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Edit summary: Copied from Anxiety Disorder

Diagnosis[original] -

Anxiety disorders are often severe chronic conditions, which can be present from an early age or begin suddenly after a triggering event. They are prone to flare up at times of high stress and are frequently accompanied by physiological symptoms such as headache, sweating, muscle spasms, tachycardia, palpitations, and hypertension, which in some cases lead to fatigue.

In casual discourse the words "anxiety" and "fear" are often used interchangeably; in clinical usage, they have distinct meanings: "anxiety" is defined as an unpleasant emotional state for which the cause is either not readily identified or perceived to be uncontrollable or unavoidable, whereas "fear" is an emotional and physiological response to a recognized external threat. The umbrella term "anxiety disorder" refers to a number of specific disorders that include fears (phobias) or anxiety symptoms.

The diagnosis of anxiety disorders is difficult because there are no objective biomarkers, it is based on symptoms, which typically need to be present at least six months, be more than would be expected for the situation, and decrease functioning. Several generic anxiety questionnaires can be used to detect anxiety symptoms, such as the State-Trait Anxiety Inventory (STAI), the Generalized Anxiety Disorder 7 (GAD-7), the Beck Anxiety Inventory (BAI), the Zung Self-Rating Anxiety Scale, and the Taylor Manifest Anxiety Scale. Other questionnaires combine anxiety and depression measurement, such as the Hamilton Anxiety Rating Scale, the Hospital Anxiety and Depression Scale (HADS), the Patient Health Questionnaire (PHQ), and the Patient-Reported Outcomes Measurement Information System (PROMIS). Examples of specific anxiety questionnaires include the Liebowitz Social Anxiety Scale (LSAS), the Social Interaction Anxiety Scale (SIAS), the Social Phobia Inventory (SPIN), the Social Phobia Scale (SPS), and the Social Anxiety Questionnaire (SAQ-A30).

Anxiety disorders often occur along with other mental disorders, in particular depression, which may occur in as many as 60% of people with anxiety disorders. The fact that there is considerable overlap between symptoms of anxiety and depression, and that the same environmental triggers can provoke symptoms in either condition, may help to explain this high rate of comorbidity.

Studies have also indicated that anxiety disorders are more likely among those with family history of anxiety disorders, especially certain types.

Sexual dysfunction often accompanies anxiety disorders, although it is difficult to determine whether anxiety causes the sexual dysfunction or whether they arise from a common cause. The most common manifestations in individuals with anxiety disorder are avoidance of intercourse, premature ejaculation or erectile dysfunction among men and pain during intercourse among women. Sexual dysfunction is particularly common among people affected by panic disorder (who may fear that a panic attack will occur during sexual arousal) and posttraumatic stress disorder.

Diagnosis

Anxiety disorders are often chronic conditions, which can be present from an early age or develop over the course of someone's life. They are prone to flare up at times of high stress and can be accompanied by physiological symptoms such as headaches, sweating, muscle spasms, tachycardia, palpitations, hypertension, and/or fatigue.

In casual conversation, the words "anxiety" and "fear" are erroneously used interchangeably. However, in clinical settings, the words have distinct meanings. Anxiety can take many forms but is most commonly defined as a subjectively negative emotion involving uncontrollable or unavoidable tension and worry. Fear is an emotional and physiological response caused by a perceived external threat of danger. The umbrella term "anxiety disorder" refers to a number of specific disorders that include fears (phobias) or anxiety symptoms.

Anxiety disorders often occur alongside other mental disorders, called co-morbidity. Depression is a common co-morbid diagnosis with anxiety. Estimates show that around 60% of individuals with anxiety will also experience symptoms of depression. There is considerable overlap between symptoms of anxiety and depression, and similar environmental triggers can provoke symptoms in either condition, which may help to explain this high rate of co-morbidity. Studies have also indicated that anxiety disorders are more likely to occur among those with a family history of anxiety or depressive disorders.

Assessment Measures:

There are ways in which to assess for, and diagnose, anxiety disorders. It is valuable to first rule out general medical conditions (e.g., hyperthyroidism) that may be mimicking anxiety symptoms. It can be difficult to diagnose anxiety disorders because assessment relies on the presentation of symptoms rather than objective biomarkers. Additionally, the majority of anxiety disorders require the symptoms to be present for a minimum of six months before a diagnosis can be given.

Adult Assessment:

There are questionnaires that can be used to detect anxiety symptoms in adults, such as the State-Trait Anxiety Inventory (STAI), the Generalized Anxiety Disorder-7 (GAD-7), the Beck Anxiety Inventory (BAI), the Penn State Worry Questionnaire (PSWQ), the Depression Anxiety Stress Scales (DASS), and the Taylor Manifest Anxiety Scale.

As a more specific example, the DASS (long form) consists of 43 items measured on a Likert scale that ask questions like, "I found myself getting upset by quite trivial things" or "I felt that I had nothing to look forward to." See the image to the right for instructions to administer the DASS-43.

Other questionnaires combine anxiety and depression measurement, such as the Hamilton Anxiety Rating Scale, the Hospital Anxiety and Depression Scale (HADS), the Patient Health Questionnaire (PHQ), and the Patient-Reported Outcomes Measurement Information System (PROMIS).

Examples of specific anxiety questionnaires include the Liebowitz Social Anxiety Scale (LSAS), the Social Interaction Anxiety Scale (SIAS), the Social Phobia Inventory (SPIN), the Social Phobia Scale (SPS), and the Social Anxiety Questionnaire (SAQ-A30).

Child Assessment:

There are also assessments to examine anxiety in children. A common test is the Multidimensional Anxiety Scale for Children, Second Edition (MASC 2). The (MASC 2™) assesses the presence of symptoms related to anxiety disorders and is able to distinguish between important anxiety symptoms. Another measure is the Screen for Child Anxiety and Related Emotional Disorders (SCARED), which contains 41 items rated on a 3 point Likert scale. This measure has two versions: one for the child to answer for themselves and one for the parent or caregiver to answer about the child. This instrument measures anxiety using four domains: panic/somatic, separation anxiety, generalized anxiety, and school phobia. Additionally, the Spence Children’s Anxiety Scale (SCAS) can be utilized to assess anxiety in youth and also has two forms: child version and parent version. The SCAS consists of 44 items rated on a 4 point Likert scale involving the frequency with which each symptom is experienced. This assessment assesses six domains of anxiety: generalized anxiety, panic or agoraphobia, social phobia, separation anxiety, obsessive compulsive disorder, and physical injury fears.