Comprehensive Summary of Anxiety and Trauma-Related Disorders
I. Generalized Anxiety Disorder (GAD)
1. American Psychiatric Association Definition
o A disorder characterized by excessive anxiety and worry about various
domains, occurring more days than not for at least 6 months (American
Psychiatric Association [APA], 2013).
2. Layman's Term Definition
o Persistent and overwhelming worry about everyday things, like health, work,
or relationships, that is hard to control.
3. Example
o A person worrying excessively about finances despite having stable savings and
income.
4. Diagnostic Criteria (DSM-5)
o Excessive anxiety and worry occurring more days than not for at least 6
months, about a number of events or activities (APA, 2013).
o The individual finds it difficult to control the worry.
o Associated with three (or more) of the following six symptoms: restlessness,
being easily fatigued, difficulty concentrating, irritability, muscle tension, and
sleep disturbance.
o The anxiety, worry, or physical symptoms cause clinically significant distress
or impairment in social, occupational, or other important areas of functioning.
o The disturbance is not attributable to physiological effects of a substance or
another medical condition.
o The disturbance is not better explained by another mental disorder (APA, 2013).
5. Possible Comorbidities
o Major depressive disorder, panic disorder, substance use disorders (APA, 2013).
6. Prevalence, Age of Onset, and Gender Differences
o 12-month prevalence in the U.S. is 2.9%; lifetime prevalence is approximately
6%.
o Onset: typically in childhood or adolescence but can occur at any age.
o Gender: Women are twice as likely to develop GAD as men (APA, 2013).
7. Stats
o Approximately one-third of affected individuals seek treatment (Comer & Comer,
2021).
8. Causes
o Biological Factors: Genetic predisposition with an estimated heritability of
30%; neurotransmitter abnormalities, including GABA dysregulation; and
neurobiological differences in areas like the amygdala and stria terminalis
(Kring & Johnson, 2021; APA, 2013).
o Psychological Factors: Anxiety sensitivity, which involves distress in
response to arousal-related sensations, and maladaptive coping mechanisms
, o Pharmacological: SSRIs (e.g., sertraline), SNRIs (e.g., venlafaxine).
II. Panic Disorder
1. American Psychiatric Association Definition
o Recurrent unexpected panic attacks with persistent concern about additional
attacks or their consequences (APA, 2013).
2. Layman's Term Definition
o Sudden and intense episodes of fear that feel like a heart attack or loss of
control.
3. Example
o A person suddenly experiencing chest pain and a racing heart while watching TV,
fearing they are dying.
4. Diagnostic Criteria (DSM-5)
o Recurrent unexpected panic attacks (APA, 2013).
o At least one of the attacks has been followed by 1 month (or more) of one or
both of the following:
Persistent concern or worry about additional panic attacks or their
consequences.
Significant maladaptive change in behavior related to the attacks (e.g.,
behaviors designed to avoid having panic attacks).
o The disturbance is not attributable to the physiological effects of a substance or
another medical condition.
o The disturbance is not better explained by another mental disorder (APA, 2013).
5. Possible Comorbidities
o Agoraphobia, major depressive disorder (APA, 2013).
6. Prevalence, Age of Onset, and Gender Differences
o 12-month prevalence in the U.S.: 2–3%.
o Median age of onset: 20–24 years.
o Gender: Women are twice as likely to experience panic disorder (APA, 2013).
7. Stats
o Often co-occurs with other anxiety disorders (Comer & Comer, 2021).
8. Causes
o Biological Factors: Moderate heritability (30-34%); dysfunction in brain
regions such as the amygdala and hippocampus; abnormalities in
neurotransmitters like serotonin and norepinephrine (Barlow et al., 2017).
o Psychological Factors: Increased sensitivity to interoceptive cues and a
heightened fear response to perceived physical symptoms (Kring & Johnson,
2021).
o Environmental Factors: Stressful life events often precede the first panic
attack, but not all individuals exposed to such events develop panic disorder
,1. American Psychiatric Association Definition
o Exposure to actual or threatened death, serious injury, or sexual violence
resulting in intrusive symptoms, avoidance, alterations in cognition, and
hyperarousal (APA, 2013).
