Anxiety disorders are a cluster of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal functions are significantly impaired. Anxiety may cause physical and cognitive symptoms, such as restlessness, irritability, easy fatigue, difficulty concentrating, increased heart rate, chest pain, abdominal pain, and a variety of other symptoms that may vary based on the individual.
|The Scream (Norwegian: Skrik) a painting by Norwegian artist Edvard Munch|
|Specialty||Psychiatry, clinical psychology|
|Symptoms||Worrying, fast heart rate, shakiness|
|Complications||Depression, trouble sleeping, poor quality of life, substance use disorder, alcohol use disorder, suicide|
|Usual onset||15–35 years old|
|Duration||Over 6 months|
|Causes||Genetic, environmental, and psychological factors|
|Risk factors||Child abuse, family history, poverty|
|Diagnostic method||Psychological assessment|
|Differential diagnosis||Hyperthyroidism; heart disease; caffeine, alcohol, cannabis use; withdrawal from certain drugs|
|Treatment||Lifestyle changes, counselling, medications|
|Medication||Benzodiazepines, antidepressants, anxiolytics, beta blockers, pregabalin|
|Frequency||12% per year|
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. The umbrella term 'anxiety disorder' refers to a number of specific disorders that include fears (phobias) and/or anxiety symptoms.
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. Individual disorders can be diagnosed using the specific and unique symptoms, triggering events, and timing of a given person. 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. 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.
Anxiety disorders are the most common type of mental disorder. They affect nearly 30% of adults at some point in their lives. However, anxiety disorders are treatable, and a number of effective treatments are available. Most people are able to lead normal, productive lives with some form of treatment.
Generalized anxiety disorder edit
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". Generalized anxiety disorder is the most common anxiety disorder to affect older adults. 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. 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. A symptom can be a strained appearance, with increased sweating from the hands, feet, and axillae, along with tearfulness, which can suggest depression. Before a diagnosis of anxiety disorder is made, physicians must rule out drug-induced anxiety and other medical causes.
Specific phobias edit
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. According to the National Institute of Mental Health, a phobia is an intense fear of or aversion to specific objects or situations. 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 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. 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.
Panic disorder edit
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 APA as fear or discomfort that abruptly arises and peaks in less than ten minutes but can last for several hours. 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).
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. 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. 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 edit
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. Social anxiety often manifests specific physical symptoms, including blushing, sweating, rapid heart rate, and difficulty speaking. 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.
Social physique anxiety (SPA) is a sub-type of social anxiety involving concern over the evaluation of one's body by others. SPA is common among adolescents, especially females.
Post-traumatic stress disorder edit
Post-traumatic stress disorder (PTSD) was once an anxiety disorder (now moved to trauma- and stressor-related disorders in the 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. 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—for example, soldiers who endure individual battles but cannot cope with continuous combat. Common symptoms include hypervigilance, flashbacks, avoidant behaviors, anxiety, anger, and depression. In addition, individuals may experience sleep disturbances. 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.
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 PTSD.
Separation anxiety disorder edit
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. 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. Treating a child earlier may prevent problems. This may include training the parents and family on how to deal with it. Often, the parents will reinforce the anxiety because they do not know how to properly work through it with the child. In addition to parent training and family therapy, medication, such as SSRIs, can be used to treat separation anxiety.
Obsessive–compulsive disorder edit
Obsessive–compulsive disorder (OCD) is not an anxiety disorder in the DSM-5 or the ICD-11. However, it was classified as such in older versions of the DSM-IV and ICD-10. OCD manifests in the form of obsessions (distressing, persistent, and intrusive thoughts or images) and 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. OCD affects roughly 1–2% of adults (somewhat more women than men) and under 3% of children and adolescents.
A person with OCD knows that the symptoms are unreasonable and struggles against both the thoughts and the behavior. 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. 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.
It is not certain why some people have OCD, but behavioral, cognitive, genetic, and neurobiological factors may be involved. Risk factors include family history, being single, being of a higher socioeconomic class, or not being in paid employment. 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%).
Selective mutism edit
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. People with selective mutism stay silent even when the consequences of their silence include shame, social ostracism, or even punishment. Selective mutism affects about 0.8% of people at some point in their lives.
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. Generally, cognitive behavioral therapy (CBT) is the recommended approach for treating selective mutism, but prospective long-term outcome studies are lacking.
The diagnosis of anxiety disorders is made by symptoms, triggers, and a person's personal and family histories. There are no objective biomarkers or laboratory tests that can diagnose anxiety. 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.
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.
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. 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). 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).
Differential diagnosis edit
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.
