersson G | title = Psychological treatment of generalized anxiety disorder: a meta-analysis | journal = Clinical Psychology Review | volume = 34 | issue = 2 | pages = 130–140 | date = March 2014 | pmid = 24487344 | doi = 10.1016/j.cpr.2014.01.002 }}</ref><ref>{{cite journal | vauthors = Otte C | title = Cognitive behavioral therapy in anxiety disorders: current state of the evidence | journal = Dialogues in Clinical Neuroscience | volume = 13 | issue = 4 | pages = 413–421 | year = 2011 | pmid = 22275847 | pmc = 3263389 | doi = 10.31887/DCNS.2011.13.4/cotte }}</ref><ref>{{cite journal | vauthors = Pompoli A, Furukawa TA, Imai H, Tajika A, Efthimiou O, Salanti G | title = Psychological therapies for panic disorder with or without agoraphobia in adults: a network meta-analysis | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | issue = 4 | article-number = CD011004 | date = April 2016 | pmid = 27071857 | pmc = 7104662 | doi = 10.1002/14651858.CD011004.pub2 }}</ref><ref name=Ol2016>{{cite journal | vauthors = Olthuis JV, Watt MC, Bailey K, Hayden JA, Stewart SH | title = Therapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | issue = 3 | article-number = CD011565 | date = March 2016 | pmid = 26968204 | pmc = 7077612 | doi = 10.1002/14651858.CD011565.pub2 }}</ref>{{Excessive citations inline|date=September 2021}} CBT is the most widely studied and preferred form of psychotherapy for anxiety disorders.<ref name="Szuhany 2022" /> 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 | vauthors = Mayo-Wilson E, Montgomery P | title = Media-delivered cognitive behavioural therapy and behavioural therapy (self-help) for anxiety disorders in adults | journal = The Cochrane Database of Systematic Reviews | issue = 9 | article-number = CD005330 | date = September 2013 | pmid = 24018460 | doi = 10.1002/14651858.CD005330.pub4 | pmc = 11694413 }}</ref> There are specific CBT curriculums or strategies for the specific type of anxiety disorder. CBT has similar effectiveness to pharmacotherapy and in a meta analysis, CBT was associated with medium to large benefit effect sizes for GAD, panic disorder and social anxiety disorder.<ref name="Szuhany 2022" /> CBT has low dropout rates and its positive effects have been shown to be maintained at least for 12 months. CBT is sometimes given as once weekly sessions for 8–20 weeks, but regimens vary widely. Booster sessions may need to be restarted for patients who have a relapse of symptoms.<ref name="Szuhany 2022" />

[[Exposure_therapy#Exposure_and_response_prevention_(ERP)|Exposure and response prevention (ERP)]] has been found effective for treating OCD.<ref>{{Cite journal |last1=Hezel |first1=Dianne M |last2=Simpson |first2=H Blair |date=January 2019 |title=Exposure and response prevention for obsessive-compulsive disorder: A review and new directions |journal=Indian Journal of Psychiatry |language=en |volume=61 |issue=Suppl 1 |pages=S85–S92 |doi=10.4103/psychiatry.IndianJPsychiatry_516_18 |doi-access=free |pmid=30745681 |pmc=6343408 }}</ref>

[[Mindfulness]]-based programs also appear to be effective for managing anxiety disorders.<ref name="Roemer">{{cite journal | vauthors = Roemer L, Williston SK, Eustis EH, Orsillo SM | title = Mindfulness and acceptance-based behavioral therapies for anxiety disorders | journal = Current Psychiatry Reports | volume = 15 | issue = 11 | article-number = 410 | date = November 2013 | pmid = 24078067 | doi = 10.1007/s11920-013-0410-3 }}</ref><ref name="Lang">{{cite journal | vauthors = Lang AJ | title = What mindfulness brings to psychotherapy for anxiety and depression | journal = Depression and Anxiety | volume = 30 | issue = 5 | pages = 409–412 | date = May 2013 | pmid = 23423991 | doi = 10.1002/da.22081 | doi-access = free }}</ref> It is unclear if meditation has an effect on anxiety, and [[transcendental meditation]] appears to be no different from other types of meditation.<ref>{{cite journal | vauthors = Krisanaprakornkit T, Krisanaprakornkit W, Piyavhatkul N, Laopaiboon M | title = Meditation therapy for anxiety disorders | journal = The Cochrane Database of Systematic Reviews | issue = 1 | article-number = CD004998 | date = January 2006 | pmid = 16437509 | doi = 10.1002/14651858.CD004998.pub2 }}</ref>

