The Wiley Handbook of Anxiety Disorders

Paul Emmelkamp, Thomas Ehring

• Publisher: Wiley-Blackwell
• Year: 2014
• ISBN:
  9781118775325
• Edition: 1
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

This state-of-the-art Handbook on the research and treatment of anxiety and related disorders is the most internationally and clinically oriented Handbook currently available, encompassing a broad network of researchers, from leading experts in the field to rising stars.

• The very first handbook to cover anxiety disorders according to the new DSM-5 criteria
• Published in two volumes, the International Handbook provides the most wide-ranging treatment of the state-of-the-art research in the anxiety disorders
• Offers a truly international aspect, including authors from different continents and covering issues of relevance to non-Western countries
• Includes discussion of the latest treatments, including work on persistence of compulsions, virtual reality exposure therapy, cognitive bias modification, cognitive enhancers, and imagery rescripting
• Covers treatment failures, transdiagnostic approaches, and includes treatment issues for children as well as the older population
• Edited by leaders in the field, responsible for some of the most important advances in our understanding and treatment of anxiety disorders

2 Volumes

1
General Introduction

Paul Emmelkamp

University of Amsterdam, the Netherlands

Thomas Ehring

University of Münster, Germany

Overview of the Handbook

The aim of this two-volume handbook is to provide a comprehensive overview of the current knowledge on the phenomenology, classification, epidemiology, etiology, and clinical management of anxiety disorders. Whereas Volume 1 focuses on theory and research, Volume 2 covers assessment and treatment issues. For the most part, the different chapters of this handbook focus on the state of the art of theory, research, and treatment. However, as the field of anxiety disorders is a very vibrant one with a considerable amount of theoretical, empirical, and clinical innovation and refinement, all chapters additionally cover current developments and future directions in their respective fields. In addition, the handbook concludes with two chapters explicitly focusing on future perspectives from a psychological and psychiatric perspective respectively.

Some months before the publication of this handbook, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was introduced (APA, 2013). In the new DSM-5 – and also the ICD-11, which is currently in preparation – the definition of anxiety disorders has changed considerably in comparison to the DSM-IV-TR (APA, 2000). Most importantly, obsessive-compulsive disorders (OCD) and posttraumatic stress disorder (PTSD) are now no longer classified as anxiety disorders. Based on this recent development, one may have decided to publish a considerably slimmer book focusing on anxiety disorders according to the DSM-5 only. However, instead we decided to include OCD and PTSD that have formerly been classified in this category and certainly show a close relationship with anxiety disorders in the stricter sense. In addition, a number of supplementary anxiety-related disorders and problems are covered, including Illness Anxiety, Body Dysmorphic Disorder, Sexual Anxiety, and Test Anxiety.

As a lead-up to the specialized chapters in this handbook, this introductory chapter will give a brief overview, providing basic information regarding the definition, prevalence, etiology, and treatment of anxiety and related disorders. Throughout the introduction, we will refer to the different chapters of this handbook for more detailed information.

Prevalence, Course, and Consequences

Anxiety disorders are the most prevalent group of psychiatric disorders, being more than twice as frequent as mood disorders (Kessler, Petukhova, Sampson, Zaslavsky, & Wittchen, 2012). Lifetime and 12-month prevalence rates are highest for social phobia and specific phobias, and lower for panic disorder, agoraphobia, and obsessive-compulsive disorder (see Chapter 3, this volume). However, nearly all studies have been conducted in North America and Western Europe, so it is unclear whether these results also apply to other continents (see Chapter 6, this volume).

Anxiety disorders often begin at an early age, are typically quite persistent throughout the life course, and are associated with considerable developmental, psychosocial, and psychopathologic complications. Comorbidity with other Axis I and Axis II disorders is the rule rather than the exception, whereby anxiety disorders usually precede comorbid disorders (see Chapter 3, this volume). Prospective studies found that having an anxiety disorder in adolescence increases the risk for a subsequent depressive disorder and suicide attempts (Sareen et al., 2005a).

There is extensive evidence showing that anxiety disorders carry considerable costs at an individual and societal level and are related to high levels of disability (see Chapter 4, this volume). There is also an increased risk of somatic disorders such as asthma (Scott, 2009), diabetes (Grigsby, Anderson, Freedland, Clouse, & Lustman, 2002), hypertension (Stein, Scott, & Von Korff, 2009), and heart disease (Burger, 2009). Panic disorder and agoraphobia and posttraumatic stress disorder have been found more often to be associated with specific physical disorders than simple phobia, social anxiety disorder, or generalized anxiety disorder (Cafarella, Effing, Usmani, & Frith, 2012; Player & Peterson, 2011; Sareen, Cox, Clara, & Asmundson, 2005b; Wu & Andersen, 2011).

Many patients do not receive psychological or psychiatric treatment despite the availability of a number of empirically supported treatments. However, studies across numerous different countries demonstrate that, after depression, anxiety disorders are the second most common mental disorder presented in general practice (see Chapter 5, this volume), but patients commonly present with somatic rather than emotional concerns.