The diagnosis of an anxiety disorder requires first ruling out an underlying medical cause. Diseases that may present similar to an anxiety disorder include certain endocrine diseases (hypo- and hyperthyroidism, hyperprolactinemia), metabolic disorders (diabetes), deficiency states (low levels of vitamin D, B2, B12, folic acid), gastrointestinal diseases (celiac disease, non-celiac gluten sensitivity, inflammatory bowel disease), heart diseases, blood diseases (anemia), and brain degenerative diseases (Parkinson's disease, dementia, multiple sclerosis, Huntington's disease).
Several drugs can also cause or worsen anxiety, whether through intoxication, withdrawal, or chronic use. These include alcohol, tobacco, cannabis, sedatives (including prescription benzodiazepines), opioids (including prescription painkillers and illicit drugs like heroin), stimulants (such as caffeine, cocaine, and amphetamines), hallucinogens, and inhalants.
Focus is increasing on the prevention of anxiety disorders. There is tentative evidence to support the use of cognitive behavioral therapy and mindfulness therapy. A 2013 review found no effective measures to prevent GAD in adults. A 2017 review found that psychological and educational interventions had a small benefit for the prevention of anxiety. Research indicates that predictors of the emergence of anxiety disorders partly differ from the factors that predict their persistence.
Perception and discrimination edit
People with an anxiety disorder may be challenged by prejudices and stereotypes that the world believes, most likely as a result of misconceptions around anxiety and anxiety disorders. 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. 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.
There are two prevalent types of stigma that surround anxiety disorders: public stigma and self-stigma. Public stigma in this context is the reaction that the general population has to people with an anxiety disorder. Self-stigma is described as the prejudice that people with mental illness turn against themselves.
There is no explicit evidence that announces the exact cause of stigma towards anxiety; however, there are three highlighted perspectives. 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.
Stigma can be described in three conceptual ways: cognitive, emotional, and behavioral. This allows for differentiation between stereotypes, prejudice, and discrimination.
Treatment options include lifestyle changes, 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 for the patient's specific circumstances and symptoms. If, while on treatment with a chosen medication, the person's anxiety does not improve, another medication may be offered. Specific treatments will vary by sub-type of anxiety disorder, a person's other medical conditions, and medications.
Lifestyle and diet edit
Lifestyle changes include exercise, for which there is moderate evidence for some improvement, regularizing sleep patterns, reducing caffeine intake, and stopping smoking. Stopping smoking has benefits for anxiety as great as or greater than those of medications. Omega-3 polyunsaturated fatty acids, such as fish oil, may reduce anxiety, particularly in those with more significant symptoms. Foods rich in zinc, such as oysters, cashews, liver, beef, and egg yolks, have been linked to lowered anxiety.
Cognitive behavioral therapy (CBT) is effective for anxiety disorders and is a first-line treatment.[excessive citations] CBT appears to be equally effective when carried out via the internet compared to sessions completed face-to-face.
Mindfulness-based programs also appear to be effective for managing anxiety disorders. It is unclear if meditation has an effect on anxiety, and transcendental meditation appears to be no different from other types of meditation.
Adventure-based counseling can be an effective way to treat anxiety. Using rock-climbing as an example, climbing can often bring on fear or frustration, and tackling these negative feelings in a nurturing environment can help people develop the coping mechanisms necessary to deal with these negative feelings.
First-line choices for medications include SSRIs or SNRIs to treat generalized anxiety disorder. 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. Fluvoxamine is effective in treating a range of anxiety disorders in children and adolescents. Fluoxetine, sertraline, and paroxetine can also help with some forms of anxiety in children and adolescents. If the chosen medicine is effective, it is recommended that it be continued for at least a year. Stopping medication results in a greater risk of relapse.
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.
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.
In general, medications are not seen as helpful for specific phobias, but benzodiazepines are sometimes used to help resolve acute episodes. In 2007, data were sparse for the efficacy of any drug.
Cognitive behavioral therapy (CBT) is a good first-line therapy approach. 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. Although studies have demonstrated the effectiveness of CBT for anxiety disorders in children and adolescents, evidence that it is more effective than treatment as usual, medication, or wait list controls is inconclusive. 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. 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. 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.
If a medication option is warranted, antidepressants such as SSRIs and SNRIs can be effective. Fluvoxamine is effective in treating a range of anxiety disorders in children and adolescents. Minor side effects with medications, however, are common.
In Europe, Africa, and Asia, lifetime rates of anxiety disorders are between 9 and 16%, and yearly rates are between 4 and 7%. In the United States, the lifetime prevalence of anxiety disorders is about 29%, and between 11 and 18% of adults have the condition in a given year. This difference is affected by the range of ways in which different cultures interpret anxiety symptoms and what they consider to be normative behavior. In general, anxiety disorders represent the most prevalent psychiatric condition in the United States, outside of substance use disorder.
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, 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.
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. Gifted children are also often more prone to excessive anxiety than non-gifted children. 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.
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.
