ANXIETY DISORDERS

MS. SWATHI PS
ASSISTANT PROFESSOR
DEPARTMENT OF PSYCHOLOGY
SAHS
Excessive fear and anxiety and related behavioral disturbances.
Fear is the emotional response to real or perceived imminent
threat, whereas Anxiety is anticipation of future threat.
Neuroticism—a proneness or disposition to experience negative
mood states that is a common risk factor for both anxiety and mood
disorders.
limbic system (often known as the “emotional brain”)
(GABA), norepinephrine, and serotonin
➔ classical conditioning
➔ Learned helplessness
➔ parenting styles
➔ distorted patterns of cognition
➔ socio cultural environment
1. SEPARATION ANXIETY DISORDER

2. SELECTIVE MUTISM

3. SPECIFIC PHOBIA

4. SOCIAL ANXIETY DISORDER

5. PANIC DISORDER, PANIC ATTACK

6. AGORAPHOBIA

7. GAD

8. SUBSTANCE/MEDICATION INDUCED ANXIETY DISORDER

9. ANXIETY DISORDER CAUSED BY MEDICAL CONDITION

Separation Anxiety Disorder - 309.21 (F93.0)
Onset of separation anxiety disorder may be as early as preschool age and may
occur at any time during childhood and more rarely in adolescence.

However, the majority of children with separation anxiety disorder are free of
impairing anxiety disorders over their lifetimes.

Many adults with separation anxiety disorder do not recall a childhood onset of
separation anxiety disorder, although they may recall symptoms.
Environmental.

Separation anxiety disorder often develops after life stress, especially a loss (e.g.,
the death of a relative or pet; an illness of the individual or a relative; a change of
schools; parental divorce; a move to a new neighborhood; immigration; a disaster
that involved periods of separation from attachment figures). In young adults, other
examples of life stress include leaving the parental home, entering into a romantic
relationship, and becoming a parent. Parental overprotection and intrusiveness may
be associated with separation anxiety disorder
Genetic and physiological.

Separation anxiety disorder in children may be heritable. Heritability was

estimated at 73% in a community sample of 6-year-old twins, with higher rates in
girls. Children with separation anxiety disorder display particularly enhanced
sensitivity to respiratory stimulation using C02-enriched air.
Gender-Related Diagnostic issues

Girls manifest greater reluctance to attend or avoidance of school than boys.

Indirect expression of fear of separation may be more common in males than in
females, for example, by limited independent activity, reluctance to be away from
home alone, or distress when spouse or offspring do things independently or when
contact with spouse or offspring is not possible.
Suicide Risk

Separation anxiety disorder in children may be associated with an increased risk for
suicide. In a community sample, the presence of mood disorders, anxiety disorders,
or substance use has been associated with suicidal ideation and attempts.
However, this association is not specific to separation anxiety disorder and is found
in several anxiety disorders.
Differential diagnosis

GAD

Panic disorder

Agoraphobia

Conduct disorder

Social anxiety disorder

PTSD

Illness anxiety disorder

Bereavement

Depressive, Bipolar disorder

Oppositional defiant disorder

Psychotic disorder

Personality disorder
Comorbidity

In children, separation anxiety disorder is highly comorbid with generalized anxiety

disorder and specific phobia. In adults, common comorbidities include specific
phobia, PTSD, panic disorder, generalized anxiety disorder, social anxiety disorder,
agoraphobia, obsessive-compulsive disorder, and personality disorders. Depressive
and bipolar disorders are also comorbid with separation anxiety disorder in adults.
Selective Mutism 312.23 (F94.0)
Diagnostic Criteria 312.23 (F94.0)
A. Consistent failure to speak in specific social situations in which there is an
expectation for speaking (e.g., at school) despite speaking in other situations.

B. The disturbance interferes with educational or occupational achievement or with

social communication.

C. The duration of the disturbance is at least 1 month (not limited to the first month of
school).

D. The failure to speak is not attributable to a lack of knowledge of, or comfort with,
the spoken language required in the social situation.

