Vol 5 n° 3
- Anxiety II
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nxiety is a common psychiatric disorder.
1
It is
usually associated with fear, nervousness, apprehension,
and panic, but may also involve the cardiovascular, res-
piratory, gastrointestinal, or nervous systems, individu-
ally or in combination.
2
Anxiety has been recognized as a symptom for centuries.
However, it was only recently, with the incorporation of
Klein’s
3
conceptualization of panic disorder (PD) as a sep-
arate entity into
Diagnostic and Statistical Manual of
Mental Disorders, Third Edition
4
and
Revised Third
Edition
5
(
DSM-III
and
DSM-III-R
) that anxiety states
began to be subdivided into distinct entities such as PD
with and without agoraphobia, social phobia (SP), post-
traumatic stress disorder (PTSD), obsessive-compulsive
C l i n i c a l r e s e a r c h
2 8 1
The epidemiology of anxiety disorders:
a review
Patrick Martin, MD, PhD
A
Keywords:
anxiety disorder; epidemiology; panic disorder; generalized anxiety
disorder; posttraumatic stress disorder; phobia; comorbidity
Author affiliations:
Unit
é
de Recherche, D
é
partement de Psychiatrie et de
Psychologie Médicale, Hôpital Saint-Antoine and CREST, Paris, France
Address for correspondence:
Unit
é
de Recherche, D
é
partement de
Psychiatrie et de Psychologie Médicale, Hôpital Saint-Antoine and CREST,
75012 Paris, France
(e-mail: CREST.santepublique@wanadoo.fr)
Epidemiological studies show that anxiety disorders are highly prevalent and an important cause of functional impairment;
they constitute the most frequent mental disorders in the community. Phobias are the most common with the highest rates
for simple phobia and agoraphobia. Panic disorder (PD) and obsessive-compulsive disorder (OCD) are less frequent (2% life-
time prevalence), and there are discordant results for social phobia (SP) (2%-16%) and generalized anxiety disorder (GAD)
(3%-30%). These studies underline the importance of an accurate definition of disorders using unambiguous diagnostic and
assessment criteria. The boundaries between anxiety disorders are often ill defined and cases may vary widely according to
the definition applied. Simple phobia, agoraphobia, and GAD are more common in women, while there is no gender differ-
ence for SP, PD, and OCD. Anxiety disorders are more common in separated, divorced, and widowed subjects; their preva-
lence is highest in subjects aged 25 to 44 years and lowest in subjects aged >65 years. The age of onset of the different types
of anxiety disorders varies widely: phobic disorders begin early in life, whereas PD occurs in young adulthood. Clinical—rather
than epidemiological—studies have examined risk factors such as life events, childhood experiences, and familial factors.
Anxiety disorders have a chronic and persistent course, and are frequently comorbid with other anxiety disorders, depressive
disorders, and substance abuse. Anxiety disorders most frequently precede depressive disorders or substance abuse. Comorbid
diagnoses may influence risk factors like functional impairment and quality of life. It remains unclear whether certain anxi-
ety disorders (eg, PD) are risk factors for suicide. The comorbidity of anxiety disorders has important implications for assess-
ment and treatment, and the risk factors should be explored. The etiology, natural history, and outcome of these disorders
need to be further addressed in epidemiological studies.
© 2003, LLS SAS
Dialogues Clin Neurosci
. 2003;5:281-298.
Copyright © 2003 LLS SAS. All rights reserved
www.dialogues-cns.org
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