Abstract
In this chapter we address anxiety issues and how they affect women. We discuss gender differences in vulnerability to anxiety, specifically generalized anxiety disorder (GAD) and Panic Disorder (PD). DSM 5 classification of anxiety disorders no longer includes posttraumatic stress disorder (PTSD) and obsessive compulsive disorder (OCD), however both OCD and PTSD are included for interest and completeness of this book chapter. In addition, specific obstetric issues that may be associated with anxiety including pregnancy and the postpartum period as well as pregnancy loss and infertility are also reviewed. We also discuss gynecologic conditions and their association with anxiety, including vulvar pain, interstitial cystitis, chronic pelvic pain, incontinence and pelvic organ prolapse.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry. 2005;62(6):617–27.
Pigott TA. Anxiety disorders in women. Psychiatry Clin N Am. 2003;26(3):621–72.
Altemus M, Sarvaiya N, Neill Epperson C. Sex differences in anxiety and depression clinical perspectives. Front Neuroendocrinol. 2014;35(3):320–30.
Pigott TA. Gender differences in the epidemiology and treatment of anxiety disorders. J Clin Psychiatry. 1999;60(18):4–15.
Breslau N. Gender differences in trauma and posttraumatic stress disorder. J Gend Specif Med. 2002;132(6):959–92.
Kessler RC. Posttraumatic stress disorder in the national comorbidity survey. Arch Gen Psychiatry. 1995;52(12):1048.
Pierce KA, Kirkpatrick DR. Do men lie on fear surveys? Behav Res Ther. 1992;30(4):415–8.
McLean CP, Anderson ER. Brave men and timid women? A review of the gender differences in fear and anxiety. Clin Psychol Rev. 2009a;29(6):496–505.
Bem SL. Gender schema theory: a cognitive account of sex typing. Psychol Rev. 1981;88(4):354–64.
Cover KK, Maeng LY, LebrĂłn-Milad K, Milad MR. Mechanisms of estradiol in fear circuitry: implications for sex differences in psychopathology. Transl Psychiatry. 2014;4:e422. https://doi.org/10.1038/tp.2014.67.
Nillni YI, Toufexis DJ, Rohan KJ. Anxiety sensitivity, the menstrual cycle, and panic disorder: a putative neuroendocrine and psychological interaction. Clin Psychol Rev. 2011;31(7):1183–91.
Yoshizawa K, Okumura A, Nakashima K, Sato T, Higashi T. Role of allopregnanolone biosynthesis in acute stress-induced anxiety-like behaviors in mice. Synapse. 2017;71(8):e21978.
Zhang LM, Qiu ZK, Chen XF, Zhao N, Chen HX, Xue R, Zhang YZ, Yang RF, Li YF. Involvement of allopregnanolone in the anti-PTSD-like effects of AC-5216. J Psychopharmacol. 2016;30(5):474–81.
Takei Y, Ando H, Tsutsui K. Handbook of hormones: comparative endocrinology for basic and clinical research. Oxford: Academic; 2015.
Kendall-Tackett K, Hale TW. The use of antidepressants in pregnant and breastfeeding women: a review of recent studies. J Hum Lact. 2010;26(2):187–95.
Remes O, Wainwright N, Surtees P, Lafortune L, Khaw KT, Brayne C. Sex differences in association between area deprivation and generalized anxiety disorder: British population study. Br J Med Open. 2017;7(5):e013590.
Beesdo K, Pine DS, Lieb R, Wittchen HU. Incidence and risk patterns of anxiety and depressive disorders and categorization of generalized anxiety disorder. Arch Gen Psychiatry. 2010;67(1):47–57.
Sheikh JI, Leskin GA, Klein DF. Gender differences in panic disorder: findings from the National Comorbidity Survey. Am J Psychiatry. 2002;159(1):55–8.
Papp LA, Martinez JM, Klein DF, Coplan JD, Norman RG, Cole R, de Jesus MJ, Ross D, Goetz R, Gorman JM. Respiratory psychophysiology of panic disorder: three respiratory challenges in 98 subjects. Am J Psychiatry. 1997;154(11):1557–65.
Raines AM, Oglesby ME, Allan NP, Mathes BM, Sutton CA, Schmidt NB. Examining the role of sex differences in obsessive-compulsive symptom dimensions. Psychiatry Res. 2018;259:265–9. https://doi.org/10.1016/j.psychres.2017.10.038.
