Anxiety disorders are a group of mental disorders characterised by excessive fear or worrying. Anxiety disorders include generalised anxiety disorder, which is characterised by continuous and excessive worrying for six months or more. Specific phobias are characterised by anxiety provoked by a feared object/situation, resulting in avoidance. Social phobia is anxiety provoked by social or performance situations. Agoraphobia is anxiety about situations where escape may be difficult or help might not be available. Panic disorder is characterised by a panic attack, which is a distinct episode where a person experiences sudden apprehension and fearfulness where they may experience shortness of breath, palpitations, chest pain, or choking.

What is the evidence for anxiety disorders in people with PTSD?

Moderate quality evidence finds the rate of anxiety disorders in veterans with PTSD is between 13% and 19%. One small study reported prevalence as high as 59% in veterans. Moderate to low quality evidence finds a medium-sized increase in generalised anxiety disorder in prisoners with PTSD compared to prisoners without PTSD. Rates were highest in males and in adult prisoners, and in prisoners with any lifetime rather than a current diagnosis of PTSD.

August 2021

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Many people with PTSD experience worrying, fear, and sleep problems. These may disrupt daily functioning, but may not meet the criteria for an anxiety disorder. They may be associated directly with the trauma itself, such as being diagnosed with a physical illness or being exposed to forced displacement or war. They may also be aggravated by other, core symptoms of PTSD, including emotional distress, physical reactivity after exposure to reminders, and upsetting memories, nightmares, and flashbacks. This topic concentrates on the presence and severity of subclinical anxiety symptoms in people with PTSD. Please also see the related disorder topic that is located under the co-occurring mental disorders category.

What is the evidence for anxiety in people with PTSD?

Moderate to high quality finds a medium association between more severe PTSD symptoms and increased levels of anxiety. This association was found in North Korean refugees and in cancer patients. There was also a medium association found between more severe PTSD symptoms and more anxiety sensitivity. This sensitivity relates to fear of the physical sensations associated with anxiety, fear of cognitive incapacitation, and fear of social or public observation of anxiety.

August 2021

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Comorbid anxiety disorders are common in people with bipolar disorder. Generalised anxiety disorder is characterised by continuous and excessive worrying for six months or more. Specific phobias are characterised by anxiety provoked by a feared object or situation, resulting in avoidance. Social phobia is anxiety provoked by social or performance situations. Agoraphobia is anxiety about situations where escape may be difficult or where help might not be available. Panic disorder is characterised by a panic attack, which is a distinct episode where a person experiences sudden apprehension and fearfulness, and may experience shortness of breath, palpitations, chest pain or feeling of choking.

What is the evidence regarding anxiety disorders in people with bipolar disorder?

Moderate quality evidence found the lifetime prevalence of anxiety disorders in children, adolescents, and adults with bipolar disorder is around 45%, and the prevalence in adults in the euthymic phase is around 35%. These rates are significantly higher than in people without bipolar disorder.

The most common anxiety disorders in adults were generalised and social anxiety disorders, agoraphobia, specific phobias, and panic disorders. The most common anxiety disorders in children were generalised and separation anxiety disorders. The most common anxiety disorders in adolescents were panic disorder and social phobia.

Moderate to low quality evidence found cognitive behavioural therapy is effective for improving symptoms of anxiety in people with bipolar disorder.

Please also see the related topics on comorbid post-traumatic stress disorder and obsessive compulsive disorder, which are no longer considered anxiety disorders in the DSM-5.

October 2021

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