Anxiety Disorders

Course

The course of anxiety disorders varies between the particular disorder and between individuals. Although, the course of all anxiety disorders is usually chronic, with enduring symptoms and impairment in social functioning often many years after disease onset (Angst and Vollrath, 1991). Onset is frequently early in life, between the age of 20 and 30 years, and anxiety disorders are more common in women than in men (Angst and Vollrath, 1991; Schatzberg, 1991).

Anxiety disorders can co-occur with depression and, along with severity and duration of symptoms, comorbidity with depression is an important predictor of the outcome of the anxiety disorders (Angst and Vollrath, 1991).

There is increasing evidence that the course of anxiety disorders in women is different from the course of anxiety disorders in men. This difference is thought to be associated with the female reproductive hormone cycle and the risk of comorbid conditions (Pigott, 2003).

Course of Specific Anxiety Disorders

The course of some specific anxiety disorders is discussed briefly in this section.

• Social anxiety disorder (SAD) usually begins in adolescence and is often mistaken as teenage ‘shyness – rendering SAD an under-recognised and under-treated condition. SAD is usually a lifelong and unremitting anxiety disorder, with more pronounced anxiety, impairment in social functioning and a poorer outcome when compared with other anxiety disorders. For example, only one-third of people with SAD achieve remission within 8 years, compared with more than two-thirds of people suffering from panic disorder (Keller, 2003).
• Generalised anxiety disorder (GAD) may endure for up to 20 years, with low rates of remission and moderate rates of relapse after remission. The course of GAD is influenced by many factors, including gender, comorbid conditions, stressful life events and anxiety sensitivity (Keller, 2002)
• The course of obsessive compulsive disorder (OCD) is also chronic. However, recent evidence suggests there is a subtype of OCD sufferers who experience episodic OCD and another subtype of those who have OCD and a chronic tic disorder. Comorbidity of OCD and schizophrenia are high, and obsessions and compulsions are more common among individuals with schizophrenia (Attiullah et al, 2000).
• Phobia is a chronic condition from which people rarely experience significant relief with out intervention. There is some evidence that exposure to the causes of phobia improves long-term outcome in people with social phobia, although results are inconclusive (Juster and Heimberg, 1995).
• Post-traumatic stress disorder (PTSD) differs from the other anxiety disorders in that the experience of a traumatic event is necessary for onset of the disorder, although not all the people who suffer a traumatic life event will develop PTSD. In addition to trauma, other risk factors for PTSD are a psychiatric history, a family history of psychiatric conditions, and acute stress symptoms. PTSD has a longitudinal course, with progressive modification over time. The course varies extensively between individuals and is heavily influenced by the precipitating trauma and the characteristics of the individual. Comorbid conditions complicate the course of PTSD and major depression and substance abuse are particularly common comorbid conditions of PTSD (McFarlane, 2000; Breslau, 2001).