According to 2011 study, people who high in hypercompetitive traits are at increased risk of both anxiety and depression.
See also edit
- Aspden, Peter (20 April 2012). "So, what does 'The Scream' mean?". Financial Times. ProQuest 1008665027.
- Diagnostic and statistical manual of mental disorders 5th edition: DSM-5. Arlington, VA Washington, D.C: American Psychiatric Association. 2013. p. 189–195. ISBN 978-0-89042-555-8. OCLC 830807378.
- "Anxiety disorders – Symptoms and causes". Mayo Clinic. Retrieved 23 May 2019.
- Craske, Michelle G; Stein, Murray B (December 2016). "Anxiety". The Lancet. 388 (10063): 3048–3059. doi:10.1016/S0140-6736(16)30381-6. PMID 27349358. S2CID 208789585.
- "Anxiety Disorders". NIMH. March 2016. Archived from the original on 27 July 2016. Retrieved 14 August 2016.
- Testa, A.; Giannuzzi, R.; Daini, S.; Bernardini, L.; Petrongolo, L.; Gentiloni Silveri, N. (February 2013). "Psychiatric emergencies (part III): psychiatric symptoms resulting from organic diseases" (PDF). European Review for Medical and Pharmacological Sciences. 17 Suppl 1: 86–99. PMID 23436670.
- Kessler; et al. (2007). "Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization's World Mental Health Survey Initiative". World Psychiatry. 6 (3): 168–76. PMC 2174588. PMID 18188442.
- Pharmacological treatment of mental disorders in primary health care. World Health Organization. 2009. hdl:10665/44095. ISBN 978-92-4-154769-7.[page needed]
- "What are Anxiety Disorders?". American Psychiatric Association.
- Schacter, Daniel L.; Gilbert, Daniel T.; Wegner, Daniel M. (2011). Psychology. Macmillan. ISBN 978-1-4292-3719-2.[page needed]
- Calleo, Jessica; Stanley, Melinda (1 July 2008). "Anxiety disorders in later life: differentiated diagnosis and treatment strategies". Psychiatric Times. 25 (8): 24. Gale CA181302423.
- Barker, Phil (2003). Psychiatric and Mental Health Nursing: The Craft of Caring. Taylor & Francis. ISBN 978-0-340-81026-2.[page needed]
- Passer, Michael W.; Bremner, Andy; Smith, Ronald E.; Holt, Nigel; Vliek, Michael; Sutherland, Ed (2009). Psychology: The Science of Mind and Behaviour. McGraw-Hill Higher Education. p. 790. ISBN 978-0-07-711836-5.
- "All About Anxiety Disorders: From Causes to Treatment and Prevention". Archived from the original on 17 February 2016. Retrieved 18 February 2016.
- Gelder, Michael G.; Mayou, Richard; Geddes, John (2005). Psychiatry. Oxford University Press. p. 75. ISBN 978-0-19-852863-0.
- Varcarolis, Elizabeth M. (2010). Manual of Psychiatric Nursing Care Planning. Elsevier Health Sciences. p. 109. ISBN 978-1-4377-1783-9.
- Keeton, CP; Kolos, AC; Walkup, JT (2009). "Pediatric generalized anxiety disorder: epidemiology, diagnosis, and management". Paediatric Drugs. 11 (3): 171–83. doi:10.2165/00148581-200911030-00003. PMID 19445546. S2CID 39870253.
- "NIMH » Anxiety Disorders". www.nimh.nih.gov. Retrieved 16 November 2020.
- U.S. Department of Health & Human Services (2017). "Phobias". www.mentalhealth.gov. Archived from the original on 13 May 2017. Retrieved 1 December 2017.
- Psychology. Michael Passer, Ronald Smith, Nigel Holt, Andy Bremner, Ed Sutherland, Michael Vliek. (2009) McGrath Hill Higher Education; UK: McGrath Hill companies Inc.
- "Panic Disorder". Center for the Treatment and Study of Anxiety, University of Pennsylvania. Archived from the original on 27 May 2015.
- Craske, Michelle G. (2003). Origins of Phobias and Anxiety Disorders. doi:10.1016/B978-0-08-044032-3.X5000-X. ISBN 978-0-08-044032-3.[page needed]
- Fisher, Jane E.; O'Donohue, William T., eds. (2006). Practitioner's Guide to Evidence-Based Psychotherapy. doi:10.1007/978-0-387-28370-8. ISBN 978-0-387-28369-2.[page needed]
- "Social Anxiety Disorder". Mental Health America. Retrieved 16 November 2020.
- "NIMH » Social Anxiety Disorder: More Than Just Shyness". www.nimh.nih.gov. Retrieved 1 December 2020.
- "Managing Anxiety in the Classroom". Mental Health America. Retrieved 16 November 2020.