McLean CP, Asnaani A, Litz BT, Hofmann SG. Gender differences in anxiety disorders: prevalence, course of illness, comorbidity and burden of illness. J Psychiatr Res. 2011;45(8):1027–35. https://doi.org/10.1016/j.jpsychires.2011.03.006.
Asher M, Asnaani A, Aderka IM. Gender differences in social anxiety disorder: a review. Clin Psychol Rev. 2017;56:1–12. https://doi.org/10.1016/j.cpr.2017.05.004.
Tolin DF, Foa EB. Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research. Psychol Bull. 2006;132(6):959–92.
Brewin CR, Andrews B, Valentine JD. Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol. 2000;68(5):748–66.
Christiansen DM, Elklit A. Risk factors predict post-traumatic stress disorder differently in men and women. Ann General Psychiatry. 2008;8(7):24.
Stewart DE, Vigod SN. Mental health aspects of intimate partner violence. Psychiatr Clin N Am. 2017;40(2):321–34.
Figueiredo B, Conde A. Anxiety and depression symptoms in women and men from early pregnancy to 3-months postpartum: parity differences and effects. J Affect Disord. 2011;132(1–2):146–57.
Heron J, O’Connor TG, Evans J, Golding J, Glover V. The course of anxiety and depression through pregnancy and the postpartum in a community sample. J Affect Disord. 2004;80(1):65–73.
Dennis C, Brown HK, Falah-Hassani K, Marini FC, Vigod SN. Identifying women at risk for sustained postpartum anxiety. J Affect Disord. 2017;213:131–7.
Feldman R, Greenbaum CW, Mayes LC, Erlich SH. Change in mother-infant interactive behavior: relations to change in the mother, the infant, and the social context. Infant Behav Dev. 1997;20(2):151–63.
Skouteris H, Wertheim EH, Rallis S, Milgrom J, Paxton SJ. Depression and anxiety through pregnancy and the early postpartum: an examination of prospective relationships. J Affect Disord. 2009;113(3):303–8.
Field T, Hernandez-Reif M, Diego M, Figueiro B, Schanberg S, Kuhn C. Prenatal cortisol, prematurity and low birth weight. Infant Beh Dev. 2006;29:268–75.
Orr ST, Reiter JP, Blazer DG, James SA. Maternal prenatal anxiety and spontaneous birth in Baltimore Maryland. Psychosom Med. 2007;69:566–70.
Yonkers K, Gilstad-Hayden K, Forray A, Lipind HS. Association of panic disorder, generalized anxiety disorder, and benzodiazepine treatment during pregnancy with a risk of adverse birth outcomes. J Am Med Assoc Psychiatry. 2017;74(11):1145–52.
Ross LE, McLean LM. Anxiety disorders during pregnancy and the postpartum period. J Clin Psychiatry. 2006;67(08):1285–98.
Figueiredo B, Costa R. Mother’s stress, mood and emotional involvement with the infant: 3 months before and 3 months after childbirth. Arch Womens Ment Health. 2009;12(3):143–53.
Matthey S, Barnett B, Howie P, Kavanagh DJ. Diagnosing postpartum depression in mothers and fathers: whatever happened to anxiety? J Affect Disord. 2003;74(2):139–47.
Altshuler LL, Hendrick V, Cohen LS. Course of mood and anxiety disorders during pregnancy and the postpartum period. J Clin Psychiatry. 1998;59(Suppl 2):29–33.
Meschino DC, Dalfen A, Robinson GE. Pregnancy and postpartum (Ch. 68). In: Psychiatric care of the medical patient. New York: Oxford University Press; 2015. p. 1354–64.
Wenzel A, Haugen EN, Jackson LC, Brendle JR. Anxiety symptoms and disorders at eight weeks postpartum. J Anxiety Disord. 2005;19(3):295–311.
Wenzel A, Haugen EN, Jackson LC, Robinson K. Prevalence of generalized anxiety at eight weeks postpartum. Arch Womens Ment Health. 2003;6(1):43–9.
Brandes M, Soares CN, Cohen LS. Postpartum onset obsessive-compulsive disorder: diagnosis and management. Arch Womens Ment Health. 2004;7(2):99–110.
