|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, suicide|
|Usual onset||15–35 years old|
|Duration||> 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||Antidepressants, anxiolytics, beta blockers|
|Frequency||12% per year|
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 function are significantly impaired. Anxiety is a worry about future events, while fear is a reaction to current events. Anxiety may cause physical and cognitive symptoms such as restlessness, irritability, easy fatigability, difficulty concentrating, increased heart rate, chest pain, abdominal pain, and many others. In casual discourse the words anxiety and fear are often used interchangeably; in clinical usage, they have distinct meanings: anxiety is 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 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) or anxiety symptoms.
There are several types of anxiety disorders, including generalized anxiety disorder, specific phobia, social anxiety disorder, separation anxiety disorder, agoraphobia, panic disorder, and selective mutism. The individual disorder can be diagnosed by the specific and unique symptoms, triggering events, and timing. If a person is diagnosed with an anxiety disorder, a medical professional must have evaluated the person to ensure the anxiety cannot be attributed to a medical illness or mental disorder. It is possible for an individual to have more than one anxiety disorder during their life or at the same time. There are numerous treatments and strategies that can improve a person's mood, behaviors, and functioning in daily life.
Generalized anxiety disorder
Generalized anxiety disorder (GAD) is a common disorder, characterized by long-lasting anxiety which is not focused on any one object or situation. Those suffering from 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 lack of concentration and/or preoccupation with worry. A symptom can be a strained appearance, with increased sweating from the hands, feet, and axillae, and they may be tearful, which can suggest depression. Before a diagnosis of anxiety disorder is made, physicians must rule out drug-induced anxiety and other medical causes.
The single 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 suffer from specific phobias. According to the National Institute of Mental Health, a phobia is an intense fear of- or aversion to- specific objects or situations. Sufferers 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. Thus meaning that people with specific phobias often go out of their way to avoid encountering their phobia. People understand that their fear is not proportional to the actual potential danger but still are overwhelmed by it.
With panic disorder, a person has brief attacks of intense terror and apprehension, often marked by trembling, shaking, confusion, dizziness, nausea, and/or difficulty breathing. These panic attacks, defined by the APA as fear or discomfort that abruptly arises and peaks in less than ten minutes, can last for several hours. Attacks can be triggered by stress, irrational thoughts, general fear or fear of the unknown, or even exercise. However, sometimes the trigger is unclear and the 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 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 suffering from panic disorder experience symptoms even outside specific panic episodes. Often, normal changes in heartbeat are noticed by a panic sufferer, 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 the specific anxiety about 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 sufferers often develop. For example, following a panic attack while driving, someone suffering from agoraphobia may develop anxiety over driving and will therefore avoid driving. These avoidance behaviors can often have serious consequences and often reinforce the fear they are caused by. In a severe case of someone with Agoraphobia, they may never leave their home.
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, more typically, is experienced in most (or all) social interactions. 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 suffering from social anxiety often will attempt to avoid the source of their anxiety; in the case of social anxiety this is particularly problematic, and in severe cases can lead to complete social isolation.
It is important to understand that children are also affected by Social anxiety disorder while attending school. Although their symptoms associated with this disorder are different compared to teenagers and adults. Their symptoms can include difficult processing or retrieving information, sleep deprivation, disruptive behaviors in class, and irregular class participation.
Social physique anxiety (SPA) is a subtype of social anxiety. It is concern over the evaluation of one's body by others. SPA is common among adolescents, especially females.
Post-traumatic stress disorder
Post-traumatic stress disorder (PTSD) was once an anxiety disorder (now moved to trauma- and stressor-related disorders in 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 suffer from 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 suffering with PTSD. Such treatments include cognitive behavioral therapy (CBT), prolonged exposure therapy, stress inoculation therapy, medication, and psychotherapy and support from family and friends.
Post-traumatic stress disorder (PTSD) research began with Vietnam veterans, as well as natural and non-natural disaster victims. Studies have found the degree of exposure to a disaster has been found to be the best predictor of PTSD.
