Anxiety Disorder

Anxiety disorders (synonyms: Agoraphobia; anxiety; anxiety disorder; generalized; generalized anxiety; social phobia; specific phobias; anxious depression; ICD-10-GM F41.-: Other Anxiety Disorders) are among the most common disorders in the field of psychiatry. In their main symptomatology, they represent unrealistic or excessively pronounced anxiety. Anxiety disorders can be divided into:

• Anxiety disorder on an organic basis – caused by physical diseases.
• Anxiety disorder on psychological basis – here the cause lies in a psychiatric disease such as depression, substance dependence.
• Primary anxiety disorder – in this form, a distinction is made:
  • Panic disorder with/without agoraphobia (fear to the point of panic in certain places; anticipatory anxiety) [for this, see “Panic disorders”].
  • Generalized anxiety disorder (GAS, English : generalized anxiety disorder (GAD); ICD-10 F41.1) incl. anxiety neurosis, anxiety reaction, anxiety state.
  • Phobias
    • Social phobias (ICD-10 F40.1; see “social phobias” for details): “Fear of scrutinizing consideration by others, leading to avoidance of social situations.”
    • Specific (isolated) phobias (ICD-10 F40.2): “Phobias limited to narrowly circumscribed situations such as proximity to certain animals, heights, thunder, darkness, flying, enclosed spaces, urinating or defecating in public restrooms, eating certain foods, visiting the dentist, or the sight of blood or injury.” Incl. acrophobia, simple phobia, claustrophobia, animal phobias; recently added emetophobia (specific phobia of vomiting).
  • Post-traumatic stress reaction (possibly post-traumatic stress disorder (PTSD); English : post-traumatic stress disorder, PTSD).
  • Obsessive-compulsive disorder [see under “Obsessive-compulsive disorder”].

Multiple transitions exist between anxiety disorders and phobias. Sex ratio: males to females is 1: 2. Frequency peak: the maximum occurrence is in adolescence and early adulthood. The frequency peak of generalized anxiety disorder (GAS) is beyond the age of 18 (a cluster in the age group between 45 and 59 years, followed by the group between 30 and 44 years), but not infrequently can occur in adolescence. Anxiety disorders occur much less frequently after the 5th decade of life. The lifetime prevalence (frequency of illness throughout life) of one of the anxiety disorders is between 14 and 29%. The prevalence (frequency of illness) is 4-15% in Western Europe. The following table shows the 12-month prevalence of anxiety disorders [in %] of adults (in Germany).

Course and prognosis: Anxiety disorders very often show a chronic course. If an anxiety disorder is not recognized and properly treated, it often becomes chronic, which is often accompanied by prolonged sick leave and early retirement. Comorbidities: In patients with generalized anxiety disorder (GAS), depression is present in 40-67% of cases.Patients with anxiety disorders have an overall increased risk of developing other mental illness.The following table shows the mental comorbidity in anxiety disorders [in %] (in Germany).