Timpano KR, Abramowitz JS, Mahaffey BL, Mitchell MA, Schmidt NB. Efficacy of a prevention program for postpartum obsessive-compulsive symptoms. J Psychiatr Res. 2011;45(11):1511–7.
Sichel DA, Cohen LS, Rosenbaum JF, Driscoll J. Postpartum onset of obsessive-compulsive disorder. Psychosomatics. 1993;34(3):277–9.
Marchesi C, Ossola P, Amerio A, Daniel BD, Tonna M, De Panfilis C. Clinical management of perinatal anxiety disorders: a systematic review. J Affect Disord. 2016;190:543–50. https://doi.org/10.1016/j.jad.2015.11.004. Epub 2015 Nov 4.
Eke AC, Saccone G, Berghella V. Selective serotonin re-uptake inhibitor (SSRI) use during pregnancy and preterm birth: a systemic review and meta-analysis. BJOG. 2016;123(12):1900–7.
Ross LE, Grigoriadis S, Mamisashvili L, VonderPorten EH, Roerecke M, Rehm J, et al. Selected pregnancy and delivery outcomes after exposure to antidepressant medication: a systematic review and meta-analysis. JAMA Psychiatry. 2013;70:436–43.
Byatt N Deligiannidis KM, Freeman MP. Antidepressant use in pregnancy: a critical review focused on risks and controversies. Acta Psychiatr Scand. 2013;127:94–114.
McElhatton PR. The effects of benzodiazepine use during pregnancy and lactation. Reprod Toxicol. 1994;8(6):461–75.
Iqbal MM, Sobhan T, Ryals T. Effects of commonly used benzodiazepines on the fetus, the neonate and the nursing infant. Psychiatr Serv. 2002;53(1):39–49.
Robinson GE. Infertility, pregnancy loss, and abortion. In: Psychiatric care of the medical patient. New York: Oxford University Press; 2015. p. 1336–43.
Bergner A, Beyer R, Klapp BF, Rauchfuss M. Pregnancy after early pregnancy loss: a prospective study of anxiety, depressive symptomatology and coping. J Psychosom Obstet Gynecol. 2008;29(2):105–13.
Nikcevic AV, Tinkel SA, Kuczmierczyk AR, Nicolaides KH. Investigation of the cause of miscarriage and its influence on women’s psychological distress. BJOG Int J Obstet Gynaecol. 1999;106(8):808–13.
Brier N. Grief following miscarriage: a comprehensive review of the literature. J Women’s Health. 2008;17(3):451–64.
Bennett SM, Litz BT, Sarnoff Lee B, Maguen S. The scope and impact of perinatal loss: current status and future directions. Prof Psychol Res Pract. 2005;36(2):180–7.
Hughes P, Turton P, Hopper E, Evans CDH. Assessment of guidelines for good practice in psychosocial care of mothers after stillbirth: a cohort study. Lancet. 2002;360(9327):114–8.
Turton P, Evans C, Hughes P. Long-term psychosocial sequelae of stillbirth: phase II of a nested case-control cohort study. Arch Womens Ment Health. 2009;12(1):35–41.
Practice Committee of American Society for Reproductive Medicine. Definitions of infertility and recurrent pregnancy loss: a committee opinion. Fertil Steril. 2013;99(1):63.
Skakkebæk NE, Jørgensen N, Main KM, Rajpert-De Meyts E, Leffers H, Andersson A, Juul A, Carlsen E, Mortensen GK, Jensen TK, Toppari J. Is human fecundity declining? Int J Androl. 2006;29(1). Blackwell Publishing Ltd:2–11.
Petraglia F, Serour GI, Chapron C. The changing prevalence of infertility. Int J Gynaecol Obstet. 2013;123(2):S4–8.
Batool SS, de Visser RO. Experiences of infertility in British and Pakistani women: a cross-cultural qualitative analysis. Health Care Women Int. 2016;37(2):180–96.
Hinton L, Kurinczuk JJ, Ziebland S. Infertility; isolation and the internet: a qualitative interview study. Patient Educ Couns. 2010;81(3):436–41.
Kirkman M. Thinking of something to say: public and private narratives of infertility. Health Care Women Int. 2001;22(6):523–35.
Klemetti R, Raitanen J, Sihvo S, Saarni S, Koponen P. Infertility, mental disorders and well-being: a nationwide survey. Acta Obstet Gynecol Scand. 2010;89(5):677–82.
