Editing Anxiety disorder (section)

===Differential diagnosis===

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.<ref name= DSM5/>

The diagnosis of an anxiety disorder requires first ruling out an underlying medical cause.<ref name="Test2013partIII">{{cite journal | vauthors = Testa A, Giannuzzi R, Daini S, Bernardini L, Petrongolo L, Gentiloni Silveri N | title = Psychiatric emergencies (part III): psychiatric symptoms resulting from organic diseases | journal = European Review for Medical and Pharmacological Sciences | volume = 17 | issue = Suppl 1 | pages = 86–99 | date = February 2013 | pmid = 23436670 | url = https://www.europeanreview.org/wp/wp-content/uploads/86-99.pdf }}</ref><ref name=WHO2009 /> Diseases that may present similar to an anxiety disorder include certain endocrine diseases ([[Hypothyroidism|hypo-]] and [[hyperthyroidism]], [[hyperprolactinemia]]),<ref name=Lancet2016 /><ref name="Test2013partIII" /><ref name=Samuels2008>{{cite journal | vauthors = Samuels MH | title = Cognitive function in untreated hypothyroidism and hyperthyroidism | journal = Current Opinion in Endocrinology, Diabetes, and Obesity | volume = 15 | issue = 5 | pages = 429–433 | date = October 2008 | pmid = 18769215 | doi = 10.1097/MED.0b013e32830eb84c | type = Review }}</ref> metabolic disorders ([[diabetes mellitus|diabetes]]),<ref name="Test2013partIII" /><ref name=GrigsbyAnderson2002>{{cite journal | vauthors = Grigsby AB, Anderson RJ, Freedland KE, Clouse RE, Lustman PJ | title = Prevalence of anxiety in adults with diabetes: a systematic review | journal = Journal of Psychosomatic Research | volume = 53 | issue = 6 | pages = 1053–1060 | date = December 2002 | pmid = 12479986 | doi = 10.1016/S0022-3999(02)00417-8 | type = Systematic Review }}</ref> deficiency states (low levels of [[vitamin D]], [[Riboflavin|B2]], [[vitamin B12|B12]], [[folic acid]]),<ref name="Test2013partIII" /> gastrointestinal diseases ([[celiac disease]], [[non-celiac gluten sensitivity]], [[inflammatory bowel disease]]),<ref name=ZingoneSwift2015>{{cite journal | vauthors = Zingone F, Swift GL, Card TR, Sanders DS, Ludvigsson JF, Bai JC | title = Psychological morbidity of celiac disease: A review of the literature | journal = United European Gastroenterology Journal | volume = 3 | issue = 2 | pages = 136–145 | date = April 2015 | pmid = 25922673 | pmc = 4406898 | doi = 10.1177/2050640614560786 | type = Review }}</ref><ref name=MolinaInfanteSantolaria2015SystematicReview>{{cite journal | vauthors = Molina-Infante J, Santolaria S, Sanders DS, Fernández-Bañares F | title = Systematic review: noncoeliac gluten sensitivity | journal = Alimentary Pharmacology & Therapeutics | volume = 41 | issue = 9 | pages = 807–820 | date = May 2015 | pmid = 25753138 | doi = 10.1111/apt.13155 | type = Systematic Review | doi-access = free }}</ref><ref name=NeuendorfHarding2016>{{cite journal | vauthors = Neuendorf R, Harding A, Stello N, Hanes D, Wahbeh H | title = Depression and anxiety in patients with Inflammatory Bowel Disease: A systematic review | journal = Journal of Psychosomatic Research | volume = 87 | pages = 70–80 | date = August 2016 | pmid = 27411754 | doi = 10.1016/j.jpsychores.2016.06.001 | type = Systematic Review }}</ref> heart diseases,<ref name=Lancet2016 /><ref name="Test2013partIII" /> blood diseases ([[anemia]]),<ref name="Test2013partIII" /> and brain degenerative diseases ([[Parkinson's disease]], [[dementia]], [[multiple sclerosis]], [[Huntington's disease]]).<ref name="Test2013partIII" /><ref name=ZhaoTan2016>{{cite journal | vauthors = Zhao QF, Tan L, Wang HF, Jiang T, Tan MS, Tan L, Xu W, Li JQ, Wang J, Lai TJ, Yu JT | title = The prevalence of neuropsychiatric symptoms in Alzheimer's disease: Systematic review and meta-analysis | journal = Journal of Affective Disorders | volume = 190 | pages = 264–271 | date = January 2016 | pmid = 26540080 | doi = 10.1016/j.jad.2015.09.069 | type = Systematic Review }}</ref><ref name=WenChan2016>{{cite journal | vauthors = Wen MC, Chan LL, Tan LC, Tan EK | title = Depression, anxiety, and apathy in Parkinson's disease: insights from neuroimaging studies | journal = European Journal of Neurology | volume = 23 | issue = 6 | pages = 1001–1019 | date = June 2016 | pmid = 27141858 | pmc = 5084819 | doi = 10.1111/ene.13002 | type = Review }}</ref><ref name=MarrieReingold2015>{{cite journal | vauthors = Marrie RA, Reingold S, Cohen J, Stuve O, Trojano M, Sorensen PS, Cutter G, Reider N | title = The incidence and prevalence of psychiatric disorders in multiple sclerosis: a systematic review | journal = Multiple Sclerosis | volume = 21 | issue = 3 | pages = 305–317 | date = March 2015 | pmid = 25583845 | pmc = 4429164 | doi = 10.1177/1352458514564487 | type = Systematic Review }}</ref> Anxiety and panic disorders as well as other neuropsychiatric disorders can be a symptom of [[mast cell activation syndrome|mast cell activation syndrome (MCAS)]].<ref name="PMID38003876">{{cite journal |vauthors=Weinstock LB, Nelson RM, Blitshteyn S |title=Neuropsychiatric Manifestations of Mast Cell Activation Syndrome and Response to Mast-Cell-Directed Treatment: A Case Series |journal= J Pers Med |volume=13 |issue=11 |date=2023-10-31 |page=1562 |doi=10.3390/jpm13111562 |pmc=10672129 |pmid=38003876 |url=|doi-access=free}}</ref><ref name="PMID26162709">{{cite journal |vauthors=Afrin LB, Pöhlau D, Raithel M, Haenisch B, Dumoulin FL, Homann J, Mauer UM, Harzer S, Moderings J |title=Mast cell activation disease: An underappreciated cause of neurologic and psychiatric symptoms and diseases |journal=Brain Behav Immun |volume=50 |date=November 2015 |doi=10.1016/j.bbi.2015.07.002 |pmid=26162709 |pages=314–321}}</ref><ref name="PMID28262205">{{cite journal |vauthors=Afrin LB, Self S, Menk J, Lazarchick J |title=Characterization of Mast Cell Activation Syndrome |journal=The American Journal of the Medical Science |volume=353 |issue=3 |date=2016-12-16 |pages=207–215 |doi=10.1016/j.amjms.2016.12.013 |pmc=5341697 |pmid=28262205|url=|doi-access=free}}</ref>

Several drugs can also cause or worsen anxiety, whether through intoxication, withdrawal, or chronic use. These include [[alcohol (drug)|alcohol]], tobacco, cannabis, [[sedative]]s (including prescription [[Benzodiazepine|benzodiazepines]]), [[opioid]]s (including prescription painkillers and illicit drugs like heroin), [[stimulant]]s (such as caffeine, cocaine, and amphetamines), [[hallucinogen]]s, and [[inhalants]].<ref name=Lancet2016/><ref name= DSM5 />