Description of Anxiety Disorders

Specific phobias

Specific phobias are focused upon, and restricted to, fear of specific objects and situations (see Chapter 18, this volume). Typical examples are animals, heights, storms, darkness, enclosed spaces, needles, blood, or injury, but in fact specific phobias can develop in response to almost any type of object. The key feature differentiating specific phobia from agoraphobia is that, in the case of agoraphobia, the fear is due to anticipated difficulty in escaping or getting help should a panic attack or symptoms occur.

Specific phobia is the most common of all mental disorder with a lifetime prevalence in the community of up to 10% (Emmelkamp & Wittchen, 2009). The prevalence of specific phobias varies considerably across the lifespan. Studies in childhood, adolescent, and young adult samples usually report the highest prevalence (12-month: 6–8%), whereas prevalence rates among older adults (after age 50) appear to be lower (12-month: 4–6%), and after age 65 substantially lower (12-month: 2%). In DSM-5, the core features of specific phobia remain the same, but there is no longer a requirement that individuals over age 18 years must recognize that their fear and anxiety are excessive or unreasonable, and now the phobia has to last for 6 months or more, not only for children, as in DSM-IV, but also for adults.

Social anxiety disorder

Social anxiety disorder (social phobia) is defined as fear of scrutiny by other people leading to avoidance of social situations (see Chapter 20, this volume). These may be discrete (i.e., restricted to eating in public, to public speaking, or to encounters with the opposite sex) or diffuse, involving almost all social situations. Common features of social anxiety disorder include physical symptoms of blushing, sweating, or trembling, and fears of negative evaluation. Social phobia or social anxiety disorder is a commonly occurring mental disorder with a lifetime prevalence of 7–12% in Western cultures. Social anxiety disorder prevalence has been exhibiting prominent discrepancy between different cultures. In community studies using DSM-IV criteria the rates of social anxiety disorder are much lower in East Asia (Emmelkamp, 2012).

It is now acknowledged that social phobia often occurs in a variety of social situations rather than in one specific social situation. The diagnosis requires that a person's fear or anxiety be out of proportion in frequency and/or duration to the actual situation. It is no longer required that individuals over age 18 years must recognize that their fear or anxiety is excessive or unreasonable. The symptoms must be persistent, however, lasting 6 months or longer, not only for children, as was the case in DSM-IV, but now also for adults. Further, in DSM-5 the person must suffer significant distress or impairment that interferes with his or her ordinary routine in social settings, at work or school, or during other everyday activities. As to social anxiety disorder in children, DSM-5 includes two more behaviors as characteristic for social anxiety (i.e., extreme clinging and not being able to speak in social situations) in addition to severe, prolonged crying or tantrums, becoming physically immobilized or shrinking away from other people. These behaviors can occur as a reaction to people the child knows or to a stranger.

Panic disorder and agoraphobia

Panic disorder and agoraphobia are prevalent anxiety disorders with a lifetime prevalence estimate of approximately 4–5% (see Chapter 19, this volume). They are associated with high levels of disability and high medical utilization.

Panic disorder

Panic disorder is characterized by recurrent panic attacks accompanied by at least four symptoms. The essential features of panic attacks remain the same in DSM-5, but now a differentiation between unexpected and expected panic attacks is coded. Further, the presence of panic attacks can be listed as a specifier that is applicable to all DSM-5 disorders.

Agoraphobia

Agoraphobia is defined as marked fear or anxiety about using public transport, being in an open space, being in enclosed spaces, standing in line, being in a crowd, or being outside of the home alone. To distinguish agoraphobia from specific phobia, fear should be present for at least two agoraphobia situations. As in social anxiety disorder, in DSM-5 the criteria for agoraphobia no longer include the requirement that individuals over age 18 years recognize that their anxiety is excessive or unreasonable. Now the anxiety must be out of proportion to the actual danger or threat and fears should be present for a duration of 6 months or more.

Panic disorder and agoraphobia

Panic disorder and agoraphobia are no longer linked in DSM-5. The co-occurrence of panic disorder and agoraphobia is now coded with two diagnoses: panic disorder and agoraphobia, each with separate criteria...

Table of contents

• Cover
• Cover
• Titlepage
• Copyright
• Contents
• Contributors
• 1 General Introduction
• Part I Epidemiology and Classification
• Part II Etiology of Anxiety Disorders
• Part III Specific Anxiety Disorders and Anxiety-related Disorders
• Part IV Special Populations
• Part V Prevention
• Titlepage
• Copyright
• Contents
• Contributors
• Part VI Clinical Assessment
• Part VII Treatment of Anxiety Disorders: State of the Art
• Part VIII Clinical Management of Specific Anxiety Disorders and Anxiety-related Disorders
• Part IX Clinical Management of Comorbidity
• Part X Approaches to Improve Effectiveness and Dissemination
• Part XI Agenda for Future Research
• Index