A 2015 [[Cochrane review]] of [[Morita therapy]] for anxiety disorder in adults found insufficient evidence of an effect.<ref>{{cite journal |vauthors=Wu H, Yu D, He Y, Wang J, Xiao Z, Li C |date=February 2015 |title=Morita therapy for anxiety disorders in adults |journal=The Cochrane Database of Systematic Reviews |volume=2015 |issue=2 |article-number=CD008619 |doi=10.1002/14651858.CD008619.pub2 |pmc=10907974 |pmid=25695214}}</ref>

===Medications===
First-line choices for medications include [[Selective serotonin reuptake inhibitor|SSRIs]] or [[Serotonin–norepinephrine reuptake inhibitor|SNRIs]] to treat generalized anxiety disorder, social anxiety disorder or panic disorder.<ref name="Szuhany 2022" /><ref name="NEJM20152"/><ref name="Bald2005">{{cite journal | vauthors = Baldwin DS, Anderson IM, Nutt DJ, Allgulander C, Bandelow B, den Boer JA, Christmas DM, Davies S, Fineberg N, Lidbetter N, Malizia A, McCrone P, Nabarro D, O'Neill C, Scott J, van der Wee N, Wittchen HU | 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 | volume = 28 | issue = 5 | pages = 403–439 | date = May 2014 | pmid = 24713617 | doi = 10.1177/0269881114525674 | url = https://tud.qucosa.de/api/qucosa%3A35384/attachment/ATT-0/ }}</ref> For adults, there is no good evidence supporting which specific medication in the SSRI or SNRI class is best for treating anxiety, so cost often drives drug choice.<ref name="NEJM20152"/><ref name="Bald20052">{{cite journal | vauthors = Baldwin DS, Anderson IM, Nutt DJ, Allgulander C, Bandelow B, den Boer JA, Christmas DM, Davies S, Fineberg N, Lidbetter N, Malizia A, McCrone P, Nabarro D, O'Neill C, Scott J, van der Wee N, Wittchen HU | 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 | volume = 28 | issue = 5 | pages = 403–439 | date = May 2014 | pmid = 24713617 | doi = 10.1177/0269881114525674 | url = https://tud.qucosa.de/id/qucosa%3A35384 }}</ref> [[Fluvoxamine]] is effective in treating a range of anxiety disorders in children and adolescents.<ref name=Kwint2022>{{cite journal | vauthors = Kwint J  |title=Antidepressants for children and teenagers: what works for anxiety and depression? |journal=NIHR Evidence |date=November 2022 |doi=10.3310/nihrevidence_53342 |doi-access=free }}</ref><ref name="Boaden_2020">{{cite journal | vauthors = Boaden K, Tomlinson A, Cortese S, Cipriani A | title = Antidepressants in Children and Adolescents: Meta-Review of Efficacy, Tolerability and Suicidality in Acute Treatment | journal = Frontiers in Psychiatry | volume = 11 | article-number = 717 | date = 2 September 2020 | pmid = 32982805 | pmc = 7493620 | doi = 10.3389/fpsyt.2020.00717 | doi-access = free }}</ref><ref name="Correll_2021">{{cite journal | vauthors = Correll CU, Cortese S, Croatto G, Monaco F, Krinitski D, Arrondo G, Ostinelli EG, Zangani C, Fornaro M, Estradé A, Fusar-Poli P, Carvalho AF, Solmi M | title = Efficacy and acceptability of pharmacological, psychosocial, and brain stimulation interventions in children and adolescents with mental disorders: an umbrella review | journal = World Psychiatry | volume = 20 | issue = 2 | pages = 244–275 | date = June 2021 | pmid = 34002501 | pmc = 8129843 | doi = 10.1002/wps.20881 }}</ref> [[Fluoxetine]], [[sertraline]], and [[paroxetine]] can also help with some forms of anxiety in children and adolescents.<ref name=Kwint2022/><ref name="Boaden_2020" /><ref name="Correll_2021" /> If the chosen medicine is effective, it is recommended that it be continued for at least a year to mitigate the risk of a relapse.<ref name="Szuhany 2022" /><ref name="Batelaan Bosman Muntingh et al 2017">{{cite journal | vauthors = Batelaan NM, Bosman RC, Muntingh A, Scholten WD, Huijbregts KM, van Balkom AJ | 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 | article-number = j3927 | date = September 2017 | pmid = 28903922 | pmc = 5596392 | doi = 10.1136/bmj.j3927 }}</ref>

