Editing Anxiety disorder (section)

==Types==
=== Generalized anxiety disorder ===
{{Main|Generalized anxiety disorder}}
Generalized anxiety disorder (GAD) is a common disorder characterized by long-lasting anxiety that is not focused on any one object or situation. Those with 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".<ref>{{cite book | vauthors = Schacter DL, Gilbert DT, Wegner DM |title=Psychology |date=2011 |publisher=Macmillan |isbn=978-1-4292-3719-2 }}{{page needed|date=July 2023}}</ref> Generalized anxiety disorder is the most common anxiety disorder to affect older adults.<ref name="Calleo">{{cite journal |id={{Gale|CA181302423}} | vauthors = Calleo J, Stanley M |title=Anxiety disorders in later life: differentiated diagnosis and treatment strategies |journal=Psychiatric Times |date=1 July 2008 |volume=25 |issue=8 |pages=24 }}</ref> 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.<ref name="Barker2003">{{cite book | vauthors = Barker P |title=Psychiatric and Mental Health Nursing: The Craft of Caring |date=2003 |publisher=Taylor & Francis |isbn=978-0-340-81026-2 }}{{page needed|date=July 2023}}</ref> 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 a lack of concentration and/or preoccupation with worry.<ref>{{cite book | vauthors = Passer MW, Bremner A, Smith RE, Holt N, Vliek M, Sutherland E |title=Psychology: The Science of Mind and Behaviour |date=2009 |publisher=McGraw-Hill Higher Education |isbn=978-0-07-711836-5 |page=790 }}</ref> A symptom can be a strained appearance, with increased sweating from the hands, feet, and axillae,<ref>{{cite web | veditors = Bhandari S | date = 7 January 2023 | work = WebMD |url=http://www.webmd.com/anxiety-panic/guide/mental-health-anxiety-disorders |title=All About Anxiety Disorders: From Causes to Treatment and Prevention |access-date=2016-02-18 |url-status=live |archive-url=https://web.archive.org/web/20160217225046/http://www.webmd.com/anxiety-panic/guide/mental-health-anxiety-disorders |archive-date=17 February 2016}}</ref> along with tearfulness, which can suggest depression.<ref name=Gelder2005>{{cite book | vauthors = Gelder MG, Mayou R, Geddes J |title=Psychiatry |date=2005 |publisher=Oxford University Press |isbn=978-0-19-852863-0 |page=75 }}</ref> Before a diagnosis of anxiety disorder is made, physicians must rule out drug-induced anxiety and other medical causes.<ref>{{cite book | vauthors = Varcarolis EM |title=Manual of Psychiatric Nursing Care Planning |date=2010 |publisher=Elsevier Health Sciences |isbn=978-1-4377-1783-9 |page=109 }}</ref>

In children, GAD may be associated with headaches, restlessness, abdominal pain, and [[Palpitations|heart palpitations]].<ref name=PedGAD2009>{{cite journal | vauthors = Keeton CP, Kolos AC, Walkup JT | title = Pediatric generalized anxiety disorder: epidemiology, diagnosis, and management | journal = Paediatric Drugs | volume = 11 | issue = 3 | pages = 171–183 | year = 2009 | pmid = 19445546 | doi = 10.2165/00148581-200911030-00003 }}</ref> Typically, it begins around eight to nine years of age.<ref name=PedGAD2009/>