Sethi P, Sharma A, Devi Goyal L, Gurmeet K. Prevalence of psychiatric morbidity in females amongst infertile couples: a hospital based report. J Clin Diagn Res. 2016;10(7):VC04–7.
Domar AD, Zuttermeister PC, Friedman R. The psychological impact of infertility: a comparison with patients with other medical conditions. J Psychosom Obstet Gynaecol. 1993;14:45–52.
Maroufizadeh S, Karimi E, Vesali S, Omani Samani R. Anxiety and depression after failure of assisted reproductive treatment among patients experiencing infertility. Int J Gynaecol Obstet:Off Organ Int Fed Gynaecol Obstet. 2015;130(3):253–6.
Domar AD. Impact of psychological factors on dropout rates in insured infertility patients. Fertil Steril. 2004;81(2):271–3.
Olivius C, Friden B, Borg G, Bergh C. Why do couples discontinue in vitro fertilization treatment? A cohort study. Fertil Steril. 2004;81(2):258–61.
Lynch CD, Sundaram R, Maisog JM, Sweeney AM, Buck Louis GM. Preconception stress increases the risk of infertility: results from a couple-based prospective cohort study—the LIFE study. Hum Reprod. 2014;29(5). Oxford University Press:1067–75.
Li X, Ma Y, Geng L, Qin L, Hu H, Li S. Baseline psychological stress and ovarian norepinephrine levels negatively affect the outcome of in vitro fertilisation. Gynecol Endocrinol. 2011;27(3):139–43.
Kalantaridou SN, Zoumakis E, Makrigiannakis A, Lavasidis LG, Vrekoussis T, Chrousos GP. Corticotropin-releasing hormone, stress and human reproduction: an update. J Reprod Immunol. 2010;85(1):33–9.
Ebbesen SMS, Zachariae R, Mehlsen MY, Thomsen D, Højgaard A, Ottosen L, Petersen T, Ingerslev HJ. Stressful life events are associated with a poor in-vitro fertilization (IVF) outcome: a prospective study. Human Reprod. 2009;24(9):2173–82.
Frederiksen Y, Farver-Vestergaard I, Grønhøj Skovgård N, Jakob Ingerslev H, Zachariae R. Efficacy of psychosocial interventions for psychological and pregnancy outcomes in infertile women and men: a systematic review and meta-analysis. BMJ Open. 2015;5(1):e006592.
Alvarez S. Do some addictions interfere with fertility? Fertil Steril. 2015;103(1):22–6.
Wdowiak A, Sulima M, Sadowska M, Grzegorz B, Bojar I. Alcohol consumption and quality of embryos obtained in programmes of in vitro fertilization. Ann Agric Environ Med. 2014;21(2):450–3.
Wang H, Dey SK, Maccarrone M. Jekyll and Hyde: two faces of cannabinoid signaling in male and female fertility. Endocr Rev. 2006;27(5):427–48.
Park B, McPartland JM, Glass M. Cannabis, cannabinoids and reproduction. Prostaglandins Leukot Essent Fat Acids. 2004;70(2):189–97.
Klonoff-Cohen H, Lam-Kruglick P, Gonzalez C. Effects of maternal and paternal alcohol consumption on the success rates of in vitro fertilization and gamete intrafallopian transfer. Fertil Steril. 2003;79(2):330–9.
Augood C, Duckitt K, Templeton AA. Smoking and female infertility: a systematic review and meta-analysis. Hum Reprod. 1998;13(6):1532–9.
Mendelson JH, Mello NK, Ellingboe J, Skupny AS, Lex BW, Griffin M. Marihuana smoking suppresses luteinizing hormone in women. J Pharmacol Exp Ther. 1986;237(3):862–6.
Nillni YI, Wesselink AK, Gradus JL, Hatch EE, Rothman KJ, Mikkelsen EM, Wise LA. Depression, anxiety, and psychotropic medication use and fecundability. Am J Obstet Gynecol. 2016;215(4):453.e1–8.
Hemels MEH, Einarson A, Koren G, Lanctôt KL, Einarso TR. Antidepressant use during pregnancy and the rates of spontaneous abortions: a meta-analysis. Ann Pharmacother. 2005;39(5):803–9.
Casilla-Lennon MM, Meltzer-Brody S, Steiner AZ. The effect of antidepressants on fertility. Am J Obstet Gynecol. 2016;215(3):314.e1–5.