E. The disturbance is not better explained by a communication disorder (e.g.,

childhood onset fluency disorder) and does not occur exclusively during the course of
autism spectrum disorder, schizophrenia, or another psychotic disorder
Development and Course
The onset of selective mutism is usually before age 5 years, but the disturbance
may not come to clinical attention until entry into school, where there is an
increase in social interaction and performance tasks, such as reading aloud.

The persistence of the disorder is variable. Although clinical reports suggest that
many individuals "'outgrow" selective mutism, the longitudinal course of the
disorder is unknown.

In some cases, particularly in individuals with social anxiety disorder, selective

mutism may disappear, but symptoms of social anxiety disorder remain.
Associated Features Supporting Diagnosis

● Associated features of selective mutism may include excessive shyness, fear of

social embarrassment, social isolation and withdrawal, clinging, compulsive
traits, negativism, temper tantrums, or mild oppositional behavior.
● Although children with this disorder generally have normal language skills, there
may occasionally be an associated communication disorder, although no
particular association with a specific communication disorder has been identified.
● Even when these disorders are present, anxiety is present as well. In clinical
settings, children with selective mutism are almost always given an additional
diagnosis of another anxiety disorder—most commonly, social anxiety disorder
(social phobia)
Prevalence
● Selective mutism is a relatively rare disorder and has not been included as a
diagnostic category in epidemiological studies of prevalence of childhood
disorders.
● Point prevalence using various clinic or school samples ranges between 0.03%
and 1% depending on the setting (e.g., clinic vs. school vs. general population)
and ages of the individuals in the sample.
● The prevalence of the disorder does not seem to vary by sex/race/ethnicity.
● The disorder is more likely to manifest in young children than in adolescents
and adults.
Risk and Prognostic Factors

Temperamental

● Negative affectivity (neuroticism) or behavioral inhibition may play a role, as

may parental history of shyness, social isolation, and social anxiety.

● Children with selective mutism may have subtle receptive language

difficulties compared with their peers, although receptive language is still

within the normal range.

Environmental.

Social inhibition on the part of parents may serve as a model for social reticence
and selective mutism in children. Furthermore, parents of children with selective
mutism have been described as overprotective or more controlling than parents of
children with other anxiety disorders or no disorder.

Genetic and physiological factors.

Because of the significant overlap between selective mutism and social anxiety
disorder, there may be shared genetic factors between these conditions.
Differential Diagnosis

Communication disorders.

Selective mutism should be distinguished from speech disturbances that are better
explained by a communication disorder, such as language disorder, speech sound
disorder (previously phonological disorder), childhood-onset fluency disorder
(stuttering), or pragmatic (social) communication disorder. Unlike selective
mutism, the speech disturbance in these conditions is not restricted to a specific
social situation.
Neurodevelopmental disorders and schizophrenia and other psychotic disorders.

Individuals with an autism spectrum disorder, schizophrenia or another psychotic

disorder, or severe intellectual disability may have problems in social communication

and be unable to speak appropriately in social situations. In contrast, selective

mutism should be diagnosed only when a child has an established capacity to speak

in some social situations (e.g., typically at home). Social anxiety disorder (social

phobia). The social anxiety and social avoidance in social anxiety disorder may be

associated with selective mutism. In such cases, both diagnoses may be given.
Comorbidity

The most common comorbid conditions are other anxiety disorders, most

commonly social anxiety disorder, followed by separation anxiety disorder and

specific phobia. Oppositional behaviors have been noted to occur in children with

selective mutism, although oppositional behavior may be limited to situations

requiring speech. Communication delays or disorders also may appear in some

children with selective mutism.

Social Anxiety Disorder (Social Phobia)
Diagnostic Criteria 300.23 (F40.10)
A. Marked fear or anxiety about one or more social situations in which the individual

is exposed to possible scrutiny by others. Examples include social interactions (e.g.,

having a conversation, meeting unfamiliar people), being observed (e.g., eating or

drinking), and performing in front of others (e.g., giving a speech). Note: In children,

the anxiety must occur in peer settings and not just during interactions with adults.

B. The individual fears that he or she will act in a way or show anxiety symptoms that

will be negatively evaluated (i.e., will be humiliating or embarrassing: will lead to

rejection or offend others).