- The Oxford Handbook of Exercise Psychology. Oxford University Press. 2012. p. 56. ISBN 9780199930746.
- "What Is PTSD?". psychiatry.org. Retrieved 16 November 2020.
- Post-traumatic Stress Disorder (PTSD) and the Family: For Parents with Young Children (PDF). Veterans Affairs Canada. 2006. ISBN 978-0-662-42627-1.
- Psychological Disorders Archived 4 December 2008 at the Wayback Machine, Psychologie Anglophone[unreliable source?]
- Shalev, Arieh; Liberzon, Israel; Marmar, Charles (22 June 2017). "Post-Traumatic Stress Disorder". The New England Journal of Medicine. 376 (25): 2459–2469. doi:10.1056/NEJMra1612499. PMID 28636846.
- Fullerton, Carol (1997). Posttraumatic Stress Disorder. Washington, D.C.: American Psychiatric Press Inc. pp. 8–9. ISBN 978-0-88048-751-1.
- Siegler, Robert S. (2006). How Children Develop, Exploring Child Develop. Worth Pub. ISBN 978-0-7167-6113-6.[page needed]
- Arehart-Treichel, Joan (7 July 2006). "Adult Separation Anxiety Often Overlooked Diagnosis". Psychiatric News. 41 (13): 30. doi:10.1176/pn.41.13.0030.
- Shear, Katherine; Jin, Robert; Ruscio, Ayelet Meron; Walters, Ellen E.; Kessler, Ronald C. (June 2006). "Prevalence and correlates of estimated DSM-IV child and adult separation anxiety disorder in the National Comorbidity Survey Replication". The American Journal of Psychiatry. 163 (6): 1074–1083. doi:10.1176/ajp.2006.163.6.1074. PMC 1924723. PMID 16741209.
- Mohatt, Justin; Bennett, Shannon M.; Walkup, John T. (July 2014). "Treatment of separation, generalized, and social anxiety disorders in youths". The American Journal of Psychiatry. 171 (7): 741–748. doi:10.1176/appi.ajp.2014.13101337. PMID 24874020.
- Marras, Anna; Fineberg, Naomi; Pallanti, Stefano (August 2016). "Obsessive compulsive and related disorders: comparing DSM-5 and ICD-11". CNS Spectrums. 21 (4): 324–333. doi:10.1017/S1092852916000110. PMID 27401060. S2CID 13129793.
- National Collaborating Centre for Mental Health (UK) (2006). Obsessive-Compulsive Disorder: Core Interventions in the Treatment of Obsessive-Compulsive Disorder and Body Dysmorphic Disorder. National Institute for Health and Care Excellence: Guidelines. British Psychological Society. ISBN 978-1-85433-430-5. PMID 21834191.[page needed]
- Soomro, G. Mustafa (18 January 2012). "Obsessive compulsive disorder". BMJ Clinical Evidence. 2012: 1004. PMC 3285220. PMID 22305974.
- "6B20 Obsessive-compulsive disorder". ICD-11 for Mortality and Morbidity Statistics.
- "Obsessive-compulsive disorder: Overview". InformedHealth.org. Institute for Quality and Efficiency in Health Care. 19 October 2017.
- Viana, Andres G.; Beidel, Deborah C.; Rabian, Brian (February 2009). "Selective mutism: A review and integration of the last 15 years". Clinical Psychology Review. 29 (1): 57–67. doi:10.1016/j.cpr.2008.09.009. PMID 18986742.
- Brown, Harriet (12 April 2005). "The Child Who Would Not Speak a Word". The New York Times.
- "Selective Mutism". American Speech-Language-Hearing Association.
- Oerbeck, Beate; Overgaard, Kristin Romvig; Stein, Murray B.; Pripp, Are Hugo; Kristensen, Hanne (August 2018). "Treatment of selective mutism: a 5-year follow-up study". European Child & Adolescent Psychiatry. 27 (8): 997–1009. doi:10.1007/s00787-018-1110-7. PMC 6060963. PMID 29357099.
- Rose, Matthias; Devine, Janine (June 2014). "Assessment of patient-reported symptoms of anxiety". Dialogues in Clinical Neuroscience. 16 (2): 197–211. doi:10.31887/DCNS.2014.16.2/mrose. PMC 4140513. PMID 25152658.
- Samuels MH (2008). "Cognitive function in untreated hypothyroidism and hyperthyroidism". Current Opinion in Endocrinology, Diabetes and Obesity (Review). 15 (5): 429–33. doi:10.1097/MED.0b013e32830eb84c. PMID 18769215. S2CID 27235034.
- Grigsby AB, Anderson RJ, Freedland KE, Clouse RE, Lustman PJ (2002). "Prevalence of anxiety in adults with diabetes: a systematic review". Journal of Psychosomatic Research (Systematic Review). 53 (6): 1053–60. doi:10.1016/S0022-3999(02)00417-8. PMID 12479986.
