Anxiety Disorders

  • Cierra B. Edwards
  • Amber L. Billingsley
  • Shari A. SteinmanEmail author


Anxiety disorders are common in virtually all cultures; however, accurately diagnosing them can be challenging. This chapter briefly describes each of the anxiety disorders categorized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and available diagnostic interviewing tools. The advantages and weaknesses of various interviewing and assessment strategies for anxiety disorders are discussed. Issues related to diversity, differential diagnosis, and other noteworthy diagnostic considerations are described to provide context for attending to individual differences and evaluating complex presentations. We also make recommendations for best practices when evaluating anxiety disorders.


Anxiety Fear Worry Interviewing Assessment 


  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5). Arlington, VA: American Psychiatric Publications.Google Scholar
  2. American Psychiatric Association. (2014). Desk reference to the diagnostic criteria from DSM-5. Arlington, VA: American Psychiatric Publications.Google Scholar
  3. American Psychological Association. (2014). Guidelines for psychological practice with older adults. American Psychologist, 69(1), 34–65.Google Scholar
  4. Asnaani, A., Richey, J. A., Dimaite, R., Hinton, D. E., & Hofmann, S. G. (2010). A cross-ethnic comparison of lifetime prevalence rates of anxiety disorders. The Journal of Nervous and Mental Disease, 198(8), 551–555.Google Scholar
  5. Asmundson, G. J., Taylor, S., & Smits, J. (2014). Panic disorder and agoraphobia: An overview and commentary on DSM-5 changes. Depression and Anxiety, 31(6), 480–486.Google Scholar
  6. Barlow, D. H. (2004). Anxiety and its disorders: The nature and treatment of anxiety and panic. New York, NY: Guilford Press.Google Scholar
  7. Basco, M. R., Bostic, J. Q., Davies, D., Rush, A. J., Witte, B., Hendrickse, W., & Barnett, V. (2000). Methods to improve diagnostic accuracy in a community mental health setting. American Journal of Psychiatry, 157(10), 1599–1605.Google Scholar
  8. Beck, A. T., & Clark, D. A. (1997). An information processing model of anxiety: Automatic and strategic processes. Behaviour Research and Therapy, 35(1), 49–58.Google Scholar
  9. Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56(6), 893–897.Google Scholar
  10. Bergman, R. L., Piacentini, J., & McCracken, J. T. (2002). Prevalence and description of selective mutism in a school-based sample. Journal of the American Academy of Child & Adolescent Psychiatry, 41(8), 938–946.Google Scholar
  11. Bögels, S. M., & Zigterman, D. (2000). Dysfunctional cognitions in children with social phobia, separation anxiety disorder, and generalized anxiety disorder. Journal of Abnormal Child Psychology, 28(2), 205–211.Google Scholar
  12. Borkovec, T. D., & Ruscio, A. M. (2001). Psychotherapy for generalized anxiety disorder. Journal of Clinical Psychiatry, 62(Suppl11), 37–42.Google Scholar
  13. Breslau, J., Aguilar-Gaxiola, S., Kendler, K. S., Su, M., Williams, D., & Kessler, R. C. (2006). Specifying race-ethnic differences in risk for psychiatric disorder in a USA national sample. Psychological Medicine, 36(1), 57–68.Google Scholar
  14. Briggs-Gowan, M. J., Carter, A. S., & Schwab-Stone, M. (1996). Discrepancies among mother, child, and teacher reports: Examining the contributions of maternal depression and anxiety. Journal of Abnormal Child Psychology, 24(6), 749–765.Google Scholar