Benzodiazepines are a second line option for the pharmacologic treatment of anxiety. Benzodiazepines are associated with moderate to high effect sizes with regard to symptom relief and they have an onset usually within 1 week.<ref name="Szuhany 2022" /> Clonazepam has a longer half life and may possibly be used as once per day dosing.<ref name="Szuhany 2022" /> Benzodiazepines may also be used with SNRIs or SSRIs to initially reduce anxiety symptoms, and they may potentially be continued long term. Benzodiazepines are not a first line pharmacologic treatment of anxiety disorders and they carry risks of [[physical dependence]], [[psychological dependence]], [[Opioid overdose|overdose death]] (especially when combined with opioids), misuse, [[cognitive impairment]], falls and motor vehicle crashes.<ref name="Szuhany 2022" /><ref name="Thomas 1998">{{cite journal |last1=Thomas |first1=RE |title=Benzodiazepine use and motor vehicle accidents. Systematic review of reported association. |journal=Canadian Family Physician |date=April 1998 |volume=44 |pages=799–808 |pmid=9585853|pmc=2277821 }}</ref>

[[Buspirone]] and [[pregabalin]] are second-line treatments for people who do not respond to SSRIs or SNRIs. Pregabalin and [[gabapentin]] are effective in treating some anxiety disorders, but there is concern regarding their off-label use due to the lack of strong scientific evidence for their efficacy in multiple conditions and their proven side effects.<ref name=":12">{{cite journal | vauthors = Hong JS, Atkinson LZ, Al-Juffali N, Awad A, Geddes JR, Tunbridge EM, Harrison PJ, Cipriani A | title = Gabapentin and pregabalin in bipolar disorder, anxiety states, and insomnia: Systematic review, meta-analysis, and rationale | journal = Molecular Psychiatry | volume = 27 | issue = 3 | pages = 1339–1349 | date = March 2022 | pmid = 34819636 | pmc = 9095464 | doi = 10.1038/s41380-021-01386-6 }}</ref>

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 for [[specific phobia]]s, but [[benzodiazepines]] are sometimes used to help resolve acute episodes. In 2007, data were sparse for the efficacy of any drug.<ref>{{cite journal | vauthors = Choy Y, Fyer AJ, Lipsitz JD | title = Treatment of specific phobia in adults | journal = Clinical Psychology Review | volume = 27 | issue = 3 | pages = 266–286 | date = April 2007 | pmid = 17112646 | doi = 10.1016/j.cpr.2006.10.002 }}</ref>

===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="NEJM20152"/> Stopping smoking has benefits for anxiety as great as or greater than those of medications.<ref>{{cite journal | vauthors = Taylor G, McNeill A, Girling A, Farley A, Lindson-Hawley N, Aveyard P | title = Change in mental health after smoking cessation: systematic review and meta-analysis | journal = BMJ | volume = 348 | issue = feb13 1 | article-number = g1151 | date = February 2014 | pmid = 24524926 | pmc = 3923980 | doi = 10.1136/bmj.g1151 }}</ref> A meta-analysis found 2000&nbsp;mg/day or more of omega-3 polyunsaturated fatty acids, such as fish oil, tended to reduce anxiety in placebo-controlled and uncontrolled studies, particularly in people with more significant symptoms.<ref name="SuTseng2018">{{cite journal | vauthors = Su KP, Tseng PT, Lin PY, Okubo R, Chen TY, Chen YW, Matsuoka YJ | title = Association of Use of Omega-3 Polyunsaturated Fatty Acids With Changes in Severity of Anxiety Symptoms: A Systematic Review and Meta-analysis | journal = JAMA Network Open | volume = 1 | issue = 5 | pages = e182327 | date = September 2018 | pmid = 30646157 | pmc = 6324500 | doi = 10.1001/jamanetworkopen.2018.2327 }}</ref>