C. The social situations almost always provoke fear or anxiety. Note: In
children, the fear or anxiety may be expressed by crying, tantrums,
freezing, clinging, shrinking, or failing to speak in social situations.
D. The social situations are avoided or endured with intense fear or
anxiety.
E. The fear or anxiety is out of proportion to the actual threat posed by
the social situation and to the sociocultural context.
F. The fear, anxiety, or avoidance is persistent, typically lasting for 6
months or more.
G. The fear, anxiety, or avoidance causes clinically significant distress or
impairment in social, occupational, or other important areas of
functioning.
H. The fear, anxiety, or avoidance is not attributable to the physiological
effects of a substance (e.g., a drug of abuse, a medication) or another
medical condition.
I. The fear, anxiety, or avoidance is not better explained by the symptoms
of another mental disorder, such as panic disorder, body dysmoφhic
disorder, or autism spectrum disorder.
J. If another medical condition (e.g., Parkinson’s disease, obesity,
disfigurement from bums or injury) is present, the fear, anxiety, or
avoidance is clearly unrelated or is excessive. Specify if: Performance only:
If the fear is restricted to speaking or performing in public.
Associated Features Supporting Diagnosis

● Individuals with social anxiety disorder may be inadequately assertive

or excessively submissive or, less commonly, highly controlling of the
conversation.
● They may show overly rigid body posture or inadequate eye contact,
or speak with an overly soft voice.
● These individuals may be shy or withdrawn, and they may be less
open in conversations and disclose little about themselves.
● They may seek employment in jobs that do not require social contact,
although this is not the case for individuals with social anxiety disorder,
performance only.
● They may live at home longer. Men may be delayed in marrying and
having a family, whereas women who would want to work outside the
home may live a life as homemaker and mother.
● Self-medication with substances is common (e.g., drinking before
going to a party).
● Social anxiety among older adults may also include exacerbation of
symptoms of medical illnesses, such as increased tremor or
tachycardia.
● Blushing is a hallmark physical response of social anxiety disorder.
Development and Course

Median age at onset of social anxiety disorder in the United States is 13

years, and 75% of individuals have an age at onset between 8 and 15
years.
The disorder sometimes emerges out of a childhood history of social
inhibition or shyness in U.S. and European studies. Onset can also occur in
early childhood.
Onset of social anxiety disorder may follow a stressful or humiliating
experience (e.g., being bullied, vomiting during a public speech), or it may
be insidious, developing slowly.
First onset in adulthood is relatively rare and is more likely to occur after a
stressful or humiliating event or after life changes that require new social roles
(e.g., marrying someone from a different social class, receiving a job
promotion).

Social anxiety disorder may diminish after an individual with fear of dating
marries and may reemerge after divorce.

Among individuals presenting to clinical care, the disorder tends to be

particularly persistent.
Adolescents endorse a broader pattern of fear and avoidance, including of dating,
compared with younger children.

Older adults express social anxiety at lower levels but across a broader range of
situations, whereas younger adults express higher levels of social anxiety for
specific situations.
Detection of social anxiety disorder in older adults may be challenging because of
several factors, including a focus on

● somatic symptoms,
● comorbid medical illness,
● limited insight,
● changes to social environment or roles that may obscure impairment in social
functioning, or
● reticence about describing psychological distress.
Risk and Prognostic Factors

Temperamental.
Underlying traits that predispose individuals to social anxiety disorder include
behavioral inhibition and fear of negative evaluation.
Environmental.
There is no causative role of increased rates of childhood maltreatment or other
early-onset psychosocial adversity in the development of social anxiety disorder.
However, childhood maltreatment and adversity are risk factors for social anxiety
disorder.
Genetic and physiological.