===Specific phobias===
{{Main|Specific phobias}}

The 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 has specific phobias.<ref name="Barker2003"/> According to the National Institute of Mental Health, a phobia is an intense fear of or aversion to specific objects or situations.<ref>{{cite web|title=NIMH » Anxiety Disorders|url=https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml|access-date=2020-11-16 | work = National Institute of Mental Health (NIMH) | publisher = U.S. National Institutes of Health }}</ref> Individuals with a phobia 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 [[List of phobias|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.<ref>{{cite web|url=https://www.mentalhealth.gov/what-to-look-for/anxiety-disorders/phobias/index.html|title=Phobias| work = U.S. Department of Health & Human Services|date=2017 |language=en-us|access-date=2017-12-01|archive-url=https://web.archive.org/web/20170513022004/https://www.mentalhealth.gov/what-to-look-for/anxiety-disorders/phobias/index.html|archive-date=13 May 2017|url-status=dead}}</ref> People with specific phobias often go to extreme lengths to avoid encountering their phobia. People with specific phobias understand that their fear is not proportional to the actual potential danger, but they can still become overwhelmed by it.<ref>{{cite book | vauthors = Bremner A, Holt N, Passer M, Smith R, Sutherland E, Vliek M | title = Psychology: The Science of Mind and Behaviour. | location = Berkshire UK | publisher = McGraw-Hill | date = 2009 | isbn = 978-0-07-711836-5 }}</ref>

===Panic disorder===
{{Main|Panic disorder}}
With panic disorder, a person has brief attacks of intense terror and apprehension, often marked by trembling, shaking, confusion, dizziness, or difficulty breathing. These [[panic attacks]] are defined by the [[American Psychiatric Association|APA]] as fear or discomfort that abruptly arises and peaks in less than ten minutes but can last for several hours.<ref>{{cite web|title=Panic Disorder|url=https://www.med.upenn.edu/ctsa/panic_symptoms.html|website=Center for the Treatment and Study of Anxiety, University of Pennsylvania|url-status=live|archive-url= https://web.archive.org/web/20150527074826/http://www.med.upenn.edu/ctsa/panic_symptoms.html|archive-date=27 May 2015}}</ref> Attacks can be triggered by stress, irrational thoughts, general fear, fear of the unknown, or even when engaging in exercise. However, sometimes the trigger is unclear, and 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 and 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 with panic disorder experience symptoms even outside of specific panic episodes. Often, normal changes in heartbeat are noticed, 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]]).

Panic disorder is commonly comorbid with anxiety due to the consistent fight or flight response that one’s brain is being put under at such a high repetitive rate. Another one of the very big leading causes of someone developing a panic disorder has a lot to do with one’s childhood. The article{{?}} provides knowledge on a positive trend in children who experience abuse and have low self-esteem to later on develop disorders such as generalized anxiety disorder and panic disorder.<ref>{{cite journal |last1=Sarkar |first1=Nilakshi |last2=Zainal |first2=Nur Hani |last3=Newman |first3=Michelle G. |title=Self-esteem mediates child abuse predicting adulthood anxiety, depression, and substance use symptoms 18 years later |journal=Journal of Affective Disorders |date=November 2024 |volume=365 |pages=542–552 |doi=10.1016/j.jad.2024.08.107 |pmc=11415822 |pmid=39178955 |pmc-embargo-date=November 15, 2025 }}</ref>

===Agoraphobia===
{{Main|Agoraphobia}}
Agoraphobia is a specific anxiety disorder wherein an individual is afraid of being in a place or situation where escape is difficult or embarrassing or where help may be unavailable.<ref>{{cite book |doi=10.1016/B978-0-08-044032-3.X5000-X |title=Origins of Phobias and Anxiety Disorders |year=2003 |isbn=978-0-08-044032-3 | vauthors = Craske MG }}{{page needed|date=July 2023}}</ref> 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 individuals often develop.<ref>{{cite book | vauthors = Hazlett-Stevens H | chapter = Agoraphobia | pages = 24–34 | veditors = Fisher JE, O'Donohue WT |title= Practitioner's Guide to Evidence-Based Psychotherapy |year=2006 | location = Boston, MA | publisher = Springer |doi=10.1007/978-0-387-28370-8_2  |isbn=978-0-387-28369-2 }}</ref> For example, following a panic attack while driving, someone with agoraphobia may develop anxiety over driving and will therefore avoid driving. These avoidance behaviors can have serious consequences and often reinforce the fear they are caused by. In a severe case of agoraphobia, the person may never leave their home.

