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Updated July 31, 2026
Condition Guide
Anxiety Disorders
Anxiety becomes clinically significant when fear, worry, or avoidance is persistent, disproportionate to the situation, difficult to control, and associated with meaningful distress or impaired functioning. Assessment should identify the specific anxiety pattern while also addressing safety, medical and substance-related contributors, comorbidity, development, and the person's goals.
Neurobiology
Fear and threat systems interact across multiple pathways
Anxiety involves interacting systems rather than a single pathway. Relevant findings include amygdala hyperreactivity and altered prefrontal regulation of fear circuitry, HPA-axis dysregulation, imbalance across inhibitory GABA and excitatory glutamate signaling, and heightened locus coeruleus–norepinephrine activity. Genetic vulnerability, learning history, stress exposure, and temperamental behavioral inhibition can shape risk and expression.
Epidemiology and Course
Onset and trajectory vary by anxiety presentation
Separation anxiety and specific phobias commonly begin in childhood; social anxiety often emerges by adolescence; panic disorder frequently begins in late adolescence or early adulthood; and generalized anxiety may become evident later and follow a fluctuating, chronic course. Depressive disorders are common across anxiety presentations, and alcohol, cannabis, sedatives, or other substances may be used in attempts to manage distress while ultimately worsening symptoms or risk.
Diagnostic Features by Disorder
Distinguish the feared cue, symptom pattern, and functional impact
Anxiety disorders share heightened threat anticipation, autonomic arousal, avoidance, and reinforcement of fear, but the focus and course differ. Normal anxiety is generally proportionate, time-limited, and compatible with adaptive action. Clinically significant anxiety persists beyond the expected context, produces avoidance or safety behaviors, and causes meaningful distress or impairment.
Generalized Anxiety Disorder
Primary scales · GAD-7 / PSWQ
Excessive anxiety and worry occur across multiple life areas on more days than not for at least six months and are difficult to control. Adults also have at least three associated symptoms, such as restlessness, fatigue, concentration difficulty, irritability, muscle tension, or disturbed sleep; only one is required in children. Symptoms must cause clinically meaningful distress or impairment.
Rating scales
GAD-7 tracks generalized anxiety symptom severity. PSWQ focuses on excessive, pervasive, and difficult-to-control worry.
Panic Disorder
Primary scale · PDSS
Recurrent, unexpected panic attacks are followed by at least one month of persistent concern about additional attacks or their consequences, or by maladaptive behavioral change such as avoidance. Panic attacks may occur in many conditions; the unexpected and persistent aftermath defines panic disorder.
Marked fear centers on social situations in which scrutiny or negative evaluation is possible. The situations almost always provoke fear and are avoided or endured with intense distress. The response is disproportionate, persists for at least six months, and causes meaningful distress or impairment.
Rating scales
SPIN measures fear, avoidance, and physiologic symptoms. LSAS rates fear and avoidance across social and performance situations.
Specific Phobia
Primary scale · FSS-III
A particular object or situation reliably produces immediate fear and is avoided or endured with intense distress. The fear is disproportionate to actual danger and sociocultural context, persists for at least six months, and impairs functioning or causes significant distress.
Rating scale
Fear Survey Schedule–III (FSS-III) can help identify and quantify fear across common objects and situations; focused behavioral assessment remains essential.
Agoraphobia
Primary scale · MI
Marked fear involves at least two types of situations—public transportation, open spaces, enclosed places, crowds or lines, or being outside the home alone—because escape or help may be difficult if panic-like or incapacitating symptoms occur. Avoidance or companion dependence persists for at least six months and causes significant distress or impairment.
Rating scale
Mobility Inventory for Agoraphobia (MI) measures avoidance when alone and when accompanied across common situations.
Separation Anxiety Disorder
Primary scale · SCARED
Developmentally inappropriate and excessive fear concerns separation from major attachment figures, with at least three characteristic symptoms involving anticipated harm, refusal, distress, nightmares, or physical complaints. The pattern lasts at least four weeks in children and adolescents and typically at least six months in adults, with clinically meaningful distress or impairment.
Rating scale
SCARED separation-anxiety subscale screens for separation-related symptoms in children and adolescents using youth and caregiver reports.
For guidance on selecting, administering, and interpreting these measures, see the Toolbox's Rating Scales & Screening.
Relevant Medication Classes
Use diagnosis, time course, comorbidity, and risk to guide selection
Medication is one component of treatment and should be paired with ongoing assessment of benefit, adverse effects, adherence, functional recovery, and access to psychotherapy. For practical support with actual-use histories, interactions, and monitoring, see the Toolbox's Medication Reconciliation & Monitoring.
SSRIs
First-line medication options for most anxiety disorders; begin thoughtfully, monitor early activation and tolerability, and allow an adequate trial.
SNRIs
Venlafaxine and duloxetine are evidence-supported options for selected anxiety disorders; monitor blood pressure, adverse effects, and discontinuation symptoms.
Buspirone
A non-benzodiazepine alternative or adjunct for GAD; it requires scheduled dosing and is not an immediate-relief medication.
Hydroxyzine
May help with short-term or situational symptoms; consider sedation, anticholinergic burden, cardiac risk, and effects on driving or work.
Beta-blockers
Sometimes used for circumscribed performance-related autonomic symptoms; assess asthma, bradycardia, hypotension, and other contraindications.
Pregabalin
Has evidence for GAD and is used off-label for this purpose in the United States; consider sedation, misuse potential, renal dosing, and withdrawal effects.
Benzodiazepines
Reserve for carefully selected short-term or bridge use because tolerance, dependence, withdrawal, falls, cognitive effects, and dangerous co-use can outweigh benefit.
TCAs
Older alternatives with evidence in panic disorder; anticholinergic effects, orthostasis, cardiac conduction concerns, and overdose toxicity limit routine use.
Relevant Psychotherapy Modalities
Target avoidance and build durable coping through practice
Psychotherapy selection should reflect the specific anxiety disorder, developmental context, patient preference, readiness, access, and clinician competence. For a broader comparison of approaches, see the Toolbox's Psychotherapy Modalities.
Cognitive Behavioral Therapy
First-line across anxiety disorders; addresses threat appraisal, avoidance, safety behaviors, and skills for managing physical and cognitive symptoms.
Exposure-based therapy
Graduated, repeated exposure is central for specific phobia, panic, agoraphobia, and social anxiety. Exposure and response prevention principles help interrupt avoidance and reassurance cycles.
Acceptance and Commitment Therapy
Builds psychological flexibility by helping patients make values-guided choices while allowing uncomfortable thoughts and sensations to be present.
Psychodynamic therapy
May explore recurring relational patterns, conflicts, meanings, and defenses associated with anxiety when this approach fits the formulation and patient preference.
Family therapy
Particularly relevant for childhood-onset anxiety when accommodation, reassurance, separation patterns, or family stress maintain symptoms or limit exposure practice.
Clinical Practice Guidelines
Use disorder-specific recommendations with clinical judgment
No current APA or VA/DoD guideline specifically covers this full group of anxiety disorders. The following authoritative guidance addresses major adult and pediatric anxiety presentations.
Use when severe panic, suicidality, intoxication or withdrawal, inability to function, or another acute presentation requires stabilization and disposition planning.