- Zingone F, Swift GL, Card TR, Sanders DS, Ludvigsson JF, Bai JC (April 2015). "Psychological morbidity of celiac disease: A review of the literature". United European Gastroenterology Journal (Review). 3 (2): 136–45. doi:10.1177/2050640614560786. PMC 4406898. PMID 25922673.
- Molina-Infante J, Santolaria S, Sanders DS, Fernández-Bañares F (May 2015). "Systematic review: noncoeliac gluten sensitivity". Alimentary Pharmacology & Therapeutics (Systematic Review). 41 (9): 807–20. doi:10.1111/apt.13155. PMID 25753138. S2CID 207050854.
- Neuendorf R, Harding A, Stello N, Hanes D, Wahbeh H (2016). "Depression and anxiety in patients with Inflammatory Bowel Disease: A systematic review". Journal of Psychosomatic Research (Systematic Review). 87: 70–80. doi:10.1016/j.jpsychores.2016.06.001. PMID 27411754.
- Zhao QF, Tan L, Wang HF, Jiang T, Tan MS, Tan L, et al. (2016). "The prevalence of neuropsychiatric symptoms in Alzheimer's disease: Systematic review and meta-analysis". Journal of Affective Disorders (Systematic Review). 190: 264–71. doi:10.1016/j.jad.2015.09.069. PMID 26540080.
- Wen MC, Chan LL, Tan LC, Tan EK (2016). "Depression, anxiety, and apathy in Parkinson's disease: insights from neuroimaging studies". European Journal of Neurology (Review). 23 (6): 1001–19. doi:10.1111/ene.13002. PMC 5084819. PMID 27141858.
- Marrie RA, Reingold S, Cohen J, Stuve O, Trojano M, Sorensen PS, et al. (2015). "The incidence and prevalence of psychiatric disorders in multiple sclerosis: a systematic review". Multiple Sclerosis Journal (Systematic Review). 21 (3): 305–17. doi:10.1177/1352458514564487. PMC 4429164. PMID 25583845.
- Bienvenu, OJ; Ginsburg, GS (December 2007). "Prevention of anxiety disorders". International Review of Psychiatry. Abingdon, England. 19 (6): 647–54. doi:10.1080/09540260701797837. PMID 18092242. S2CID 95140.
- Khoury B, Lecomte T, Fortin G, et al. (August 2013). "Mindfulness-based therapy: a comprehensive meta-analysis". Clinical Psychology Review. 33 (6): 763–71. doi:10.1016/j.cpr.2013.05.005. PMID 23796855.
- Sharma M, Rush SE (July 2014). "Mindfulness-based stress reduction as a stress management intervention for healthy individuals: a systematic review". J Evid Based Complementary Altern Med. 19 (4): 271–86. doi:10.1177/2156587214543143. PMID 25053754.
- Patel, Gayatri; Fancher, Tonya L. (3 December 2013). "In the clinic. Generalized anxiety disorder". Annals of Internal Medicine. 159 (11): 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. doi:10.7326/0003-4819-159-11-201312030-01006. PMID 24297210. S2CID 42889106.
- 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 (1 October 2017). "Effectiveness of Psychological and/or Educational Interventions in the Prevention of Anxiety: A Systematic Review, Meta-analysis, and Meta-regression". JAMA Psychiatry. 74 (10): 1021–1029. doi:10.1001/jamapsychiatry.2017.2509. PMC 5710546. PMID 28877316.
- Schmidt, Norman B.; Allan, Nicholas P.; Knapp, Ashley A.; Capron, Dan (2019). "Targeting anxiety sensitivity as a prevention strategy". The Clinician's Guide to Anxiety Sensitivity Treatment and Assessment. pp. 145–178. doi:10.1016/B978-0-12-813495-5.00008-5. ISBN 978-0-12-813495-5. S2CID 81782119.
- Hovenkamp-Hermelink, Johanna H. M.; Jeronimus, Bertus F.; Myroniuk, Solomiia; Riese, Harriëtte; Schoevers, Robert A. (May 2021). "Predictors of persistence of anxiety disorders across the lifespan: a systematic review" (PDF). The Lancet. Psychiatry. 8 (5): 428–443. doi:10.1016/S2215-0366(20)30433-8. PMID 33581052. S2CID 231919782.
- Corrigan, Patrick W. (February 2016). "Lessons learned from unintended consequences about erasing the stigma of mental illness". World Psychiatry. 15 (1): 67–73. doi:10.1002/wps.20295. PMC 4780288. PMID 26833611.
- "Stigma relating to anxiety". Beyond Blue.