===Social anxiety disorder===
{{Main|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 it can be experienced in most or all social situations. 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.<ref>{{Cite web |title=Social Anxiety Disorder |url=https://mhanational.org/conditions/social-anxiety-disorder/ |access-date=2025-04-28 |website=Mental Health America |language=en-US}}</ref> [[Social anxiety]] often manifests specific physical symptoms, including blushing, sweating, rapid heart rate, and difficulty speaking.<ref>{{cite web|title=NIMH » Social Anxiety Disorder: More Than Just Shyness|url=https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness/index.shtml#pub3|access-date=2020-12-01| work = National Institute of Mental Health (NIMH) | publisher = U.S. National Institutes of Health }}</ref> As with all phobic disorders, those with social anxiety often attempt to avoid the source of their anxiety; in the case of social anxiety, this is particularly problematic, and in severe cases, it can lead to complete social isolation.

Children are also affected by social anxiety disorder, although their associated symptoms are different from those of teenagers and adults. They may experience difficulty processing or retrieving information, sleep deprivation, disruptive behaviors in class, and irregular class participation.<ref>{{cite web|title=Managing Anxiety in the Classroom|url=https://www.mhanational.org/blog/managing-anxiety-classroom|access-date=2020-11-16|website=Mental Health America|language=en}}</ref>

Social physique anxiety (SPA) is a sub-type of social anxiety involving concern over the evaluation of one's body by others.<ref>{{cite book | vauthors = Ginis KM, Bassett-Gunter RL, Conlin C | chapter = Body image and exercise | veditors = Acevedo EO |title=The Oxford Handbook of Exercise Psychology|date=2012 |publisher=Oxford University Press |isbn=978-0-19-993074-6 |pages=55–75 (56) | chapter-url = https://books.google.com/books?id=VR1pAgAAQBAJ&pg=PA56}}</ref> SPA is common among adolescents, especially females.

===Post-traumatic stress disorder===
{{Main|Post-traumatic stress disorder}}
Post-traumatic stress disorder (PTSD) was once an anxiety disorder (now moved to ''trauma- and stressor-related disorders'' in the 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.<ref>{{cite web|title=What Is PTSD?|url=https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd|access-date=2020-11-16|website=psychiatry.org}}</ref> 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—<ref>{{cite book |title=Post-traumatic Stress Disorder (PTSD) and the Family: For Parents with Young Children |date=2006 |publisher=Veterans Affairs Canada |isbn=978-0-662-42627-1 |url=https://www.veterans.gc.ca/public/pages/publications/system-pdfs/pstd_families_e.pdf |archive-date=6 March 2024 |access-date=3 July 2023 |archive-url=https://web.archive.org/web/20240306063922/https://www.veterans.gc.ca/public/pages/publications/system-pdfs/pstd_families_e.pdf |url-status=dead }}</ref> for example, soldiers who endure individual battles but cannot [[coping (psychology)|cope]] with continuous combat. Common symptoms include [[hypervigilance]], [[Flashback (psychological phenomenon)|flashbacks]], avoidant behaviors, anxiety, anger, and depression.<ref name="psycho-prat">{{cite web | url = http://www.psycho-prat.fr/index.php?module=webuploads&func=download&fileId=2963_0 | title = Psychological Disorders | archive-url = https://web.archive.org/web/20081204123458/http://www.psycho-prat.fr/index.php?module=webuploads&func=download&fileId=2963_0 | archive-date=4 December 2008 | work = Psychologie Anglophone, Cours de Madame Lacroix }}{{unreliable source?|date=July 2023}}</ref> In addition, individuals may experience sleep disturbances.<ref>{{cite journal | vauthors = Shalev A, Liberzon I, Marmar C | title = Post-Traumatic Stress Disorder | journal = The New England Journal of Medicine | volume = 376 | issue = 25 | pages = 2459–2469 | date = June 2017 | pmid = 28636846 | doi = 10.1056/NEJMra1612499 }}</ref> People who have 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 with PTSD; such treatments include [[cognitive behavioral therapy]] (CBT), prolonged exposure therapy, stress inoculation therapy, medication, psychotherapy, and support from family and friends.<ref name="Barker2003"/>

