Including separation anx­ iety disorder, selective mutism, specific phobia, social



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Anxiety disorders 

(FIG. 1)


, including separation anx­

iety disorder, selective mutism, specific phobia, social 

 anxiety disorder, panic disorder, agoraphobia and 

general ized anxiety disorder, constitute the largest 

group of mental disorders in most western societies and 

are a leading cause of disability

1–3

. In 2010, >60  million 



Europeans had an anxiety disorder

2

, resulting in a total 



cost of >74 billion euros

1

, which was largely due to 



 indirect costs such as disability. The essential features of 

anxiety disorders are excessive and enduring fear, anx­

iety and/or the avoidance of perceived threats either in 

the external (for example, social situations) or internal 

(for example, bodily sensations) environment. In addi­

tion, panic attacks can be a feature of anxiety disorders 

as a type of abrupt fear response. The avoidance behav­

iours that are features of some anxiety disorders can 

range from a refusal to enter certain situations to a subtle 

 reliance on objects or people to cope.

The onset of most anxiety disorders occurs during 

childhood, adolescence or early adulthood

4

. If untreated, 



anxiety disorders tend to be chronic with waxing and 

waning symptoms

5

, although symptom reduction might 



occur for ~40% of patients

6,7


. Anxiety disorders are 

often followed by depression and several other condi­

tions, meaning that they can also be a risk marker for 

disease burden

8

.

The diagnostic criteria for anxiety disorders are 



similar across the two most common classification sys­

tems: the Diagnostic and Statistical Manual of Mental 

Disorders, Fifth Edition (DSM­5)

9

 and the International 



Classification of Diseases, Tenth Edition (ICD­10)

10



Anxiety disorders can also be conceptualized as dimen­

sional, ranging from mild to severe. To illustrate, social 

anxiety covers mild social anxiety (for example, anxiety in 

performance situations that impairs functioning in work 

meetings), moderate social anxiety (for example, anxiety 

in several interactive and performance situations that 

impairs work performance and social relationships) and 

severe social anxiety (for example, anxiety in most social 

situations that results in job loss and social isolation).

Although post­traumatic stress disorder (PTSD) and 

obsessive–compulsive disorder (OCD) were historically 

included in the anxiety disorder category of the DSM, 

they were moved to adjoining chapters in the DSM­5. 

Given that both of these disorders were previously con­

sidered anxiety disorders, research pertaining to these 

conditions contributes to our understanding of anxiety 

disorders as a whole. Consequently, these disorders are 

occasionally referenced throughout this Primer.

This Primer discusses the epidemiology, diagnosis 

and management of anxiety disorders as a whole, refer­

ring to individual anxiety disorders where possible. 

Correspondence to M.G.C. 

Department of Psychology, 

University of California 

Los Angeles, 405 Hilgard 

Avenue, Los Angeles

California 90095, USA.

craske@psych.ucla.edu

Article number: 17024

doi:10.1038/nrdp.2017.24

Published online 4 May 2017; 

corrected online 14 Dec 2017

Anxiety disorders



Michelle G. Craske

1

, Murray B. Stein

2,3

, Thalia C. Eley

4

, Mohammed R. Milad

5,6



Andrew Holmes

7

, Ronald M. Rapee

8

 and Hans-Ulrich Wittchen

9

Abstract | Anxiety disorders constitute the largest group of mental disorders in most western 

societies and are a leading cause of disability. The essential features of anxiety disorders are 

excessive and enduring fear, anxiety or avoidance of perceived threats, and can also include panic 

attacks. Although the neurobiology of individual anxiety disorders is largely unknown, some 

generalizations have been identified for most disorders, such as alterations in the limbic system, 

dysfunction of the hypothalamic–pituitary–adrenal axis and genetic factors. In addition, general risk 

factors for anxiety disorders include female sex and a family history of anxiety, although 

disorder-specific risk factors have also been identified. The diagnostic criteria for anxiety disorders 

varies for the individual disorders, but are generally similar across the two most common 

classification systems: the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition 

(DSM-5) and the International Classification of Diseases, Tenth Edition (ICD-10). Despite their 

public health significance, the vast majority of anxiety disorders remain undetected and untreated 

by health care systems, even in economically advanced countries. If untreated, these disorders are 

usually chronic with waxing and waning symptoms. Impairments associated with anxiety disorders 

range from limitations in role functioning to severe disabilities, such as the patient being unable to 

leave their home.

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