- Rossler, Wulf (2016). "The stigma of mental disorders". EMBO Reports. 17 (9): 1250–1253. doi:10.15252/embr.201643041. PMC 5007563. PMID 27470237.
- Stein, Murray B.; Sareen, Jitender (19 November 2015). "Generalized Anxiety Disorder". New England Journal of Medicine. 373 (21): 2059–2068. doi:10.1056/nejmcp1502514. PMID 26580998.
- Taylor, G.; McNeill, A.; Girling, A.; Farley, A.; Lindson-Hawley, N.; Aveyard, P. (13 February 2014). "Change in mental health after smoking cessation: systematic review and meta-analysis". BMJ. 348 (feb13 1): g1151. doi:10.1136/bmj.g1151. PMC 3923980. PMID 24524926.
- Su, Kuan-Pin; Tseng, Ping-Tao; Lin, Pao-Yen; Okubo, Ryo; Chen, Tien-Yu; Chen, Yen-Wen; Matsuoka, Yutaka J. (7 September 2018). "Association of Use of Omega-3 Polyunsaturated Fatty Acids With Changes in Severity of Anxiety Symptoms: A Systematic Review and Meta-analysis". JAMA Network Open. 1 (5): e182327. doi:10.1001/jamanetworkopen.2018.2327. PMC 6324500. PMID 30646157.
- "Nutritional strategies to ease anxiety". Harvard Health. 13 April 2016. Retrieved 6 July 2023.
- Cuijpers, P; Sijbrandij, M; Koole, S; Huibers, M; Berking, M; Andersson, G (March 2014). "Psychological treatment of generalized anxiety disorder: A meta-analysis". Clinical Psychology Review. 34 (2): 130–140. doi:10.1016/j.cpr.2014.01.002. PMID 24487344.
- Otte, C (2011). "Cognitive behavioral therapy in anxiety disorders: current state of the evidence". Dialogues in Clinical Neuroscience. 13 (4): 413–21. doi:10.31887/DCNS.2011.13.4/cotte. PMC 3263389. PMID 22275847.
- Pompoli, Alessandro; Furukawa, Toshi A.; Imai, Hissei; Tajika, Aran; Efthimiou, Orestis; Salanti, Georgia (13 April 2016). "Psychological therapies for panic disorder with or without agoraphobia in adults: a network meta-analysis". The Cochrane Database of Systematic Reviews. 2016 (4): CD011004. doi:10.1002/14651858.CD011004.pub2. PMC 7104662. PMID 27071857.
- Olthuis, Janine V.; Watt, Margo C.; Bailey, Kristen; Hayden, Jill A.; Stewart, Sherry H. (12 March 2016). "Therapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults". The Cochrane Database of Systematic Reviews. 2016 (3): CD011565. doi:10.1002/14651858.CD011565.pub2. PMC 7077612. PMID 26968204.
- Mayo-Wilson, Evan; Montgomery, Paul (9 September 2013). "Media-delivered cognitive behavioural therapy and behavioural therapy (self-help) for anxiety disorders in adults". The Cochrane Database of Systematic Reviews (9): CD005330. doi:10.1002/14651858.CD005330.pub4. PMID 24018460.
- Roemer L, Williston SK, Eustis EH (November 2013). "Mindfulness and acceptance-based behavioral therapies for anxiety disorders". Curr Psychiatry Rep. 15 (11): 410. doi:10.1007/s11920-013-0410-3. PMID 24078067. S2CID 23278447.
- Lang AJ (May 2013). "What mindfulness brings to psychotherapy for anxiety and depression". Depress Anxiety. 30 (5): 409–12. doi:10.1002/da.22081. PMID 23423991. S2CID 25705284.
- Krisanaprakornkit, Thawatchai; Sriraj, Wimonrat; Piyavhatkul, Nawanant; Laopaiboon, Malinee (25 January 2006). "Meditation therapy for anxiety disorders". Cochrane Database of Systematic Reviews (1): CD004998. doi:10.1002/14651858.CD004998.pub2. PMID 16437509.
- Wu, Hui; Yu, Dehua; He, Yanling; Wang, Jijun; Xiao, Zeping; Li, Chunbo (19 February 2015). "Morita therapy for anxiety disorders in adults". Cochrane Database of Systematic Reviews (2): CD008619. doi:10.1002/14651858.CD008619.pub2. PMID 25695214.
- Mayrav, Almaz; Adiel, Doron; Sigal, Mazar; Irena, Rubanovich; Shmuel, Hirschmann (17 February 2022). "Wall Climbing Therapy for Adults Diagnosed with Complex PTSD Due Childhood Sexual Assault". Journal of Loss and Trauma. 27 (2): 191–193. doi:10.1080/15325024.2021.1946303. S2CID 237775067.