[[Post-traumatic stress disorder]] research began with US military veterans of the Vietnam War, as well as natural and non-natural disaster victims. Studies have found the degree of exposure to a disaster to be the best predictor of [[Post-traumatic stress disorder|PTSD]].<ref>{{cite book|title = Posttraumatic Stress Disorder|url = https://archive.org/details/posttraumaticstr0000full|url-access = limited| vauthors = Fullerton C |publisher = American Psychiatric Press Inc.|year = 1997|isbn = 978-0-88048-751-1|location = Washington, D.C.|pages = [https://archive.org/details/posttraumaticstr0000full/page/8 8]–9}}</ref>

===Separation anxiety disorder===
{{Main|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.<ref>{{cite book | vauthors = Siegler RS |title=How Children Develop, Exploring Child Develop |date=2006 |publisher=Worth Pub |isbn=978-0-7167-6113-6 }}{{page needed|date=July 2023}}</ref> Separation anxiety disorder affects roughly 7% of adults and 4% of children, but childhood cases tend to be more severe; in some instances, even a brief separation can produce panic.<ref>{{cite journal | vauthors = Arehart-Treichel J |title=Adult Separation Anxiety Often Overlooked Diagnosis |journal=Psychiatric News |date=7 July 2006 |volume=41 |issue=13 |pages=30 |doi=10.1176/pn.41.13.0030 }}</ref><ref>{{cite journal | vauthors = Shear K, Jin R, Ruscio AM, Walters EE, Kessler RC | title = Prevalence and correlates of estimated DSM-IV child and adult separation anxiety disorder in the National Comorbidity Survey Replication | journal = The American Journal of Psychiatry | volume = 163 | issue = 6 | pages = 1074–1083 | date = June 2006 | pmid = 16741209 | pmc = 1924723 | doi = 10.1176/ajp.2006.163.6.1074 }}</ref> Treating a child earlier may prevent problems. This may include training the parents and family on how to deal with it.<!-- <ref name=Moh2014/> --> Often, the parents will reinforce the anxiety because they do not know how to properly work through it with the child.<!-- <ref name=Moh2014/> --> In addition to parent training and family therapy, medication, such as [[Selective serotonin reuptake inhibitor|SSRIs]], can be used to treat separation anxiety.<ref name=Moh2014>{{cite journal | vauthors = Mohatt J, Bennett SM, Walkup JT | title = Treatment of separation, generalized, and social anxiety disorders in youths | journal = The American Journal of Psychiatry | volume = 171 | issue = 7 | pages = 741–748 | date = July 2014 | pmid = 24874020 | doi = 10.1176/appi.ajp.2014.13101337 }}</ref>

===Obsessive–compulsive disorder===
{{Main|Obsessive–compulsive disorder}}
Obsessive–compulsive disorder (OCD) is not an anxiety disorder in the [[DSM-5]] or the [[ICD-11]].<ref name="Marras et al. (2016)">{{cite journal | vauthors = Marras A, Fineberg N, Pallanti S | title = Obsessive compulsive and related disorders: comparing DSM-5 and ICD-11 | journal = CNS Spectrums | volume = 21 | issue = 4 | pages = 324–333 | date = August 2016 | pmid = 27401060 | doi = 10.1017/S1092852916000110 }}</ref> However, it was classified as such in older versions of the DSM-IV and [[ICD-10]]. OCD manifests in the form of [[Fixation (psychology)|obsession]]s (distressing, persistent, and intrusive thoughts or images) and [[Compulsive behavior|compulsions]] (urges to repeatedly perform specific acts or rituals) that are not caused by drugs or physical disorders and which cause anxiety or distress plus (more or less important) functional disabilities.<ref name="NICE-2006">{{cite book |title=Obsessive-Compulsive Disorder: Core Interventions in the Treatment of Obsessive-Compulsive Disorder and Body Dysmorphic Disorder |series=National Institute for Health and Care Excellence: Guidelines |date=2006 |publisher=British Psychological Society |isbn=978-1-85433-430-5 |url=https://www.ncbi.nlm.nih.gov/books/NBK56458/ |pmid=21834191 |author1=National Collaborating Centre for Mental Health (UK) }}{{page needed|date=July 2023}}</ref><ref name="Soomro-2012">{{cite journal | vauthors = Soomro GM | title = Obsessive compulsive disorder | journal = BMJ Clinical Evidence | volume = 2012 | pages = 1004 | date = January 2012 | pmid = 22305974 | pmc = 3285220 }}</ref><ref name="Marras et al. (2016)" /><ref>{{cite web |title=6B20 Obsessive-compulsive disorder |url=https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1582741816 |website=ICD-11 for Mortality and Morbidity Statistics |access-date=3 July 2023 |archive-date=15 October 2023 |archive-url=https://web.archive.org/web/20231015122454/https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1582741816 |url-status=dead }}</ref> OCD affects roughly 1–2% of adults (somewhat more women than men) and under 3% of children and adolescents.<ref name="NICE-2006" /><ref name="Soomro-2012" />

