Anxiety is a physiological and psychological state of increased arousal that is universal in humans. It can be considered one of the vital factors for the basis of continuing life. Anxiety improves performance, improves survival, and keeps us alive. Every person has some anxiety, and each person will experience it differently. The key words “some” and “differently” are pivotal to understanding the role of anxiety in a healthy individual versus an anxiety disorder. Every individual needs some level of anxiety to motivate him or her to perform the daily functions required in one’s life. However, excessive anxiety causes a patient to become “frozen with fear” and incapable of taking action when needed. When, for a specific situation, a person has too much anxiety for too long a period of time, that person may be characterized as having an anxiety disorder. The disorder causes significant subjective and objective discomfort or bad feelings and lasts for a specific time period. In addition, anxiety or its effects cause marked, negative consequences in important areas of the patient’s life, such as in his or her family life, social life and/or occupation.

Misconceptions About Anxiety

Because anxiety is universal and every individual has experienced it at some point in his or her life, it may seem logical for a person to view another’s experience with anxiety through his or her own “eyes.” If one has never experienced a significant amount of anxiety for a prolonged time (and consequently does not have an anxiety disorder), the person may interpret the meaning and experience of anxiety in another person as mild and acceptable rather than a disorder that requires attention and treatment. Consequently, the public as well as many healthcare professionals may not view anxiety disorders as serious health problems with problematic and even tragic consequences when left untreated. They may have less difficulty relating to other psychiatric disorders illnesses such as schizophrenia or bipolar disorders as a problem because these are often outside the realm of normal human experiences. Often, anxiety disorders are discounted in terms of their levels of intensity and their need for treatment. Some people may view an anxiety disorder as the psychiatric equivalent of the common cold. However, given the high prevalence of these disorders and the impairment they cause, healthcare professionals need to re-examine their understanding of what constitutes an anxiety disorder.

Prevalence of Anxiety Disorders

Before recent epidemiological studies were conducted, many practitioners thought of anxiety disorders as occurring relatively infrequently and posing minor difficulties in people’s lives. Two important studies, the Epidemiologic Catchment Area (ECA) Study, conducted in 1989, and the National Comorbidity Study (NCS), conducted in 1992, yielded a much more impressive picture. In the ECA study, as many as 20% of the adult population was found to have an anxiety disorder. In addition, 1 in 5 people had not sought treatment in the last year. The NCS results further refined these numbers and found that up to 25% of the American adult population can expect to have an anxiety disorder in their lifetime. The actual incidence can vary between 15%-25% when taking into account whether these disorders interfere with daily functioning or impair social and occupational areas of a person’s life. One of the most common psychiatric illnesses, anxiety disorders affect females more than males. TABLE 1 shows the lifetime prevalence of the anxiety disorders in the United States.

Common Anxiety Disorders

Once the essentials of a panic attack are understood, the specific disorders that fall under the umbrella of “anxiety disorders” can be put into perspective. There are five common, but distinctly different, types of anxiety disorders: panic disorder (PD), generalized anxiety disorder (GAD), social phobia (SP), obsessive compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). (Specific phobia and acute stress disorder, while clinically significant, will not be discussed, as there is very limited pharmacologic treatment for these two disorders.) All of these disorders are distinct entities with their own characteristic presentation; however, the similarities will be emphasized to promote better understanding and to help pharmacists recognize these undertreated and often-overlooked disorders.