● Traits predisposing individuals to social anxiety disorder, such as behavioral

inhibition, are strongly genetically influenced.
● The genetic influence is subject to gene-environment interaction; that is,
children with high behavioral inhibition are more susceptible to environmental
influences, such as socially anxious modeling by parents.
● Also, social anxiety disorder is heritable (but performance-only anxiety less so).
First-degree relatives have a two to six times greater chance of having social
anxiety disorder, and liability to the disorder involves the interplay of
disorder-specific (e.g., fear of negative evaluation) and nonspecific (e.g.,
neuroticism) genetic factors.
Females with social anxiety disorder report a greater number of social fears and
comorbid depressive, bipolar, and anxiety disorders,

whereas males are more likely to fear dating, have oppositional defiant disorder or
conduct disorder, and use alcohol and illicit drugs to relieve symptoms of the
disorder.
Differential Diagnosis
Normative shyness
Agoraphobia
Panic disorder
Generalized anxiety disorder
Separation anxiety disorder
Specific phobias
MDD
ODD
ASD
PD
Comorbidity
Social anxiety disorder is often comorbid with other anxiety disorders, major depressive disorder,
and substance use disorders, and the onset of social anxiety disorder generally precedes that of
the other disorders, except for specific phobia and separation anxiety disorder.
Chronic social isolation in the course of a social anxiety disorder may result in major depressive
disorder. Comorbidity with depression is high also in older adults. Substances may be used as
self-medication for social fears, but the symptoms of substance intoxication or withdrawal, such as
trembling, may also be a source of (further) social fear.
Social anxiety disorder is frequently comorbid with bipolar disorder or body dysmorphic disorder;
for example, an individual has body dysmorphic disorder concerning a preoccupation with a slight
irregularity of her nose, as well as social anxiety disorder because of a severe fear of sounding
unintelligent.
The more generalized form of social anxiety disorder, but not social anxiety disorder, performance
only, is often comorbid with avoidant personality disorder. In children, comorbidities with
high-functioning autism and selective mutism are common.
Specific Phobia
300.29 (F40.218) Animal (e.g., spiders, insects, dogs).

300.29 (F40.228) Natural environment (e.g., heights, storms, water).

300.29 (F40.23X) Blood-injection-injury (e.g., needles, invasive medical procedures).

Coding note: Select specific ICD-10-CM code as follows:

F40.230 fear of blood;

F40.231 fear of injections and transfusions;

F40.232 fear of other medical care; or

F40.233 fear of injury.

300.29 (F40.248) Situational (e.g., airplanes, elevators, enclosed places).

300.29 (F40.298) Other (e.g., situations that may lead to choking or vomiting: in children, e.g., loud sounds or
costumed characters)
A. Marked fear or anxiety about a specific object or situation (e.g., flying,
heights, animals, receiving an injection, seeing blood). Note: In children, the
fear or anxiety may be expressed by crying, tantrums, freezing, or clinging.

B. The phobic object or situation almost always provokes immediate fear or

anxiety.

C. The phobic object or situation is actively avoided or endured with intense

fear or anxiety.

D. The fear or anxiety is out of proportion to the actual danger posed by the
specific object or situation and to the sociocultural context.
E. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or
more.

F. The fear, anxiety, or avoidance causes clinically significant distress or

impairment in social, occupational, or other important areas of functioning.

G. The disturbance is not better explained by the symptoms of another mental

disorder, including fear, anxiety, and avoidance of situations associated with
panic-like symptoms or other incapacitating symptoms (as in agoraphobia):
objects or situations related to obsessions (as in obsessive-compulsive
disorder); reminders of traumatic events (as in posttraumatic stress disorder);
separation from home or attachment figures (as in separation anxiety disorder);
or social situations (as in social anxiety disorder)
https://study.com/academy/lesson/specific-and-social-phobias-definition-causes-an
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Associated Features Supporting Diagnosis
Individuals with specific phobia typically experience an increase in physiological
arousal in anticipation of or during exposure to a phobic object or situation.
However, the physiological response to the feared situation or object varies.
Whereas individuals with situational, natural environment, and animal specific
phobias are likely to show sympathetic nervous system arousal, individuals with
blood-injection-injury specific phobia often demonstrate a vasovagal fainting or
near-fainting response that is marked by initial brief acceleration of heart rate and
elevation of blood pressure followed by a deceleration of heart rate and a drop in
blood pressure.