A person with OCD knows that the symptoms are unreasonable and struggles against both the thoughts and the behavior.<ref name="NICE-2006" /><ref name="IQWiG-2014">{{cite book |title=InformedHealth.org |date=19 October 2017 |publisher=Institute for Quality and Efficiency in Health Care |chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK279562/ |chapter=Obsessive-compulsive disorder: Overview }}</ref> Their symptoms could be related to external events they fear, such as their home burning down because they forgot to turn off the stove, or they could worry that they will behave inappropriately.<ref name="IQWiG-2014" /> The compulsive rituals are personal rules they follow to relieve discomfort, such as needing to verify that the stove is turned off a specific number of times before leaving the house.<ref name="Soomro-2012" />

It is not certain why some people have OCD, but behavioral, cognitive, genetic, and neurobiological factors may be involved.<ref name="Soomro-2012" /> Risk factors include family history, being single, being of a higher socioeconomic class, or not being in paid employment.<ref name="Soomro-2012" /> 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%).<ref name="NICE-2006" />

===Selective mutism===
{{Main|Selective mutism}}
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]].<ref>{{cite journal | vauthors = Viana AG, Beidel DC, Rabian B | title = Selective mutism: a review and integration of the last 15 years | journal = Clinical Psychology Review | volume = 29 | issue = 1 | pages = 57–67 | date = February 2009 | pmid = 18986742 | doi = 10.1016/j.cpr.2008.09.009 }}</ref> People with selective mutism stay silent even when the consequences of their silence include shame, social ostracism, or even punishment.<ref>{{Cite news |last=Brown |first=Harriet |date=2005-04-12 |title=The Child Who Would Not Speak a Word |url=https://www.nytimes.com/2005/04/12/health/psychology/the-child-who-would-not-speak-a-word.html |access-date=2025-04-28 |work=The New York Times |language=en-US |issn=0362-4331}}</ref> Selective mutism affects about 0.8% of people at some point in their lives.<ref name="Lancet2016">{{cite journal | vauthors = Craske MG, Stein MB | title = Anxiety | journal = Lancet | volume = 388 | issue = 10063 | pages = 3048–3059 | date = December 2016 | pmid = 27349358 | doi = 10.1016/S0140-6736(16)30381-6 }}</ref>

Testing for selective mutism is important because doctors must determine if it is an issue associated with the child's hearing or movements associated with the jaw or tongue and if the child can understand when others are speaking to them.<ref>{{Cite web |title=Selective Mutism |url=https://www.asha.org/public/speech/disorders/selective-mutism/ |access-date=2025-04-28 |website=American Speech-Language-Hearing Association |language=en}}</ref> Generally, [[cognitive behavioral therapy]] (CBT) is the recommended approach for treating selective mutism, but prospective long-term outcome studies are lacking.<ref>{{cite journal | vauthors = Oerbeck B, Overgaard KR, Stein MB, Pripp AH, Kristensen H | title = Treatment of selective mutism: a 5-year follow-up study | journal = European Child & Adolescent Psychiatry | volume = 27 | issue = 8 | pages = 997–1009 | date = August 2018 | pmid = 29357099 | pmc = 6060963 | doi = 10.1007/s00787-018-1110-7 }}</ref>