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. Separation anxiety disorder affects roughly 7% of adults and 4% of children, but the 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 (OCD) is not classified as an anxiety disorder by the DSM-5 but is by the ICD-10. It was previously classified as an anxiety disorder in the DSM-IV. It is a condition where the person has 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 disorder, and which cause distress or social dysfunction. The compulsive rituals are personal rules followed to relieve the feeling of discomfort. 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 forget to turn off the stove) or worry that they will behave inappropriately.
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 (although that may result from the disorder), and 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 (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 life.
Testing for selective mutism is important because doctors must determine if it as issue associated with the child's hearing, movements associated with the jaw or tongue, and if the child can understand when others are speaking to them.
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 for 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 be vary between each subtype 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; 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 measurement, 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).
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, including 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).
Also, several drugs can cause or worsen anxiety, whether in intoxication, withdrawal, or from chronic use. These include alcohol, tobacco, cannabis, sedatives (including prescription benzodiazepines), opioids (including prescription pain killers and illicit drugs like heroin), stimulants (such as caffeine, cocaine and amphetamines), hallucinogens, and inhalants.
Focus is increasing on 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.
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 to the patient's specific circumstances and symptoms. If while on treatment with a chosen medication, the person does not improve with his or her anxiety, another medication may be offered. Specific treatments will vary by subtype of anxiety disorder, a person's other medical conditions, and medications.
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. Stopping smoking has benefits in anxiety as large as or larger than those of medications. Omega-3 polyunsaturated fatty acids, such as fish oil, may reduce anxiety, particularly in those with more significant symptoms.
Cognitive behavioral therapy (CBT) is effective for anxiety disorders and is a first line treatment. 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 than other types of meditation.
First line choices for medications include SSRIs or SNRIs to treat generalized anxiety disorder. There is no good evidence supporting which specific medication in the SSRI or SNRI is best for treating anxiety, so cost often drives drug choice. If they are effective, it is recommended that they are continued for at least a year. Stopping these medications results in a greater risk of relapse.
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.
Other remedies have been used or are under research for treating anxiety disorders. As of 2019, there is little evidence for cannabis in anxiety disorders. Kava is under preliminary research for its potential in short-term use by people with mild to moderate anxiety. The American Academy of Family Physicians recommends use of kava for mild to moderate anxiety disorders in people not using alcohol or taking other medicines metabolized by the liver, while preferring remedies thought to be natural. Inositol has been found to have modest effects in people with panic disorder or obsessive-compulsive disorder. There is insufficient evidence to support the use of St. John's wort, valerian or passionflower.
Neurofeedback training (NFT) training is another form of alternative medicine, where practitioners use monitoring devices to see moment to moment information in relation to the nervous system and the brain. Sensors are placed along the scalp, and the brain responses are recorded and amplified in association with specific brain activity. The practitioners then discuss the responses associated with the client, in an attempt to determine different principles of learning, and practitioner guidance to create changes in brain patterns.
Cognitive behavioral therapy (CBT) is a good first therapy approach. Studies have gathered substantial evidence for treatments that are not CBT based as being 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.
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 an attention deficit disorder or, due to the tendency of children to interpret their emotions physically (as stomach aches, head aches, 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 or Asperger's 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.
- Peter Aspden (21 April 2012). "So, what does 'The Scream' mean?". Financial Times. Archived from the original on 14 October 2013.
- Diagnostic and Statistical Manual of Mental DisordersAmerican Psychiatric Associati (5th ed.). Arlington: American Psychiatric Publishing. 2013. pp. 189–195. ISBN 978-0890425558.
- "Anxiety disorders – Symptoms and causes". Mayo Clinic. Retrieved 23 May 2019.
- Craske, MG; Stein, MB (24 June 2016). "Anxiety". 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 (2013). "Psychiatric emergencies (part III): psychiatric symptoms resulting from organic diseases" (PDF). Eur Rev Med Pharmacol Sci (Review). 17 Suppl 1: 86–99. PMID 23436670. Archived (PDF) from the original on 10 March 2016.