  15. Brown, T. A., Barlow, D. H., & Di Nardo, P. A. (2014). Anxiety disorders interview schedule for DSM-5 (ADIS-5): Client interview schedule. New York: Oxford University Press.Google Scholar
  16. Byers, A. L., Yaffe, K., Covinsky, K. E., Friedman, M. B., & Bruce, M. L. (2010). High occurrence of mood and anxiety disorders among older adults: The National Comorbidity Survey Replication. Archives of General Psychiatry, 67(5), 489–496.Google Scholar
  17. Carleton, R. N., Norton, M. P. J., & Asmundson, G. J. (2007). Fearing the unknown: A short version of the Intolerance of Uncertainty Scale. Journal of Anxiety Disorders, 21(1), 105–117.Google Scholar
  18. Chambless, D. L., Caputo, G. C., Bright, P., & Gallagher, R. (1984). Assessment of fear of fear in agoraphobics: The body sensations questionnaire and the agoraphobic cognitions questionnaire. Journal of Consulting and Clinical Psychology, 52(6), 1090–1097.Google Scholar
  19. Chapman, E. N., Kaatz, A., & Carnes, M. (2013). Physicians and implicit bias: How doctors may unwittingly perpetuate health care disparities. Journal of General Internal Medicine, 28(11), 1504–1510.Google Scholar
  20. Chou, T., Asnaani, A., & Hofmann, S. G. (2012). Perception of racial discrimination and psychopathology across three US ethnic minority groups. Cultural Diversity and Ethnic Minority Psychology, 18(1), 74–81.Google Scholar
  21. Conner, K. O., Copeland, V. C., Grote, N. K., Koeske, G., Rosen, D., Reynolds, C. F., III, & Brown, C. (2010). Mental health treatment seeking among older adults with depression: The impact of stigma and race. The American Journal of Geriatric Psychiatry, 18(6), 531–543.Google Scholar
  22. Costello, E. J., Egger, H. L., & Angold, A. (2005). The developmental epidemiology of anxiety disorders: Phenomenology, prevalence, and comorbidity. Child and Adolescent Psychiatric Clinics, 14(4), 631–648.Google Scholar
  23. Craske, M. (2003). Origins of phobias and anxiety disorders: Why more women than men? (BRAT series on clinical psychology) (1st ed.). Amsterdam: Elsevier.Google Scholar
  24. Craske, M. G., & Tsao, J. C. I. (1999). Self-monitoring with panic and anxiety disorders. Psychological Assessment, 11(4), 466–479.Google Scholar
  25. Dugas, M. J., Buhr, K., & Ladouceur, R. (2004). The role of intolerance of uncertainty in etiology and maintenance. In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 143–163). New York, NY: Guilford Press.Google Scholar
  26. Dugas, M. J., Gosselin, P., & Ladouceur, R. (2001). Intolerance of uncertainty and worry: Investigating specificity in a nonclinical sample. Cognitive Therapy and Research, 25(5), 551–558.Google Scholar
  27. Edelstein, B. A., Woodhead, E. L., Segal, D. L., Heisel, M. J., Bower, E. H., Lowery, A. J., & Stoner, S. A. (2007). Older adult psychological assessment: Current instrument status and related considerations. Clinical Gerontologist, 31(3), 1–35.Google Scholar
  28. Ehring, T., & Watkins, E. R. (2008). Repetitive negative thinking as a transdiagnostic process. International Journal of Cognitive Therapy, 1(3), 192–205.Google Scholar
  29. Eisenberg, D., Gollust, S. E., Golberstein, E., & Hefner, J. L. (2007). Prevalence and correlates of depression, anxiety, and suicidality among university students. American Journal of Orthopsychiatry, 77(4), 534–542.Google Scholar
  30. First, M. B., Williams, J. B., Karg, R. S., & Spitzer, R. L. (2016). SCID-5-CV: Structured clinical interview for DSM-5 disorders: Clinician version. Arlington, VA: American Psychiatric Association.Google Scholar