- Baldwin, David S; Anderson, Ian M; Nutt, David J; Allgulander, Christer; Bandelow, Borwin; Boer, Johan A den; Christmas, David M; Davies, Simon; Fineberg, Naomi (8 April 2014). "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" (PDF). Journal of Psychopharmacology. 28 (5): 403–439. doi:10.1177/0269881114525674. PMID 24713617. S2CID 28893331.
- Stein, MB; Sareen, J (19 November 2015). "Clinical Practice: Generalized Anxiety Disorder". The New England Journal of Medicine. 373 (21): 2059–68. doi:10.1056/nejmcp1502514. PMID 26580998.
- Baldwin, David S; Anderson, Ian M; Nutt, David J; Allgulander, Christer; Bandelow, Borwin; den Boer, Johan A; Christmas, David M; Davies, Simon; Fineberg, Naomi; Lidbetter, Nicky; Malizia, Andrea; McCrone, Paul; Nabarro, Daniel; O’Neill, Catherine; Scott, Jan; van der Wee, Nic; Wittchen, Hans-Ulrich (May 2014). "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 of Psychopharmacology. 28 (5): 403–439. doi:10.1177/0269881114525674. PMID 24713617. S2CID 28893331.
- Kwint, Jemma (November 2022). "Antidepressants for children and teenagers: what works for anxiety and depression?". NIHR Evidence. doi:10.3310/nihrevidence_53342. S2CID 253347210.
- Boaden, Katharine; Tomlinson, Anneka; Cortese, Samuele; Cipriani, Andrea (2 September 2020). "Antidepressants in Children and Adolescents: Meta-Review of Efficacy, Tolerability and Suicidality in Acute Treatment". Frontiers in Psychiatry. 11: 717. doi:10.3389/fpsyt.2020.00717. PMC 7493620. PMID 32982805.
- Correll, Christoph U.; Cortese, Samuele; Croatto, Giovanni; Monaco, Francesco; Krinitski, Damir; Arrondo, Gonzalo; Ostinelli, Edoardo G.; Zangani, Caroline; Fornaro, Michele; Estradé, Andrés; Fusar‐Poli, Paolo; Carvalho, Andre F.; Solmi, Marco (June 2021). "Efficacy and acceptability of pharmacological, psychosocial, and brain stimulation interventions in children and adolescents with mental disorders: an umbrella review". World Psychiatry. 20 (2): 244–275. doi:10.1002/wps.20881. PMC 8129843. PMID 34002501.
- Batelaan, Neeltje M.; Bosman, Renske C.; Muntingh, Anna; Scholten, Willemijn D.; Huijbregts, Klaas M.; van Balkom, Anton J. L. M. (13 September 2017). "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". BMJ. 358: j3927. doi:10.1136/bmj.j3927. PMC 5596392. PMID 28903922.
- Hong JS, Atkinson LZ, Al-Juffali N, Awad A, Geddes JR, Tunbridge EM, et al. (March 2022). "Gabapentin and pregabalin in bipolar disorder, anxiety states, and insomnia: Systematic review, meta-analysis, and rationale". Molecular Psychiatry. 27 (3): 1339–1349. doi:10.1038/s41380-021-01386-6. PMC 9095464. PMID 34819636.
- Choy, Yujuan; Fyer, Abby J.; Lipsitz, Josh D. (April 2007). "Treatment of specific phobia in adults". Clinical Psychology Review. 27 (3): 266–286. doi:10.1016/j.cpr.2006.10.002. PMID 17112646.
- Black, Nicola; Stockings, Emily; Campbell, Gabrielle; Tran, Lucy T; Zagic, Dino; Hall, Wayne D; Farrell, Michael; Degenhardt, Louisa (October 2019). "Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: a systematic review and meta-analysis". The Lancet Psychiatry. 6 (12): 995–1010. doi:10.1016/S2215-0366(19)30401-8. PMC 6949116. PMID 31672337.
- Wang, Zhen; Whiteside, Stephen P. H.; Sim, Leslie; Farah, Wigdan; Morrow, Allison S.; Alsawas, Mouaz; Barrionuevo, Patricia; Tello, Mouaffaa; Asi, Noor; Beuschel, Bradley; Daraz, Lubna; Almasri, Jehad; Zaiem, Feras; Larrea-Mantilla, Laura; Ponce, Oscar J.; LeBlanc, Annie; Prokop, Larry J.; Murad, Mohammad Hassan (1 November 2017). "Comparative Effectiveness and Safety of Cognitive Behavioral Therapy and Pharmacotherapy for Childhood Anxiety Disorders: A Systematic Review and Meta-analysis". JAMA Pediatrics. 171 (11): 1049–1056. doi:10.1001/jamapediatrics.2017.3036. PMC 5710373. PMID 28859190.