- 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.
- World Health Organization (2009). Pharmacological Treatment of Mental Disorders in Primary Health Care (PDF). Geneva. ISBN 978-92-4-154769-7. Archived (PDF) from the original on 20 November 2016.
- Schacter, D. L., Gilbert, D. T., & Wegner, D.M. (2011). Psychology: Second Edition. New York, NY: Worth.
- Calleo J, Stanley M (2008). "Anxiety Disorders in Later Life: Differentiated Diagnosis and Treatment Strategies". Psychiatric Times. 26 (8). Archived from the original on 4 September 2009.
- Phil Barker (7 October 2003). Psychiatric and mental health nursing: the craft of caring. London: Arnold. ISBN 978-0-340-81026-2. Archived from the original on 27 May 2013. Retrieved 17 December 2010.
- Psychology, Michael Passer, Ronald Smith, Nigel Holt, Andy Bremner, Ed Sutherland, Michael Vliek (2009) McGrath Hill Education, UK: McGrath Hill Companies Inc. p 790
- "All About Anxiety Disorders: From Causes to Treatment and Prevention". Archived from the original on 17 February 2016. Retrieved 18 February 2016.
- Psychiatry, Michael Gelder, Richard Mayou, John Geddes 3rd ed. Oxford; New York: Oxford University Press, c 2005 p. 75
- Varcarolis. E (2010). Manual of Psychiatric Nursing Care Planning: Assessment Guides, Diagnoses and Psychopharmacology. 4th ed. New York: Saunders Elsevier. p 109.
- 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 2003 harvnb error: no target: CITEREFCraske2003 (help) Gorman, 2000
- Jane E. Fisher; William T. O'Donohue (27 July 2006). Practitioner's Guide to Evidence-Based Psychotherapy. Springer. pp. 754. ISBN 978-0387283692.
- "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?". www.psychiatry.org. Retrieved 16 November 2020.
- Post-Traumatic Stress Disorder and the Family. Veterans Affairs Canada. 2006. ISBN 978-0-662-42627-1. Archived from the original on 14 February 2009. Retrieved 8 September 2017.
- Psychological Disorders Archived 4 December 2008 at the Wayback Machine, Psychologie Anglophone
- Shalev, Arieh; Liberzon, Israel; Marmar, Charles (2017). "Post-Traumatic Stress Disorder". 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 (2006). How Children Develop, Exploring Child Develop Student Media Tool Kit & Scientific American Reader to Accompany How Children Develop. New York: Worth Publishers. ISBN 0-7167-6113-0.
- Arehart-Treichel, Joan (2006). "Adult Separation Anxiety Often Overlooked Diagnosis – Arehart-Treichel 41 (13): 30 – Psychiatr News". Psychiatric News. 41 (13): 30. doi:10.1176/pn.41.13.0030.
- Shear, K.; Jin, R.; Ruscio, AM.; Walters, EE.; Kessler, RC. (June 2006). "Prevalence and correlates of estimated DSM-IV child and adult separation anxiety disorder in the National Comorbidity Survey Replication". Am J Psychiatry. 163 (6): 1074–1083. doi:10.1176/appi.ajp.163.6.1074. PMC 1924723. PMID 16741209.
- Mohatt, Justin; Bennett, Shannon M.; Walkup, John T. (1 July 2014). "Treatment of Separation, Generalized, and Social Anxiety Disorders in Youths". American Journal of Psychiatry. 171 (7): 741–748. doi:10.1176/appi.ajp.2014.13101337. ISSN 0002-953X. PMID 24874020.
- National Collaborating Centre for Mental Health, (UK) (2006). Obsessive-Compulsive Disorder: Core Interventions in the Treatment of Obsessive-Compulsive Disorder and Body Dysmorphic Disorder. NICE Clinical Guidelines. ISBN 9781854334305. PMID 21834191. Archived from the original on 29 May 2013. Retrieved 21 November 2015.