  31. Foa, E. B., Huppert, J. D., Leiberg, S., Langner, R., Kichic, R., Hajcak, G., & Salkovskis, P. M. (2002). The Obsessive-Compulsive Inventory: Development and validation of a short version. Psychological Assessment, 14(4), 485–496.Google Scholar
  32. Goodman, J. H., Watson, G. R., & Stubbs, B. (2016). Anxiety disorders in postpartum women: A systematic review and meta-analysis. Journal of Affective Disorders, 203, 292–331.Google Scholar
  33. Hallion, L. S., & Ruscio, A. M. (2013). Should uncontrollable worry be removed from the definition of GAD? A test of incremental validity. Journal of Abnormal Psychology, 122(2), 369–375.Google Scholar
  34. Heimberg, R. G., & Magee, L. (2014). Social anxiety disorder. In D. H. Barlow (Ed.), Clinical handbook of psychological disorders: A step-by-step treatment manual (pp. 114–154). New York, NY: Guilford Publications.Google Scholar
  35. Hofmann, S. G., Asnaani, A., & Hinton, D. E. (2010). Cultural aspects in social anxiety and social anxiety disorder. Depression and Anxiety, 27(12), 1117–1127.Google Scholar
  36. Hudson, C. G. (2005). Socioeconomic status and mental illness: Tests of the social causation and selection hypotheses. American Journal of Orthopsychiatry, 75(1), 3–18.Google Scholar
  37. Hunsley, J., & Mash, E. J. (2007). Evidence-based assessment. Annual Review of Clinical Psychology, 3, 29–51.Google Scholar
  38. Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593–602.Google Scholar
  39. Leyro, T. M., Zvolensky, M. J., & Bernstein, A. (2010). Distress tolerance and psychopathological symptoms and disorders: A review of the empirical literature among adults. Psychological Bulletin, 136(4), 576–600.Google Scholar
  40. Liebowitz, M. R. (1987). Social phobia. Modern Problems of Pharmacopsychiatry, 22, 141–173.Google Scholar
  41. Loughnan, S. A., Wallace, M., Joubert, A. E., Haskelberg, H., Andrews, G., & Newby, J. M. (2018). A systematic review of psychological treatments for clinical anxiety during the perinatal period. Archives of Women's Mental Health, 21(5), 481–490.Google Scholar
  42. Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the depression anxiety stress scales. Sydney: Psychology Foundation of Australia.Google Scholar
  43. Matthey, S., Barnett, B., Howie, P., & Kavanagh, D. J. (2003). Diagnosing postpartum depression in mothers and fathers: Whatever happened to anxiety? Journal of Affective Disorders, 74(2), 139–147.Google Scholar
  44. Matud, M. P. (2004). Gender differences in stress and coping styles. Personality and Individual Differences, 37(7), 1401–1415.Google Scholar
  45. McLaughlin, K. A., & Nolen-Hoeksema, S. (2011). Rumination as a transdiagnostic factor in depression and anxiety. Behaviour Research and Therapy, 49(3), 186–193.Google Scholar
  46. McLean, C. P., Asnaani, A., Litz, B. T., & Hofmann, S. G. (2011). Gender differences in anxiety disorders: Prevalence, course of illness, comorbidity and burden of illness. Journal of Psychiatric Research, 45(8), 1027–1035.Google Scholar
  47. Merikangas, K. R., He, J. P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., … Swendsen, J. (2010). Lifetime prevalence of mental disorders in US adolescents: Results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS- A). Journal of the American Academy of Child & Adolescent Psychiatry, 49(10), 980–989.Google Scholar
  48. Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28(6), 487–495.Google Scholar
  49. Miller, P. R., Dasher, R., Collins, R., Griffiths, P., & Brown, F. (2001). Inpatient diagnostic assessments: 1. Accuracy of structured vs. unstructured interviews. Psychiatry Research, 105(3), 255–264.Google Scholar