Current neural systems models for specific phobia emphasize the amygdala and
related structures, much as in other anxiety disorders
Development and course
● Following a traumatic event (e.g., being attacked by an animal or stuck in an
elevator), observation of others going through a traumatic event (e.g. watching
someone drowning) an unexpected panic attack in the to be feared situation
(e.g., an unexpected panic attack while on the subway), or informational
transmission (e.g., extensive media coverage of a plane crash)
● Although most specific phobias develop in childhood and adolescence, it is
possible for a specific phobia to develop at any age, often as the result of
experiences that are traumatic. For example, phobias of choking almost always
follow a near-choking event at any age.
Agoraphobia 300.22 (F40.00)
AGORAPHOBIA 300.22 (F40.00)
A. Marked fear or anxiety about two (or more) of the following five situations:
1. Using public transportation (e.g., automobiles, buses, trains, ships, planes).
2. Being in open spaces (e.g., parking lots, marketplaces, bridges).
3. Being in enclosed places (e.g., shops, theaters, cinemas).
4. Standing in line or being in a crowd.
5. Being outside of the home alone.
B. The individual fears or avoids these situations because of thoughts that escape might be
difficult or help might not be available in the event of developing panic-like symptoms or
other incapacitating or embarrassing symptoms (e.g., fear of falling in the elderly; fear of
incontinence).
C. The agoraphobic situations almost always provoke fear or anxiety.

D. The agoraphobic situations are actively avoided, require the presence of a companion, or
are endured with intense fear or anxiety.

E. The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic
situations and to the sociocultural context.

F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in

social, occupational, or other important areas of functioning.
H. If another medical condition (e.g., inflammatory bowel disease, Parkinson’s disease)
is present, the fear, anxiety, or avoidance is clearly excessive.

I. The fear, anxiety, or avoidance is not better explained by the symptoms of another
mental disorder—for example, the symptoms are not confined to specific phobia,
situational type; do not involve only social situations (as in social anxiety disorder): and
are not related exclusively to obsessions (as in obsessive-compulsive disorder),
perceived defects or flaws in physical appearance (as in body dysmoφhic disorder),
reminders of traumatic events (as in posttraumatic stress disorder), or fear of
separation (as in separation anxiety disorder).

Note: Agoraphobia is diagnosed irrespective of the presence of panic disorder. If an

individual’s presentation meets criteria for panic disorder and agoraphobia, both
diagnoses should be assigned.
Associated Features Supporting Diagnosis
In its most severe forms, agoraphobia can cause individuals to become
completely homebound, unable to leave their home and dependent on others
for services or assistance to provide even for basic needs.

Demoralization and depressive symptoms, as well as abuse of alcohol and

sedative medication as inappropriate self-medication strategies, are common.
Temperamental.
Behavioral inhibition and neurotic disposition (i.e., negative affectivity [neuroticism] and
anxiety sensitivity) are closely associated with agoraphobia but are relevant to most
anxiety disorders (phobic disorders, panic disorder, generalized anxiety disorder).
Anxiety sensitivity (the disposition to believe that symptoms of anxiety are harmful) is also
characteristic of individuals with agoraphobia.
Environmental.
Negative events in childhood (e.g., separation, death of parent) and other stressful
events, such as being attacked or mugged, are associated with the onset of
agoraphobia. Furthermore, individuals with agoraphobia describe the family climate and
child-rearing behavior as being characterized by reduced warmth and increased
overprotection.
Genetic and physiological.
Heritability for agoraphobia is 61%. Of the various phobias, agoraphobia has the
strongest and most specific association with the genetic factor that represents
proneness to phobias.
Psychoanalytic view

phobias represent a defense against anxiety that stems from repressed impulses
from the id.

Because it is too dangerous to “know” the repressed id impulse, the anxiety is

displaced onto some external object or situation that has some symbolic
relationship to the real object of the anxiety (Freud, 1909).
Numerous other theorists in the 1960s and 1970s also agreed that the principles of
classical conditioning appeared to account for the acquisition of irrational fears and
phobias.

The fear response can readily be conditioned to previously neutral stimuli when
these stimuli are paired with traumatic or painful events.

We would also expect that, once acquired, phobic fears would generalize to other,
similar objects or situations.
Several behavior genetic studies also suggest a modest genetic contribution to the
development of specific phobias.