2. Layman's Term Definition
o Lingering mental and emotional distress after experiencing or witnessing a
traumatic event.
3. Example
o A survivor of a car crash who relives the incident through flashbacks and avoids
driving.
4. Diagnostic Criteria (DSM-5)
o Exposure to a traumatic event (APA, 2013).
o Presence of one or more intrusion symptoms (e.g., flashbacks, nightmares).
o Persistent avoidance of stimuli associated with the trauma.
o Negative alterations in cognitions and mood.
o Marked alterations in arousal and reactivity.
o Duration of symptoms for more than 1 month.
o Clinically significant distress or impairment in functioning.
o Not attributable to substance use or another medical condition (APA, 2013).
5. Possible Comorbidities
o Depression, substance use disorder, anxiety disorders (APA, 2013).
6. Prevalence, Age of Onset, and Gender Differences
o Lifetime prevalence in the U.S.: 6.8%.
o Higher rates in individuals exposed to war or sexual assault.
o Gender: Women are more likely to develop PTSD (APA, 2013).
7. Stats
o More common in populations exposed to war or natural disasters (Comer &
Comer, 2021).
8. Causes
o Biological Factors: Overactive hypothalamic-pituitary-adrenal (HPA) axis,
hippocampal damage (potentially reversible), and genetic predispositions to
stress sensitivity (Barlow et al., 2017).
o Psychological Factors: Pre-existing mental health conditions, learned alarm
responses, and difficulties in emotional regulation (Kring & Johnson, 2021).
o Social Factors: Lack of social support and exposure to severe or repeated
trauma (APA, 2013).
9. Treatments
o Psychological: Prolonged exposure therapy, trauma-focused CBT.
o Pharmacological: SSRIs (e.g., paroxetine), Prazosin for nightmares.
, o A cycle of intrusive thoughts and repetitive behaviors to manage anxiety.
3. Example
o Checking locks repeatedly before leaving the house despite knowing they are
secure.
4. Diagnostic Criteria (DSM-5)
o Presence of obsessions, compulsions, or both (APA, 2013).
o The obsessions or compulsions are time-consuming (e.g., take more than 1
hour per day) or cause significant distress or impairment.
o The symptoms are not attributable to the physiological effects of a substance or
another medical condition.
o The disturbance is not better explained by the symptoms of another mental
disorder (APA, 2013).
5. Possible Comorbidities
o Anxiety disorders, depression, tic disorders (APA, 2013).
6. Prevalence, Age of Onset, and Gender Differences
o Lifetime prevalence: 2%.
o Onset: typically before 25 years of age.
o Gender: Slightly more common in women (APA, 2013).
7. Stats
o Often chronic if untreated (Comer & Comer, 2021).
8. Causes
o Biological Factors: Abnormalities in the cortico-striato-thalamo-cortical
circuit, increased serotonin activity, and genetic contributions with higher
concordance rates among monozygotic twins (Butcher et al., 2020).
o Psychological Factors: Cognitive distortions, low confidence in memory, and
difficulty in inhibiting intrusive thoughts (Barlow et al., 2017).
o Environmental Factors: Early infections or autoimmune responses (e.g.,
PANDAS) and environmental stressors (APA, 2013).
9. Treatments
o Psychological: Exposure and response prevention (ERP).
o Pharmacological: SSRIs (e.g., fluvoxamine).
V. Agoraphobia
1. American Psychiatric Association Definition
o Agoraphobia is characterized by marked fear or anxiety about two or more
situations such as using public transportation, being in open spaces, being
in enclosed spaces, standing in line, being in a crowd, or being outside of
the home alone due to thoughts that escape might be difficult or help
unavailable during panic-like or other incapacitating symptoms (APA, 2013).