  50. Newman, M. G., Zuellig, A. R., Kachin, K. E., Constantino, M. J., Przeworski, A., Erickson, T., & Cashman-McGrath, L. (2002). Preliminary reliability and validity of the Generalized Anxiety Disorder Questionnaire-IV: A revised self-report diagnostic measure of generalized anxiety disorder. Behavior Therapy, 33(2), 215–233.Google Scholar
  51. Ollendick, T. H., & Hirshfeld-Becker, D. R. (2002). The developmental psychopathology of social anxiety disorder. Biological Psychiatry, 51(1), 44–58.Google Scholar
  52. Pachana, N. A., Byrne, G. B., Siddle, H., Koloski, N., Harley, E., & Arnold, E. (2007). Development and validation of the Geriatric Anxiety Inventory. International Psychogeriatrics, 19, 103–114.Google Scholar
  53. Puliafico, A. C., Comer, J. S., & Pincus, D. B. (2012). Adapting parent-child interaction therapy to treat anxiety disorders in young children. Child and Adolescent Psychiatric Clinics, 21(3), 607–619.Google Scholar
  54. Peterson, R. A. (2001). On the use of college students in social science research: Insights from a second-order meta-analysis. Journal of Consumer Research, 28(3), 450–461.Google Scholar
  55. Pieper, M. J., Francke, A. L., van der Steen, J. T., Scherder, E. J., Twisk, J. W., Kovach, C. R., & Achterberg, W. P. (2016). Effects of a stepwise multidisciplinary intervention for challenging behavior in advanced dementia: A cluster randomized controlled trial. Journal of the American Geriatrics Society, 64(2), 261–269.Google Scholar
  56. Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35(8), 741–756.Google Scholar
  57. Roy-Byrne, P. P., Joesch, J. M., Wang, P. S., & Kessler, R. C. (2009). Low socioeconomic status and mental health care use among respondents with anxiety and depression in the NCS- R. Psychiatric Services, 60(9), 1190–1197.Google Scholar
  58. Segal, D. L., June, A., Payne, M., Coolidge, F. L., & Yochim, B. (2010). Development and initial validation of a self-report assessment tool for anxiety among older adults: The Geriatric Anxiety Scale. Journal of Anxiety Disorders, 24, 709–714.Google Scholar
  59. Shear, M. K., Brown, T. A., Barlow, D. H., Money, R., Sholomskas, D. E., Woods, S. W., … Papp, L. A. (1997). Multicenter collaborative Panic Disorder Severity Scale. American Journal of Psychiatry, 154, 1571–1575.Google Scholar
  60. Sheehan, D. V. (2015). Mini international neuropsychiatric interview 7.0. Jacksonville, FL: Medical Outcomes Systems.Google Scholar
  61. Silverman, W. K., Saavedra, L. M., & Pina, A. A. (2001). Test-retest reliability of anxiety symptoms and diagnoses with the Anxiety Disorders Interview Schedule for DSM-IV: Child and parent versions. Journal of the American Academy of Child & Adolescent Psychiatry, 40(8), 937–944.Google Scholar
  62. Simons, J., & Gaher, R. (2005). The Distress Tolerance Scale: Development and validation of a self-report measure. Motivation and Emotion, 29, 83–102.Google Scholar
  63. Southam-Gerow, M. A., & Chorpita, B. F. (2007). Anxiety in children and adolescents. In E. J. Mash & R. A. Barkley (Eds.), Assessment of childhood disorders (4th ed., pp. 347–397). New York, NY: Guilford Press.Google Scholar
  64. Spielberger, C. D., Gorsuch, R. L., Lushene, R., Vagg, P. R., & Jacobs, G. A. (1983). Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press.Google Scholar
  65. Stockdale, S. E., Lagomasino, I. T., Siddique, J., McGuire, T., & Miranda, J. (2008). Racial and ethnic disparities in detection and treatment of depression and anxiety among psychiatric and primary health care visits, 1995–2005. Medical Care, 46(7), 668–677.Google Scholar