- Higa-McMillan, Charmaine K.; Francis, Sarah E.; Rith-Najarian, Leslie; Chorpita, Bruce F. (3 March 2016). "Evidence Base Update: 50 Years of Research on Treatment for Child and Adolescent Anxiety". Journal of Clinical Child & Adolescent Psychology. 45 (2): 91–113. doi:10.1080/15374416.2015.1046177. PMID 26087438.
- James, Anthony C.; James, Georgina; Cowdrey, Felicity A.; Soler, Angela; Choke, Aislinn (18 February 2015). "Cognitive behavioural therapy for anxiety disorders in children and adolescents". The Cochrane Database of Systematic Reviews. 2015 (2): CD004690. doi:10.1002/14651858.CD004690.pub4. PMC 6491167. PMID 25692403.
- Creswell, Cathy; Cruddace, Susan; Gerry, Stephen; Gitau, Rachel; McIntosh, Emma; Mollison, Jill; Murray, Lynne; Shafran, Rosamund; Stein, Alan; Violato, Mara; Voysey, Merryn; Willetts, Lucy; Williams, Nicola; Yu, Ly-Mee; Cooper, Peter J. (May 2015). "Treatment of childhood anxiety disorder in the context of maternal anxiety disorder: a randomised controlled trial and economic analysis". Health Technology Assessment. 19 (38): 1–184, vii–viii. doi:10.3310/hta19380. PMC 4781330. PMID 26004142.
- Kozlowska, Kasia; Hanney, Lesley (June 1999). "Family Assessment and Intervention Using an Interactive Art Exercise". Australian and New Zealand Journal of Family Therapy. 20 (2): 61–69. doi:10.1002/j.1467-8438.1999.tb00358.x.
- Bratton, Sue Carlton; Ray, Dee (2002). "Humanistic play therapy". Humanistic psychotherapies: Handbook of research and practice. pp. 369–402. doi:10.1037/10439-012. ISBN 978-1-55798-787-7.
- Vos, Theo; Flaxman, Abraham D.; Naghavi, Mohsen; Lozano, Rafael; Michaud, Catherine; et al. (15 December 2012). "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". Lancet. 380 (9859): 2163–2196. doi:10.1016/S0140-6736(12)61729-2. PMC 6350784. PMID 23245607.
- "Evolving concepts of anxiety". Anxiety Disorders. 2010. pp. 6–68. doi:10.1017/CBO9780511777578.004. ISBN 978-0-511-77757-8.
- Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE (June 2005). "Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication". Arch. Gen. Psychiatry. 62 (6): 593–602. doi:10.1001/archpsyc.62.6.593. PMID 15939837.
- Brockveld, Keila C.; Perini, Sarah J.; Rapee, Ronald M. (2014). "Social Anxiety and Social Anxiety Disorder Across Cultures". Social Anxiety. pp. 141–158. doi:10.1016/B978-0-12-394427-6.00006-6. ISBN 978-0-12-394427-6.
- Hofmann, Stefan G.; Asnaani, Anu (December 2010). "Cultural Aspects in Social Anxiety and Social Anxiety Disorder". Depress Anxiety. 27 (12): 1117–1127. doi:10.1002/da.20759. PMC 3075954. PMID 21132847.
- Fricchione, Gregory (12 August 2004). "Generalized Anxiety Disorder". New England Journal of Medicine. 351 (7): 675–682. doi:10.1056/NEJMcp022342. PMID 15306669.
- Essau, Cecilia (2006). Child and Adolescent Psychopathology: Theoretical and Clinical Implications. Routledge. p. 79. ISBN 978-1-58391-834-0.
- "Generalized Anxiety Disorder in Children". Anxiety Canada.
- Merrill, Anna. "Anxiety and Autism Spectrum Disorders". Indiana Resource Center for Autism. Archived from the original on 11 June 2015. Retrieved 10 June 2015.
- Guignard, Jacques-Henri; Jacquet, Anne-Yvonne; Lubart, Todd I. (2012). "Perfectionism and Anxiety: A Paradox in Intellectual Giftedness?". PLOS ONE. 7 (7): e41043. Bibcode:2012PLoSO...741043G. doi:10.1371/journal.pone.0041043. PMC 3408483. PMID 22859964.
- Rapee, Ronald M.; Schniering, Carolyn A.; Hudson, Jennifer L. (April 2009). "Anxiety Disorders During Childhood and Adolescence: Origins and Treatment". Annual Review of Clinical Psychology. 5 (1): 311–341. doi:10.1146/annurev.clinpsy.032408.153628. PMID 19152496.
- Swab, R. Gabrielle; Johnson, Paul D. (February 2019). "Steel sharpens steel: A review of multilevel competition and competitiveness in organizations". Journal of Organizational Behavior. 40 (2): 147–165. doi:10.1002/job.2340. ISSN 0894-3796.