Isojärvi J. Disorders of reproduction in patients with epilepsy: antiepileptic drug related mechanisms. Seizure J Br Epilepsy Assoc. 2008;17(2):111–9.
Misra M, Papakostas GI, Klibanski A. Effects of psychiatric disorders and psychotropic medications on prolactin and bone metabolism. J Clin Psychiatry. 2004;65(12):1607–18.
Haddad PM, Hellewell JSE, Wieck A. Antipsychotic induced hyperprolactinaemia: a series of illustrative case reports. J Psychopharmacol. 2001;15(4):293–5.
Danby CS, Margesson LJ. Approach to the diagnosis and treatment of vulvar pain. Dermatol Ther. 2010;23(5):485–504.
Burrows LJ, Creasey A, Goldstein AT. The treatment of vulvar lichen sclerosus and female sexual dysfunction. J Sex Med. 2011;8(1):219–22.
Hanno PM, Erickson D, Moldwin R, Faraday MM, American Urological Association. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome: AUA guideline amendment. J Urol. 2015;193(5):1545–53.
Chuang YC, Weng SF, Hsu YW, Lung-Cheng Huang C, Wu MP. Increased risks of healthcare-seeking behaviors of anxiety, depression and insomnia among patients with bladder pain syndrome/intersitital cystitis: a nationwide population-based study. Int Urol Nephrol. 2014;47:275–81.
Nickel JC, Tripp DA, Pontari M, Moldwin R, Mayer R, Carr LK, Doggweiler R, Yang C, Mishra N, Nordling J. Childhood sexual trauma in women with interstitial cystitis/bladder pain syndrome: a case control study. Can Urol Assoc J. 2011;5(6):410–5.
Watkins KE, Eberhart N, Hilton L, Suttorp MJ, Hepner KA, Clemens JQ, Berry SH. Depressive disorders and panic attacks in women with bladder pain syndrome/interstitial cystitis: a population-based sample. Gen Hosp Psychiatry. 2011;33(2):143–9.
Chung KH, Liu SP, Lin HC, Chung SD. Bladder pain syndrome/interstitial cystitis is associated with anxiety disorder. Neurourol Urodyn. 2014;33:101–5.
Brunahl C, Dybowski C, Albrecht R, Riegel B, Hoink J, Fisch M, Lowe B. Mental disorders in patients with chronic pelvic pain syndrome (CPPS). J Psychol Res. 2017;98:19–26.
Jarrell JA, Vilos GA, Allaire C, Burgress S, Fortin C, Gerwin R, et al., Society of Obstetrics and Gynaecologists of Canada. Consensus guidelines for the management of chronic pelvic pain. J Obstet Gynaecol Can. 2005;27(8):781–801.
Asoglu MR, Selcuk S, Cam C, Cogendez E, Karateke A. Effects of urinary incontinence subtypes on women’s quality of life (including sexual life) and psychosocial state. Eur J Obstet Gynecol Reprod Biol. 2011;176:187–90.
Lim JR, Bak CW, Back CW, Lee JB. Comparison of anxiety between patients with mixed incontinence and those with stress urinary incontinence. Scand J Urol Nephrol. 2007;41:403–6.
Ghetti C, Lowder JL, Ellison R, Krohn MA, Maolli P. Depressive symptoms in women seeking surgery for pelvic organ prolapse. Int Urogynecol J. 2010;21:855–60.
Ghetti C, Skoczylas LC, Oliphant SS, Nikolajski C, Lowder JL. The emotional burden of pelvic organ prolapse in women seeking treatment: a qualitative study. Female Pelvic Med Reconstr Surg. 2015;21(6):323–38.
Lowder JL, Ghetti C, Nikolajski C, Oliphant SS, Zyczynski HM. Body image perceptions in women with pelvic organ prolapse: a qualitative study. Am J Obstet Gynecol. 2011;204(5):441.e1–5.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Becker, M.A., Silver, N.E., Chandy, A., Maheshwari, S. (2019). Anxiety Disorders. In: O’Neal, M. (eds) Neurology and Psychiatry of Women. Springer, Cham. https://doi.org/10.1007/978-3-030-04245-5_7
Download citation
DOI: https://doi.org/10.1007/978-3-030-04245-5_7
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-04244-8
Online ISBN: 978-3-030-04245-5
eBook Packages: MedicineMedicine (R0)