2. Layman's Term Definition
o A fear of being in situations where escape or help may not be available, often
I. Generalized Anxiety Disorder (GAD)
1. American Psychiatric Association Definition
o A disorder characterized by excessive anxiety and worry about various
domains, occurring more days than not for at least 6 months (American
Psychiatric Association [APA], 2013).
2. Layman's Term Definition
o Persistent and overwhelming worry about everyday things, like health, work,
or relationships, that is hard to control.
3. Example
o A person worrying excessively about finances despite having stable savings and
income.
4. Diagnostic Criteria (DSM-5)
o Excessive anxiety and worry occurring more days than not for at least 6
months, about a number of events or activities (APA, 2013).
o The individual finds it difficult to control the worry.
o Associated with three (or more) of the following six symptoms: restlessness,
being easily fatigued, difficulty concentrating, irritability, muscle tension, and
sleep disturbance.
o The anxiety, worry, or physical symptoms cause clinically significant distress
or impairment in social, occupational, or other important areas of functioning.
o The disturbance is not attributable to physiological effects of a substance or
another medical condition.
o The disturbance is not better explained by another mental disorder (APA, 2013).
5. Possible Comorbidities
o Major depressive disorder, panic disorder, substance use disorders (APA, 2013).
6. Prevalence, Age of Onset, and Gender Differences
o 12-month prevalence in the U.S. is 2.9%; lifetime prevalence is approximately
6%.
o Onset: typically in childhood or adolescence but can occur at any age.
o Gender: Women are twice as likely to develop GAD as men (APA, 2013).
7. Stats
o Approximately one-third of affected individuals seek treatment (Comer & Comer,
2021).
8. Causes
o Biological Factors: Genetic predisposition with an estimated heritability of
30%; neurotransmitter abnormalities, including GABA dysregulation; and
neurobiological differences in areas like the amygdala and stria terminalis
(Kring & Johnson, 2021; APA, 2013).
o Psychological Factors: Anxiety sensitivity, which involves distress in
response to arousal-related sensations, and maladaptive coping mechanisms
, o Pharmacological: SSRIs (e.g., sertraline), SNRIs (e.g., venlafaxine).
II. Panic Disorder
1. American Psychiatric Association Definition
o Recurrent unexpected panic attacks with persistent concern about additional
attacks or their consequences (APA, 2013).
2. Layman's Term Definition
o Sudden and intense episodes of fear that feel like a heart attack or loss of
control.
3. Example
o A person suddenly experiencing chest pain and a racing heart while watching TV,
fearing they are dying.
4. Diagnostic Criteria (DSM-5)
o Recurrent unexpected panic attacks (APA, 2013).
o At least one of the attacks has been followed by 1 month (or more) of one or
both of the following:
Persistent concern or worry about additional panic attacks or their
consequences.
Significant maladaptive change in behavior related to the attacks (e.g.,
behaviors designed to avoid having panic attacks).
o The disturbance is not attributable to the physiological effects of a substance or
another medical condition.
o The disturbance is not better explained by another mental disorder (APA, 2013).
5. Possible Comorbidities
o Agoraphobia, major depressive disorder (APA, 2013).
6. Prevalence, Age of Onset, and Gender Differences
o 12-month prevalence in the U.S.: 2–3%.
o Median age of onset: 20–24 years.
o Gender: Women are twice as likely to experience panic disorder (APA, 2013).
7. Stats
o Often co-occurs with other anxiety disorders (Comer & Comer, 2021).
8. Causes
o Biological Factors: Moderate heritability (30-34%); dysfunction in brain
regions such as the amygdala and hippocampus; abnormalities in
neurotransmitters like serotonin and norepinephrine (Barlow et al., 2017).
o Psychological Factors: Increased sensitivity to interoceptive cues and a
heightened fear response to perceived physical symptoms (Kring & Johnson,
2021).
o Environmental Factors: Stressful life events often precede the first panic
attack, but not all individuals exposed to such events develop panic disorder
,1. American Psychiatric Association Definition
o Exposure to actual or threatened death, serious injury, or sexual violence
resulting in intrusive symptoms, avoidance, alterations in cognition, and
hyperarousal (APA, 2013).