- Soomro, GM (18 January 2012). "Obsessive compulsive disorder". BMJ Clinical Evidence. 2012. PMC 3285220. PMID 22305974.
- Institute for Quality and Efficiency in Health Care (IQWiG). "Obsessive-compulsive disorder: overview". PubMed Health. Institute for Quality and Efficiency in Health Care (IQWiG). Retrieved 21 November 2015.
- Viana, A. G.; Beidel, D. C.; Rabian, B. (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.
- "The Child Who Would Not Speak a Word" Archived 3 April 2015 at the Wayback Machine
- "Selective Mutism". American Speech-Language-Hearing Association. Retrieved 16 November 2020.
- Rose M, Devine J (2014). "Assessment of patient-reported symptoms of anxiety". Dialogues Clin Neurosci (Review). 16 (2): 197–211 (Table 1). doi:10.31887/DCNS.2014.16.2/mrose. PMC 4140513. PMID 25152658.
- Rose M, Devine J (2014). "Assessment of patient-reported symptoms of anxiety". Dialogues Clin Neurosci (Review). 16 (2): 197–211 (Table 2). doi:10.31887/DCNS.2014.16.2/mrose. PMC 4140513. PMID 25152658.
- Samuels MH (2008). "Cognitive function in untreated hypothyroidism and hyperthyroidism". Curr Opin Endocrinol Diabetes Obes (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". J Psychosom Res (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 Gastroenterol J (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". Aliment Pharmacol Ther (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". J Psychosom Res (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". J Affect Disord (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". Eur J Neurol (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". Mult Scler (Systematic Review). 21 (3): 305–17. doi:10.1177/1352458514564487. PMC 4429164. PMID 25583845.
- American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association. ISBN 978-0890425558.
- 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". Clin Psychol Rev. 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, G; Fancher, TL (3 December 2013). "In the clinic. Generalized anxiety disorder" (PDF). 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. Archived (PDF) from the original on 4 January 2015.
currently there is no evidence on the effectiveness of preventive measures for GAD in adult
- 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). "8 - Targeting anxiety sensitivity as a prevention strategy". The Clinician's Guide to Anxiety Sensitivity Treatment and Assessment. Academic Press. pp. 145–178. ISBN 978-0-12-813495-5.
- 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.
- 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. (2018). "Association of Use of Omega-3 Polyunsaturated Fatty Acids With Changes in Severity of Anxiety Symptoms". JAMA Network Open. 1 (5): e182327. doi:10.1001/jamanetworkopen.2018.2327. ISSN 2574-3805. PMC 6324500. PMID 30646157.
- 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, A; Furukawa, TA; Imai, H; Tajika, A; Efthimiou, O; Salanti, G (13 April 2016). "Psychological therapies for panic disorder with or without agoraphobia in adults: a network meta-analysis" (PDF). The Cochrane Database of Systematic Reviews. 4: CD011004. doi:10.1002/14651858.CD011004.pub2. PMC 7104662. PMID 27071857.
- Olthuis, JV; Watt, MC; Bailey, K; Hayden, JA; Stewart, SH (12 March 2016). "Therapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults". The Cochrane Database of Systematic Reviews. 3: CD011565. doi:10.1002/14651858.cd011565.pub2. PMC 7077612. PMID 26968204.
- E, Mayo-Wilson; P, Montgomery (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, T; Krisanaprakornkit, W; Piyavhatkul, N; Laopaiboon, M (25 January 2006). "Meditation therapy for anxiety disorders". The 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.
- 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.
- 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.
- Batelaan, NM; Bosman, RC; Muntingh, A; Scholten, WD; Huijbregts, KM; van Balkom, AJLM (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 (Clinical Research Ed.). 358: j3927. doi:10.1136/bmj.j3927. PMC 5596392. PMID 28903922.
- Choy, Y; Fyer, AJ; Lipsitz, JD (April 2007). "Treatment of specific phobia in adults". Clinical Psychology Review. 27 (3): 266–86. 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.
