Anxiety disorders

Anxiety symptoms and disorders are common in community settings, and in primary and secondary care. Symptoms can be mild and transient, but many people are troubled by severe symptoms that cause great personal distress, and which impair social and occupational function. The societal burden associated with anxiety disorders is considerable, but many who might benefit from treatment are not recognized or treated by healthcare professionals. By contrast, some patients receive unnecessary or inappropriate treatment. Recognition relies on keen awareness of the psychological and physical symptoms seen in all anxiety disorders, and accurate diagnosis rests on the identification of the specific features of particular disorders. The need for treatment is determined by the severity and persistence of symptoms, the level of associated disability and impact on everyday life, the presence of co-existing depressive symptoms, and other features such as a good response to or poor tolerability of previous treatment approaches. Choice of treatment is influenced by patient characteristics, patient and doctor preferences, and the local availability of potential interventions. There is much overlap between the different anxiety disorders for evidence-based and effective therapies (such as the prescription of a selective serotonin reuptake inhibitor or a course of individual cognitive–behavioural therapy) but there are also important differences, so it helps to become familiar with the characteristic features and evidence base for each disorder.