15.4 Anxiety Disorders

By the end of this section, you will be able to:

• Distinguish normal anxiety from pathological anxiety
• List and describe the major anxiety disorders, including their main features and prevalence
• Describe basic psychological and biological factors that are suspected to be important in the etiology of anxiety disorder

Everybody experiences anxiety from time to time. Although anxiety is closely related to fear, the two states possess important differences. Fear involves an instantaneous reaction to an imminent threat, whereas anxiety involves apprehension, avoidance, and cautiousness regarding a potential threat, danger, or other negative event (Craske, 1999). While anxiety is unpleasant to most people, it is important to our health, safety, and well-being. Anxiety motivates us to take actions—such as preparing for exams, watching our weight, showing up to work on time—that enable us to avert potential future problems. Anxiety also motivates us to avoid certain things—such as running up debts and engaging in illegal activities—that could lead to future trouble. Most individuals’ level and duration of anxiety approximates the magnitude of the potential threat they face. For example, suppose a student who came to the U.S. as a “Dreamer” (someone whose parents didn’t lawfully immigrate) is concerned about the possibility of being unable to continue in the university program or of losing access to academic financial aid, due to changes and litigation around the Deferred Action for Childhood Arrivals (DACA) program. This person likely would experience anxiety of greater intensity and duration than would a 21-year-old junior who entered college as a birthright citizen. Some people experience anxiety that is excessive, persistent, and greatly out of proportion to the actual threat; if one’s anxiety has a disruptive influence on one’s life, this is a strong indicator that the individual is experiencing an anxiety disorder.

Anxiety disorders are characterized by excessive and persistent fear and anxiety, and by related disturbances in behavior (APA, 2013). Although anxiety is universally experienced, anxiety disorders cause considerable distress. As a group, anxiety disorders are common: approximately 25%–30% of the U.S. population meets the criteria for at least one anxiety disorder during their lifetime (Kessler et al., 2005). Also, these disorders appear to be much more common in women than they are in men; within a 12-month period, around 23% of women and 14% of men will experience at least one anxiety disorder (National Comorbidity Survey, 2007). Anxiety disorders are the most frequently occurring class of mental disorders and are often comorbid with each other and with other mental disorders (Kessler, Ruscio, Shear, & Wittchen, 2009).