Anxiety disorders are the most common psychiatric disorders affecting both children and adults, affecting an estimated 19 million Americans. Anxiety disorders are caused by a complex set of risk factors including genetics, brain chemistry, personality, and life events. Only about one-third of anxiety sufferers receive treatment. Anxiety disorders include general anxiety disorder (GAD), obsessive compulsive disorder, panic disorder, post-traumatic stress disorder, social anxiety disorder, and phobias. We will focus on general anxiety disorder in this column.

General anxiety disorder is characterized by excessive uncontrollable worry about everyday things that is present more days than not for more than 6 months. The focus of anxiety can shift on issues such as job, finances, and health but can also include minor things such as daily errands or being late for appointments. The intensity, duration and frequency of anxiety interfere with the sufferer's performance and ability to concentrate. GAD sufferers may experience physical symptoms including muscle tension, sweating, nausea, clammy hands, difficulty swallowing, jumpiness, and diarrhea. GAD may interfere with sleep resulting in fatigue.

Children and teens suffer from anxiety disorders just like adults. Stressful events such as starting school, the loss of a parent or moving can trigger an anxiety disorder but a disorder does not necessarily have a specific triggering event. Children with untreated anxiety disorders are more likely to perform poorly in school, have socialization problems and are at greater risk for substance abuse. Separation anxiety disorder and phobias are more common in younger children ages 6 to 9, GAD and social anxiety disorder are more common in older children and teens. Although children and teens suffer symptoms of GAD just like adults, they display them differently, which may make diagnosis difficult.

Until recently it was believed that anxiety was rare in the elderly. It is now believed that anxiety is as common in the elderly but is expressed differently. Most older sufferers had an anxiety disorder when they were younger. The disorder returns as the person suffers the stresses and vulnerabilities of the aging process such as chronic physical ailments, memory loss, and emotional losses. Older adults are less likely to report psychiatric symptoms and concentrate more on physical complaints.

The majority of patients can be helped with professional care. Treatment is often complicated, as patients may have more than one anxiety disorder, depression, and substance abuse. Treatment must be individualized for each patient and may involve a number of treatment methods. Behavioral therapy aims to modify and gain control over unwanted behaviors. Cognitive therapy aims to change unproductive or harmful thought patterns. Cognitive and behavioral therapies are often combined. Relaxation techniques are taught to help develop the ability to cope with the symptoms of anxiety. Techniques usually include exercise and breathing techniques. Medication is often combined with the above treatment methods. Treatment begins with recognition by the primary care provider. Effective treatment may require a team approach of practitioners including psychiatrists, psychologists, clinical social workers, and psychiatric nurses.

Self test tools are available on http://www.adaa.org to help individuals, parents and caregivers determine if someone should be evaluated for an anxiety disorder.

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