Anxiety disorders, epidemiology and classification

By Cristiano Antonino On Nov 7, 2022

Surveys of the general population have documented that more than one in five people may experience some form of anxiety disorder during their lifetime

During periods of increased symptom intensity, people with anxiety disorders are unable to attend to their activities profitably: it has been estimated that in such cases, absence (or inefficient presence) can occur for 10-40% of the monthly working days.

Currently, the most widely used clinical classification of anxiety disorders refers to the American Psychiatric Association’s DSM-IV-TR (2000)

The classification terminology of the DSM is easy to compare because it uses explicit descriptions, but the use of the criteria for constructing diagnoses should be reserved for experienced professionals who are able to grasp the true essence of the clinical manifestations.

Below are the diagnoses of anxiety disorders currently provided for by the DSM:

Panic disorder (without/with agoraphobia): is characterised by the recurrence of very intense anxiety attacks lasting several minutes.
Agoraphobia without a history of panic disorder: people avoid going to specific places for fear of feeling ill.
Specific (or simple) phobia: disproportionate or unreasonable fear of confronting situations or external objects deemed dangerous (e.g. high places, means of transport, animals, blood, medical practices).
Social phobia (or Social Anxiety Disorder): the subject fears not being able to perform in public (e.g. speaking in front of strangers).
Obsessive-compulsive disorder: mental contents (e.g. unpleasant images) and behavioural expressions (e.g. tidying up) impose themselves on the patient’s will in a repetitive and unreasonable manner, and compulsive behaviour is often aimed at neutralising the anxiety caused by obsessive thoughts.
Post-traumatic Stress Disorder and Acute Stress Disorder: specific pictures following exposure to events that determine danger to personal safety (e.g. serious accidents, natural disasters, war scenes, assaults and rapes).

Generalised anxiety disorder: chronic anxiety symptoms last for many months and cause constant apprehension

In some cases, formal diagnostic criteria may be met for more than one disorder in the same individual (comorbidity).

Conversely, when anxiety symptoms are present but no specific diagnosis can be made, one speaks of Anxiety Disorder Not Otherwise Specified.

Then there are individuals whose anxious characteristics appear innate and are not perceived as disturbing: it is possible in these cases to consider a diagnosis of group ‘C’ personality disorder (avoidant, dependent, obsessive-compulsive).

The pattern of anxious manifestations is affected by exposure to stressful factors (demands of the environment to be coped with) that are sometimes entirely generic (from daily overwork to health problems) but more often refer to emotionally significant personal events (e.g. the end of a romantic relationship).

When a stressful environmental factor can be identified at the origin of non-specific manifestations of anxiety, a diagnosis of Adaptation Disorder with anxiety is made.

Finally, the diagnosis of Anxiety disorder due to a general medical condition and substance-induced anxiety disorder directly identifies an organic cause.

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