Anxiety disorders

Anxiety is a common emotion and as such is often a normal response to the vicissitudes of life. In its mild forms, anxiety may be adaptive. A little anxiety, forexample, helps a student prepare for examinations. In its extreme forms, however, anxiety is incapacitating or terrifying. High anxiety may cause the same student to lose concentration, memory, or even his or her voice.

Physicians observe anxiety most commonly in patients experiencing an acute external stress. Although short-term treatment with antianxiety or sedative drugs, such as benzodiazepines, has a place in the management of such patients, physicians often can offer more help by their presence, reassurances, and attitude. Anxiety states often resolve spontaneously with time, although clinicians should be aware that acute stress can lead to chronic anxiety or posttraumatic stress disorder.

The word anxiety has more precise diagnostic meaning in psychiatry. It refers to both paroxysmal and persistent psychological feelings (dread, irritability, ruminations) and physiologic changes (dyspnea, sweating, insomnia, trembling) which endure over time and impair normal functioning. These are often chronic disorders in which symptoms persist in the absence of obvious contemporaneous external stresses or in which the degree of symptoms seems out of proportion to the degree of external stress. Anxiety disorders were formerly lumped together under the term “anxiety neurosis.” It is now recognized that a number of relatively distinct clinical syndromes exist under the general rubric of anxiety disorders, as reflected in the diagnostic criteria in the third edition of the Diagnostic and Statistical Manual (DSM-III).