===Cannabis===
{{as of|2019}}, there is little evidence for the use of [[cannabis]] in treating anxiety disorders.<ref>{{cite journal | vauthors = Black N, Stockings E, Campbell G, Tran LT, Zagic D, Hall WD, Farrell M, Degenhardt L | 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 = December 2019 | pmid = 31672337 | pmc = 6949116 | doi = 10.1016/S2215-0366(19)30401-8 }}</ref>

===Treatments for children ===
Both therapy and a number of medications have been found to be useful for treating childhood anxiety disorders.<ref name=Wang2017>{{cite journal | vauthors = Wang Z, Whiteside SP, Sim L, Farah W, Morrow AS, Alsawas M, Barrionuevo P, Tello M, Asi N, Beuschel B, Daraz L, Almasri J, Zaiem F, Larrea-Mantilla L, Ponce OJ, LeBlanc A, Prokop LJ, Murad MH | title = Comparative Effectiveness and Safety of Cognitive Behavioral Therapy and Pharmacotherapy for Childhood Anxiety Disorders: A Systematic Review and Meta-analysis | journal = JAMA Pediatrics | volume = 171 | issue = 11 | pages = 1049–1056 | date = November 2017 | pmid = 28859190 | pmc = 5710373 | doi = 10.1001/jamapediatrics.2017.3036 }}</ref> Therapy is generally preferred to medication.<ref name="Higa-McMillan"/>

[[Cognitive behavioral therapy]] (CBT) is a good first-line therapy approach.<ref name="Higa-McMillan">{{cite journal | vauthors = Higa-McMillan CK, Francis SE, Rith-Najarian L, Chorpita 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 | pages = 91–113 | date = 3 March 2016 | 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 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 | vauthors = James AC, James G, Cowdrey FA, Soler A, Choke A | title = Cognitive behavioural therapy for anxiety disorders in children and adolescents | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 2 | article-number = CD004690 | date = February 2015 | pmid = 25692403 | pmc = 6491167 | doi = 10.1002/14651858.CD004690.pub4 }}</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. [[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 | vauthors = Kozlowska K, Hanney L |title=Family Assessment and Intervention Using an Interactive Art Exercise |journal=Australian and New Zealand Journal of Family Therapy |date=June 1999 |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 | vauthors = Creswell C, Cruddace S, Gerry S, Gitau R, McIntosh E, Mollison J, Murray L, Shafran R, Stein A, Violato M, Voysey M, Willetts L, Williams N, Yu LM, Cooper PJ | title = Treatment of childhood anxiety disorder in the context of maternal anxiety disorder: a randomised controlled trial and economic analysis | journal = Health Technology Assessment | volume = 19 | issue = 38 | pages = 1–184, vii–viii | date = May 2015 | pmid = 26004142 | pmc = 4781330 | doi = 10.3310/hta19380 }}</ref><ref>{{cite book |doi=10.1037/10439-012 |chapter=Humanistic play therapy |title=Humanistic psychotherapies: Handbook of research and practice |year=2002 | vauthors = Bratton SC, Ray D |pages=369–402 |isbn=978-1-55798-787-7 }}</ref>

