Primer

Anxiety disorders

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Abstract

Anxiety disorders constitute the largest group of mental disorders in most western societies and are a leading cause of disability. The essential features of anxiety disorders are excessive and enduring fear, anxiety or avoidance of perceived threats, and can also include panic attacks. Although the neurobiology of individual anxiety disorders is largely unknown, some generalizations have been identified for most disorders, such as alterations in the limbic system, dysfunction of the hypothalamic–pituitary–adrenal axis and genetic factors. In addition, general risk factors for anxiety disorders include female sex and a family history of anxiety, although disorder-specific risk factors have also been identified. The diagnostic criteria for anxiety disorders varies for the individual disorders, but are generally similar across the two most common classification systems: the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the International Classification of Diseases, Tenth Edition (ICD-10). Despite their public health significance, the vast majority of anxiety disorders remain undetected and untreated by health care systems, even in economically advanced countries. If untreated, these disorders are usually chronic with waxing and waning symptoms. Impairments associated with anxiety disorders range from limitations in role functioning to severe disabilities, such as the patient being unable to leave their home.

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Author information

Affiliations

  1. Department of Psychology, University of California Los Angeles, 405 Hilgard Avenue, Los Angeles, California 90095, USA.

    • Michelle G. Craske
  2. Department of Psychiatry, University of California San Diego, La Jolla, California, USA.

    • Murray B. Stein
  3. Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA.

    • Murray B. Stein
  4. King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, UK.

    • Thalia C. Eley
  5. Department of Psychiatry, Harvard Medical School, Harvard University, Boston, Massachusetts, USA.

    • Mohammed R. Milad
  6. Department of Psychiatry, Massachusetts General Hospital, Charleston, Massachusetts, USA.

    • Mohammed R. Milad
  7. Laboratory of Behavioral and Genomic Neuroscience, National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland, USA.

    • Andrew Holmes
  8. Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, New South Wales, Australia.

    • Ronald M. Rapee
  9. Institute of Clinical Psychology and Psychotherapy, Faculty of Science, Technische Universitaet Dresden, Dresden, Germany.

    • Hans-Ulrich Wittchen

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Contributions

Introduction (M.G.C.); Epidemiology (H.-U.W.); Mechanisms/pathophysiology (T.C.E., A.H., M.R.M. and M.B.S.); Diagnosis, screening and prevention (M.G.C. and R.M.R.); Management (M.G.C., M.B.S. and R.M.R.); Quality of life (H.-U.W.); Outlook (M.G.C.); Overview of Primer (M.G.C.).

Competing interests

M.B.S. has received consulting fees in the past 3 years from Actelion Pharmaceuticals, Janssen, Neurocrine Biosciences, and Pfizer, and stock options from Oxeia Biopharmaceuticals and Resilience Therapeutics. M.B.S. also receives editorial honoraria from the journal Biological Psychiatry, and in his role of Co-Editor-in-Chief for UpToDate in Psychiatry. All other authors declare no competing interests.

Corresponding author

Correspondence to Michelle G. Craske.