Anxiety disorders

  • A Correction to this article was published on 14 December 2017

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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Figure 1: Anxiety disorders.
Figure 2: Prevalence and sex ratio of anxiety disorders.
Figure 3: Key brain regions involved in the generation and regulation of emotions and threat detection.
Figure 4: Symptom progression model of anxiety disorders.
Figure 5: Disability-adjusted life years lost for mental disorders, neurological disorders and other disease groups.

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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.).

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Correspondence to Michelle G. Craske.

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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.

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Craske, M., Stein, M., Eley, T. et al. Anxiety disorders. Nat Rev Dis Primers 3, 17024 (2017). https://doi.org/10.1038/nrdp.2017.24

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