==Epidemiology==
Globally, as of 2010, approximately 273&nbsp;million (4.5% of the population) had an anxiety disorder.<ref name=LancetEpi2012>{{cite journal | vauthors = Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, Basáñez MG, Baxter A, Bell ML, Benjamin EJ, Bennett D, Bernabé E, Bhalla K, Bhandari B, Bikbov B, Bin Abdulhak A, Birbeck G, Black JA, Blencowe H, Blore JD, Blyth F, Bolliger I, Bonaventure A, Boufous S, Bourne R, Boussinesq M, Braithwaite T, Brayne C, Bridgett L, Brooker S, Brooks P, Brugha TS, Bryan-Hancock C, Bucello C, Buchbinder R, Buckle G, Budke CM, Burch M, Burney P, Burstein R, Calabria B, Campbell B, Canter CE, Carabin H, Carapetis J, Carmona L, Cella C, Charlson F, Chen H, Cheng AT, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahiya M, Dahodwala N, Damsere-Derry J, Danaei G, Davis A, De Leo D, Degenhardt L, Dellavalle R, Delossantos A, Denenberg J, Derrett S, Des Jarlais DC, Dharmaratne SD, Dherani M, Diaz-Torne C, Dolk H, Dorsey ER, Driscoll T, Duber H, Ebel B, Edmond K, Elbaz A, Ali SE, Erskine H, Erwin PJ, Espindola P, Ewoigbokhan SE, Farzadfar F, Feigin V, Felson DT, Ferrari A, Ferri CP, Fèvre EM, Finucane MM, Flaxman S, Flood L, Foreman K, Forouzanfar MH, Fowkes FG, Franklin R, Fransen M, Freeman MK, Gabbe BJ, Gabriel SE, Gakidou E, Ganatra HA, Garcia B, Gaspari F, Gillum RF, Gmel G, Gosselin R, Grainger R, Groeger J, Guillemin F, Gunnell D, Gupta R, Haagsma J, Hagan H, Halasa YA, Hall W, Haring D, Haro JM, Harrison JE, Havmoeller R, Hay RJ, Higashi H, Hill C, Hoen B, Hoffman H, Hotez PJ, Hoy D, Huang JJ, Ibeanusi SE, Jacobsen KH, James SL, Jarvis D, Jasrasaria R, Jayaraman S, Johns N, Jonas JB, Karthikeyan G, Kassebaum N, Kawakami N, Keren A, Khoo JP, King CH, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lalloo R, Laslett LL, Lathlean T, Leasher JL, Lee YY, Leigh J, Lim SS, Limb E, Lin JK, Lipnick M, Lipshultz SE, Liu W, Loane M, Ohno SL, Lyons R, Ma J, Mabweijano J, MacIntyre MF, Malekzadeh R, Mallinger L, Manivannan S, Marcenes W, March L, Margolis DJ, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGill N, McGrath J, Medina-Mora ME, Meltzer M, Mensah GA, Merriman TR, Meyer AC, Miglioli V, Miller M, Miller TR, Mitchell PB, Mocumbi AO, Moffitt TE, Mokdad AA, Monasta L, Montico M, Moradi-Lakeh M, Moran A, Morawska L, Mori R, Murdoch ME, Mwaniki MK, Naidoo K, Nair MN, Naldi L, Narayan KM, Nelson PK, Nelson RG, Nevitt MC, Newton CR, Nolte S, Norman P, Norman R, O'Donnell M, O'Hanlon S, Olives C, Omer SB, Ortblad K, Osborne R, Ozgediz D, Page A, Pahari B, Pandian JD, Rivero AP, Patten SB, Pearce N, Padilla RP, Perez-Ruiz F, Perico N, Pesudovs K, Phillips D, Phillips MR, Pierce K, Pion S, Polanczyk GV, Polinder S, Pope CA, Popova S, Porrini E, Pourmalek F, Prince M, Pullan RL, Ramaiah KD, Ranganathan D, Razavi H, Regan M, Rehm JT, Rein DB, Remuzzi G, Richardson K, Rivara FP, Roberts T, Robinson C, De Leòn FR, Ronfani L, Room R, Rosenfeld LC, Rushton L, Sacco RL, Saha S, Sampson U, Sanchez-Riera L, Sanman E, Schwebel DC, Scott JG, Segui-Gomez M, Shahraz S, Shepard DS, Shin H, Shivakoti R, Singh D, Singh GM, Singh JA, Singleton J, Sleet DA, Sliwa K, Smith E, Smith JL, Stapelberg NJ, Steer A, Steiner T, Stolk WA, Stovner LJ, Sudfeld C, Syed S, Tamburlini G, Tavakkoli M, Taylor HR, Taylor JA, Taylor WJ, Thomas B, Thomson WM, Thurston GD, Tleyjeh IM, Tonelli M, Towbin JA, Truelsen T, Tsilimbaris MK, Ubeda C, Undurraga EA, van der Werf MJ, van Os J, Vavilala MS, Venketasubramanian N, Wang M, Wang W, Watt K, Weatherall DJ, Weinstock MA, Weintraub R, Weisskopf MG, Weissman MM, White RA, Whiteford H, Wiersma ST, Wilkinson JD, Williams HC, Williams SR, Witt E, Wolfe F, Woolf AD, Wulf S, Yeh PH, Zaidi AK, Zheng ZJ, Zonies D, Lopez AD, Murray CJ, AlMazroa MA, Memish ZA | 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 | volume = 380 | issue = 9859 | pages = 2163–2196 | date = December 2012 | pmid = 23245607 | pmc = 6350784 | doi = 10.1016/S0140-6736(12)61729-2 }}</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 = Archives of General 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 | veditors = Simpson HB, Neria Y, Lewis-Fernández