- Pittler MH, Ernst E (2003). Pittler MH (ed.). "Kava extract for treating anxiety". Cochrane Database of Systematic Reviews (1): CD003383. doi:10.1002/14651858.CD003383. PMC 6999799. PMID 12535473.
- Witte S, Loew D, Gaus W (March 2005). "Meta-analysis of the efficacy of the acetonic kava-kava extract WS1490 in patients with non-psychotic anxiety disorders". Phytother Res. 19 (3): 183–188. doi:10.1002/ptr.1609. PMID 15934028. S2CID 39260703.
- Saeed, SA; Bloch, RM; Antonacci, DJ (15 August 2007). "Herbal and dietary supplements for treatment of anxiety disorders". American Family Physician. 76 (4): 549–56. PMID 17853630.
- "What Is NeuroregulationTraining?". ISNR. 8 June 2019. Retrieved 16 November 2020.
- 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 (31 August 2017). "Comparative Effectiveness and Safety of Cognitive Behavioral Therapy and Pharmacotherapy for Childhood Anxiety Disorders". JAMA Pediatrics. 171 (11): 1049–1056. doi:10.1001/jamapediatrics.2017.3036. PMC 5710373. PMID 28859190.
- Higa-McMillan, CK; Francis, SE; Rith-Najarian, L; Chorpita, BF (18 June 2015). "Evidence Base Update: 50 Years of Research on Treatment for Child and Adolescent Anxiety". Journal of Clinical Child and 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 (2): CD004690. doi:10.1002/14651858.CD004690.pub4. ISSN 1469-493X. PMC 6491167. PMID 25692403.
- Creswell, Cathy; Cruddace, Susan; Gerry, Stephen; Gitau, Rachel; McIntosh, Emma; Mollison, Jill; Murray, Lynne; Shafran, Rosamund; Stein, Alan (25 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. doi:10.3310/hta19380. PMC 4781330. PMID 26004142.
- Kozlowska K.; Hanney L. (1999). "Family assessment and intervention using an interactive are exercise". Australian and New Zealand Journal of Family Therapy. 20 (2): 61–69. doi:10.1002/j.1467-8438.1999.tb00358.x.
- Bratton, S.C., & Ray, D. (2002). Humanistic play therapy. In D.J. Cain (Ed.), Humanistic psychotherapies: Handbook of research and practice (pp. 369-402). Washington, DC: American Psychological Association.
- Vos, T; Flaxman, AD; Naghavi, M; Lozano, R; Michaud, C; Ezzati, M; Shibuya, K; Salomon, JA; Abdalla, S; 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): 2163–96. doi:10.1016/S0140-6736(12)61729-2. PMC 6350784. PMID 23245607.
- Simpson, Helen Blair, ed. (2010). Anxiety disorders : theory, research, and clinical perspectives (1. publ. ed.). Cambridge, UK: Cambridge University Press. p. 7. ISBN 978-0-521-51557-3. Archived from the original on 6 May 2016.
- 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, Kelia C.; Perini, Sarah J.; Rapee, Ronald M. (2014). "6". In Hofmann, Stefan G.; DiBartolo, Patricia M. (eds.). Social Anxiety: Clinical, Developmental, and Social Perspectives (3 ed.). Elsevier. 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 A. (2006). Child and Adolescent Psychopathology: Theoretical and Clinical Implications. 27 church road, Hove, East Sussex: Routledge. p. 79.CS1 maint: location (link)
- AnxietyBC (14 November 2014). "GENERALIZED ANXIETY". AnxietyBC. AnxietyBC. Archived from the original on 12 June 2015. Retrieved 11 June 2015.
- Merrill, Anna. "Anxiety and Autism Spectrum Disorders". Indiana Resource Center for Autism. 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. "Anxiety Disorders During Childhood and Adolescence: Origins and Treatment" (PDF). Annual Review of Clinical Psychology. Archived from the original (PDF) on 11 June 2015.