2. Layman's Term Definition
o Lingering mental and emotional distress after experiencing or witnessing a
traumatic event.
3. Example
o A survivor of a car crash who relives the incident through flashbacks and avoids
driving.
4. Diagnostic Criteria (DSM-5)
o Exposure to a traumatic event (APA, 2013).
o Presence of one or more intrusion symptoms (e.g., flashbacks, nightmares).
o Persistent avoidance of stimuli associated with the trauma.
o Negative alterations in cognitions and mood.
o Marked alterations in arousal and reactivity.
o Duration of symptoms for more than 1 month.
o Clinically significant distress or impairment in functioning.
o Not attributable to substance use or another medical condition (APA, 2013).
5. Possible Comorbidities
o Depression, substance use disorder, anxiety disorders (APA, 2013).
6. Prevalence, Age of Onset, and Gender Differences
o Lifetime prevalence in the U.S.: 6.8%.
o Higher rates in individuals exposed to war or sexual assault.
o Gender: Women are more likely to develop PTSD (APA, 2013).
7. Stats
o More common in populations exposed to war or natural disasters (Comer &
Comer, 2021).
8. Causes
o Biological Factors: Overactive hypothalamic-pituitary-adrenal (HPA) axis,
hippocampal damage (potentially reversible), and genetic predispositions to
stress sensitivity (Barlow et al., 2017).
o Psychological Factors: Pre-existing mental health conditions, learned alarm
responses, and difficulties in emotional regulation (Kring & Johnson, 2021).
o Social Factors: Lack of social support and exposure to severe or repeated
trauma (APA, 2013).
9. Treatments
o Psychological: Prolonged exposure therapy, trauma-focused CBT.
o Pharmacological: SSRIs (e.g., paroxetine), Prazosin for nightmares.
, o A cycle of intrusive thoughts and repetitive behaviors to manage anxiety.
3. Example
o Checking locks repeatedly before leaving the house despite knowing they are
secure.
4. Diagnostic Criteria (DSM-5)
o Presence of obsessions, compulsions, or both (APA, 2013).
o The obsessions or compulsions are time-consuming (e.g., take more than 1
hour per day) or cause significant distress or impairment.
o The symptoms are not attributable to the physiological effects of a substance or
another medical condition.
o The disturbance is not better explained by the symptoms of another mental
disorder (APA, 2013).
5. Possible Comorbidities
o Anxiety disorders, depression, tic disorders (APA, 2013).
6. Prevalence, Age of Onset, and Gender Differences
o Lifetime prevalence: 2%.
o Onset: typically before 25 years of age.
o Gender: Slightly more common in women (APA, 2013).
7. Stats
o Often chronic if untreated (Comer & Comer, 2021).
8. Causes
o Biological Factors: Abnormalities in the cortico-striato-thalamo-cortical
circuit, increased serotonin activity, and genetic contributions with higher
concordance rates among monozygotic twins (Butcher et al., 2020).
o Psychological Factors: Cognitive distortions, low confidence in memory, and
difficulty in inhibiting intrusive thoughts (Barlow et al., 2017).
o Environmental Factors: Early infections or autoimmune responses (e.g.,
PANDAS) and environmental stressors (APA, 2013).
9. Treatments
o Psychological: Exposure and response prevention (ERP).
o Pharmacological: SSRIs (e.g., fluvoxamine).
V. Agoraphobia
1. American Psychiatric Association Definition
o Agoraphobia is characterized by marked fear or anxiety about two or more
situations such as using public transportation, being in open spaces, being
in enclosed spaces, standing in line, being in a crowd, or being outside of
the home alone due to thoughts that escape might be difficult or help
unavailable during panic-like or other incapacitating symptoms (APA, 2013).
2. Layman's Term Definition
o A fear of being in situations where escape or help may not be available, often