R, Schneier F |doi=10.1017/CBO9780511777578.004 |chapter=Evolving concepts of anxiety |title=Anxiety Disorders |year=2010 |pages=6–68 |publisher=Cambridge University Press |isbn=978-0-511-77757-8 }}</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 |doi=10.1016/B978-0-12-394427-6.00006-6 |chapter=Social Anxiety and Social Anxiety Disorder Across Cultures |title=Social Anxiety |year=2014 | vauthors = Brockveld KC, Perini SJ, Rapee RM |pages=141–158 |isbn=978-0-12-394427-6 }}</ref><ref name="Hofmann2010">{{cite journal | vauthors = Hofmann SG, Anu Asnaani MA, Hinton DE | title = Cultural aspects in social anxiety and social anxiety disorder | journal = Depression and Anxiety | volume = 27 | issue = 12 | pages = 1117–1127 | date = December 2010 | pmid = 21132847 | pmc = 3075954 | doi = 10.1002/da.20759 }}</ref> In general, anxiety disorders represent the most prevalent psychiatric condition in the United States, outside of [[substance use disorder]].<ref name="nejm 2014 on generalized anxiety">{{cite journal | vauthors = Fricchione G | title = Clinical practice. Generalized anxiety disorder | journal = The New England Journal of Medicine | volume = 351 | issue = 7 | pages = 675–682 | date = August 2004 | pmid = 15306669 | doi = 10.1056/NEJMcp022342 }}</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 | vauthors = Essau C |title=Child and Adolescent Psychopathology: Theoretical and Clinical Implications |date=2006 |publisher=Routledge |isbn=978-1-58391-834-0 |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 [[attention deficit hyperactivity disorder]], or, due to the tendency of children to interpret their emotions physically (as stomachaches, headaches, etc.), anxiety disorders may initially be confused with physical ailments.<ref name="GAD Children Anxiety Canada">{{cite web |title=Generalized Anxiety Disorder in Children |url=https://www.anxietycanada.com/disorders/generalized-anxiety-disorder-in-children/ |website=Anxiety Canada }}</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 [[autism spectrum disorder]].<ref>{{cite web| vauthors = Merrill A |title=Anxiety and Autism Spectrum Disorders|url=http://www.iidc.indiana.edu/?pageId=3616|website=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 | vauthors = Guignard JH, Jacquet AY, Lubart TI | title = Perfectionism and anxiety: a paradox in intellectual giftedness? | journal = PLOS ONE | volume = 7 | issue = 7 | article-number = e41043 | year = 2012 | pmid = 22859964 | pmc = 3408483 | doi = 10.1371/journal.pone.0041043 | doi-access = free | bibcode = 2012PLoSO...741043G }}</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 journal | vauthors = Rapee RM, Schniering CA, Hudson JL | title = Anxiety disorders during childhood and adolescence: origins and treatment | journal = Annual Review of Clinical Psychology | volume = 5 | issue = 1 | pages = 311–341 | date = April 2009 | pmid = 19152496 | doi = 10.1146/annurev.clinpsy.032408.153628 }}</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="GAD Children Anxiety Canada" />

According to a 2011 study, people who rank highly in hypercompetitive traits are at increased risk of both anxiety and depression.<ref>{{cite journal |last1=Swab |first1=R. Gabrielle |last2=Johnson |first2=Paul D. |title=Steel sharpens steel: A review of multilevel competition and competitiveness in organizations |journal=Journal of Organizational Behavior |date=February 2019 |volume=40 |issue=2 |pages=147–165 |doi=10.1002/job.2340 }}</ref>

== See also ==
{{Div col|colwidth=25em|content=
* [[Exposure therapy]]
* [[List of investigational anxiety disorder drugs]]
* [[Mixed anxiety–depressive disorder]]
* [[Symptoms of victimization]]
}}

== 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
}}

* [https://www.who.int/news-room/fact-sheets/detail/anxiety-disorders WHO fact sheet on anxiety disorders]

{{Mental and behavioral disorders|selected = neurotic}}
{{Digital media use and mental health}}
{{Autism spectrum}}
{{Authority control}}

[[Category:Anxiety disorders| ]]
[[Category:Wikipedia medicine articles ready to translate]]
[[Category:Wikipedia neurology articles ready to translate]]