For example, a large female twin study found that monozygotic (identical) twins
were more likely to share animal phobias and situational phobias (such as of
heights or water) than were dizygotic (nonidentical) twins (Kendler et al., 1999b).
Very similar results were later also found for men (Hettema et al., 2005).
Panic Disorder 300.01 (F41.0)
A. Recurrent unexpected panic attacks. A panic attack is an abrupt surge of
intense fear or intense discomfort that reaches a peak within minutes, and during
which time four (or more) of the following symptoms occur;

Note: The abrupt surge can occur from a calm state or an anxious state.

1. Palpitations, pounding heart, or accelerated heart rate.

2. Sweating.

3. Trembling or shaking.

4. Sensations of shortness of breath or smothering.

5. Feelings of choking.

6. Chest pain or discomfort.

7. Nausea or abdominal distress.

8. Feeling dizzy, unsteady, light-headed, or faint.

9. Chills or heat sensations.

10. Paresthesias (numbness or tingling sensations).

11. Derealization (feelings of unreality) or depersonalization (being detached from oneself).

12. Fear of losing control or “going crazy.”

13. Fear of dying. Note: Culture-specific symptoms (e.g., tinnitus, neck soreness, headache,
uncontrollable screaming or crying) may be seen. Such symptoms should not count as one of the
four required symptoms.
B. At least one of the attacks has been followed by 1 month (or more) of one or both
of the following:

1. Persistent concern or worry about additional panic attacks or their consequences

(e.g., losing control, having a heart attack, “going crazy”).

2. A significant maladaptive change in behavior related to the attacks (e.g.,

behaviors designed to avoid having panic attacks, such as avoidance of exercise or
unfamiliar situations).
C. The disturbance is not attributable to the physiological effects of a substance
(e.g., a drug of abuse, a medication) or another medical condition (e.g.,
hyperthyroidism, cardiopulmonary disorders).

D. The disturbance is not better explained by another mental disorder (e.g., the
panic attacks do not occur only in response to feared social situations, as in social
anxiety disorder: in response to circumscribed phobic objects or situations, as in
specific phobia: in response to obsessions, as in obsessive-compulsive disorder: in
response to reminders of traumatic events, as in posttraumatic stress disorder: or in
response to separation from attachment figures, as in separation anxiety disorder).
Generalized Anxiety Disorder 300.02 (F41.1)

A. Excessive anxiety and worry (apprehensive expectation), occurring more

days than not for at least 6 months, about a number of events or activities
(such as work or school performance).
B. The individual finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or more) of the
following six symptoms (with at least some symptoms having been present
for more days than not for the past 6 months);
Note: Only one item is required in children.
1. Restlessness or feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless,
unsatisfying sleep).
D. The anxiety, worry, or physical symptoms cause clinically significant distress or
impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance

(e.g., a drug of abuse, a medication) or another medical condition (e.g.,
hyperthyroidism).

F. The disturbance is not better explained by another mental disorder (e.g., anxiety or
worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder [social
phobia], contamination or other obsessions in obsessive-compulsive disorder, separation from attachment
figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder,
gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived
appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the
content of delusional beliefs in schizophrenia or delusional disorder).
Associated Features Supporting Diagnosis

Associated with muscle tension, there may be trembling, twitching, feeling shaky,
and muscle aches or soreness. Many individuals with generalized anxiety disorder
also experience somatic symptoms (e.g., sweating, nausea, diarrhea) and an
exaggerated startle response. Symptoms of autonomic hyperarousal (e.g.,
accelerated heart rate, shortness of breath, dizziness) are less prominent in
generalized anxiety disorder than in other anxiety disorders, such as panic
disorder. Other conditions that may be associated with stress (e.g., irritable bowel
syndrome, headaches) frequently accompany generalized anxiety disorder.
DEVELOPMENT
The median age at onset for generalized anxiety disorder is 30 years; however,
age at onset is spread over a very broad range. The median age at onset is later
than that for the other anxiety disorders. The symptoms of excessive worry and
anxiety may occur early in life but are then manifested as an anxious temperament.
Onset of the disorder rarely occurs prior to adolescence. The symptoms of
generalized anxiety disorder tend to be chronic and wax and wane across the
lifespan, fluctuating between syndromal and subsyndromal forms of the disorder.
Rates of full remission are very low.