Anxiety Disorders Health Article

Definition/epidemiology

Anxiety is normally a helpful emotion that rouses the individual to action and alerts the individual to danger. Everyone has anxiety; it is common to feel anxiety before a ‘first date,’ when beginning a new job, or before an examination. In general, anxiety is a state of tension that occurs in the body as a warning to keep the body safe and out of danger. An anxiety disorder, on the other hand, often disrupts daily life. Individuals with anxiety disorders feel anxious most of the time and without apparent reason. The anxious feelings can be so uncomfortable that an individual may stop everyday activities of daily living to avoid the discomfort or may have immobilizing bouts of anxiety. Many people misunderstand anxiety disorders and think individuals should be able to overcome their symptoms through sheer willpower. ¹

Anxiety is commonly defined as an unpleasant and overriding mental tension that has no apparent identifiable cause and is accompanied by physical distress and disruption in activities of daily living. Uhde and Nemiah ² provide a more formal definition of anxiety: a pathologic state characterized by a feeling of dread and accompanied by somatic signs indicative of a hyperactive autonomic nervous system, differentiated from fear, which has a known cause. Anxiety is considered a disorder when it becomes a problem in daily life. There are several anxiety disorders: generalized anxiety disorder (GAD), simple phobias, panic disorder (sometimes accompanied by agoraphobia), posttraumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), social phobias (general social phobia and performance anxiety), and atypical anxiety. ³

According to research sponsored by the National Institute of Mental Health (NIMH), anxiety disorders are the most common mental illnesses in the United States, some of the most commonly underdiagnosed disorders, and the most successfully treated disorders after diagnosis. More than 23 million Americans have one or more of the identified anxiety disorders, and each year billions of dollars are lost in the workplace as a result. ⁴ In addition, with undiagnosed anxiety disorders, an undetermined amount of the health care dollar is spent on additional medical testing to exclude a medical condition. As a group, anxiety disorders afflict nearly 9% of Americans during any 6-month period. ⁵

Symptoms of anxiety disorders can be so severe that sufferers are almost totally disabled—too terrified to leave their homes, to enter the elevator that takes them to their offices, or to shop for food. NIMH research shows that anxiety disorders (1) have an age of onset from late childhood to adulthood, (2) affect a higher ratio of females to males as a group across several of the individual disorders, and (3) have a family link to prevalence, with an 80% to 90% concordance in monozygotic twins for GAD. ³ Many people have a single anxiety disorder, but it is not unusual for an anxiety disorder to be accompanied by another illness, such as depression, an eating disorder, alcoholism, drug abuse, or other anxiety disorder. In these cases, the other illnesses also need to be treated. ⁶ According to NIMH sources, ‘anxiety disorders are real, identifiable brain diseases. Current research suggests that anxiety disorders arise from a combination of genetic vulnerability with an environmental ‘second hit.’ In addition, we are beginning to understand the specific circuits in the brain that are malfunctioning in PTSD, OCD, and perhaps panic disorder. Through this research we will be able to develop new and better therapies.’ ⁴

Immediate psychiatric evaluation is required for all patients with suicidal/homicidal ideation.