  66. Summerfeldt, L. J., & Antony, M. M. (2002). Structured and semistructured diagnostic interviews. In M. M. Antony & D. H. Barlow (Eds.), Handbook of assessment and treatment planning for psychological disorders (pp. 3–37). New York, NY: Guilford Press.Google Scholar
  67. Szymanski, J., & O'Donohue, W. (1995). Fear of spiders questionnaire. Journal of Behavior Therapy and Experimental Psychiatry, 26(1), 31–34.Google Scholar
  68. Taylor, S., Zvolensky, M. J., Cox, B. J., Deacon, B., Heimberg, R. G., Ledley, D. R., … Cardenas, S. J. (2007). Robust dimensions of anxiety sensitivity: Development and initial validation of the Anxiety Sensitivity Index-3. Psychological Assessment, 19, 176–188.Google Scholar
  69. Testa, A., Giannuzzi, R., Daini, S., Bernardini, L., Petrongolo, L., & Gentiloni Silveri, N. (2013). Psychiatric emergencies (part III): Psychiatric symptoms resulting from organic diseases. European Review for Medical and Pharmacological Sciences, 17(Suppl 1), 86–99.Google Scholar
  70. Tolin, D. F., Fitch, K. E., Frost, R. O., & Steketee, G. (2010). Family informants’ perceptions of insight in compulsive hoarding. Cognitive Therapy and Research, 34(1), 69–81.Google Scholar
  71. Tolin, D. F., Gilliam, C., Wootton, B. M., Bowe, W., Bragdon, L. B., Davis, E., … Hallion, L. S. (2018). Psychometric properties of a structured diagnostic interview for DSM-5 anxiety, mood, and obsessive-compulsive and related disorders. Assessment, 25(1), 3–13.Google Scholar
  72. Turner, S. M., Beidel, D. C., Dancu, C. V., & Stanley, M. A. (1989). An empirically derived inventory to measure social fears and anxiety: The Social Phobia and Anxiety Inventory. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 1(1), 35–40.Google Scholar
  73. Wilper, A. P., Woolhandler, S., Boyd, J. W., Lasser, K. E., McCormick, D., Bor, D. H., & Himmelstein, D. U. (2009). The health and health care of US prisoners: Results of a nationwide survey. American Journal of Public Health, 99(4), 666–672.Google Scholar
  74. Wolitzky-Taylor, K. B., Castriotta, N., Lenze, E. J., Stanley, M. A., & Craske, M. G. (2010). Anxiety disorders in older adults: A comprehensive review. Depression and Anxiety, 27(2), 190–211.Google Scholar
  75. Wolpe, J., & Lang, P. J. (1974). A Fear Survey Schedule for use in behavior therapy. In Behavior modification procedure: A sourcebook (pp. 228–232). New Brunswick: Aldine Transaction.Google Scholar
  76. Wood, J. J., Piacentini, J. C., Bergman, R. L., McCracken, J., & Barrios, V. (2002). Concurrent validity of the anxiety disorders section of the Anxiety Disorders Interview Schedule for DSM-IV: Child and parent versions. Journal of Clinical Child and Adolescent Psychology, 31(3), 335–342.Google Scholar
  77. Woodward, A. T., Taylor, R. J., Bullard, K. M., Aranda, M. P., Lincoln, K. D., & Chatters, L. M. (2012). Prevalence of lifetime DSM-IV affective disorders among older African Americans, Black Caribbeans, Latinos, Asians and Non-Hispanic White people. International Journal of Geriatric Psychiatry, 27(8), 816–827.Google Scholar
  78. Young, A. S., Klap, R., Sherbourne, C. D., & Wells, K. B. (2001). The quality of care for depressive and anxiety disorders in the United States. Archives of General Psychiatry, 58(1), 55–61.Google Scholar

Copyright information

© Springer International Publishing AG 2019

Authors and Affiliations

  • Cierra B. Edwards
    • 1
  • Amber L. Billingsley
    • 1
  • Shari A. Steinman
    • 1
    Email author
  1. 1.West Virginia UniversityMorgantownUSA

Personalised recommendations