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Anxiety disorder From Wikipedia, the free encyclopedia Jump to navigationJump to search Anxiety disorder The Scream.jpg The Scream (Norwegian: Skrik) a painting by Norwegian artist Edvard Munch[1] Specialty Psychiatry, clinical psychology Symptoms Worrying, fast heart rate, shakiness[2] Complications Depression, trouble sleeping, poor quality of life, suicide[3] Usual onset 15–35 years old[4] Duration > 6 months[2][4] Causes Genetic, environmental, and psychological factors[5] Risk factors Child abuse, family history, poverty[4] Diagnostic method Psychological assessment Differential diagnosis Hyperthyroidism; heart disease; caffeine, alcohol, cannabis use; withdrawal from certain drugs[4][6] Treatment Lifestyle changes, counselling, medications[4] Medication Antidepressants, anxiolytics, beta blockers[5] Frequency 12% per year[4][7] Anxiety disorders are a cluster of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear[2] such that a person's social, occupational, and personal function are significantly impaired.[2] Anxiety may cause physical and cognitive symptoms, such as restlessness, irritability, easy fatiguability, difficulty concentrating, increased heart rate, chest pain, abdominal pain, and a variety of other symptoms that may vary based on the individual.[2] In casual discourse, the words anxiety and fear are often used interchangeably. In clinical usage, they have distinct meanings: anxiety is defined as an unpleasant emotional state for which the cause is either not readily identified or perceived to be uncontrollable or unavoidable, whereas fear is an emotional and physiological response to a recognized external threat.[8] The umbrella term anxiety disorder refers to a number of specific disorders that include fears (phobias) or anxiety symptoms.[2] There are several types of anxiety disorders, including generalized anxiety disorder, specific phobia, social anxiety disorder, separation anxiety disorder, agoraphobia, panic disorder, and selective mutism.[2] The individual disorder can be diagnosed using the specific and unique symptoms, triggering events, and timing.[2] If a person is diagnosed with an anxiety disorder, a medical professional must have evaluated the person to ensure the anxiety cannot be attributed to another medical illness or mental disorder.[2] It is possible for an individual to have more than one anxiety disorder during their life or at the same time[2] and anxiety disorders are marked by a typical persistent course.[9] For individuals with anxiety, there are numerous treatments and strategies that can improve their mood, behaviors, and ability to function in daily life. Contents 1 Sub-types 1.1 Generalized anxiety disorder 1.2 Specific phobias 1.3 Panic disorder 1.4 Agoraphobia 1.5 Social anxiety disorder 1.6 Post-traumatic stress disorder 1.7 Separation anxiety disorder 1.8 Obsessive–compulsive disorder 1.9 Selective mutism 2 Diagnosis 2.1 Differential diagnosis 3 Prevention 4 Treatment 4.1 Lifestyle and diet 4.2 Psychotherapy 4.3 Medications 4.4 Alternative medicine 4.5 Children 5 Epidemiology 6 See also 7 References 8 External links Sub-types Facial expression of someone with chronic anxiety Generalized anxiety disorder Main article: Generalized anxiety disorder Generalized anxiety disorder (GAD) is a common disorder, characterized by long-lasting anxiety which is not focused on any one object or situation. Those suffering from generalized anxiety disorder experience non-specific persistent fear and worry, and become overly concerned with everyday matters. Generalized anxiety disorder is "characterized by chronic excessive worry accompanied by three or more of the following symptoms: restlessness, fatigue, concentration problems, irritability, muscle tension, and sleep disturbance".[10] Generalized anxiety disorder is the most common anxiety disorder to affect older adults.[11] Anxiety can be a symptom of a medical or substance use disorder problem, and medical professionals must be aware of this. A diagnosis of GAD is made when a person has been excessively worried about an everyday problem for six months or more.[12] These stresses can include family life, work, social life, or their own health. A person may find that they have problems making daily decisions and remembering commitments as a result of lack of concentration and/or preoccupation with worry.[13] A symptom can be a strained appearance, with increased sweating from the hands, feet, and axillae,[14] and they may be tearful, which can suggest depression.[15] Before a diagnosis of anxiety disorder is made, physicians must rule out drug-induced anxiety and other medical causes.[16] In children, GAD may be associated with headaches, restlessness, abdominal pain, and heart palpitations.[17] Typically it begins around 8 to 9 years of age.[17] Specific phobias Main article: Specific phobia The single largest category of anxiety disorders is that of specific phobias, which includes all cases in which fear and anxiety are triggered by a specific stimulus or situation. Between 5% and 12% of the population worldwide suffer from specific phobias.[12] According to the National Institute of Mental Health, a phobia is an intense fear of or aversion to specific objects or situations.[18] Sufferers typically anticipate terrifying consequences from encountering the object of their fear, which can be anything from an animal to a location to a bodily fluid to a particular situation. Common phobias are flying, blood, water, highway driving, and tunnels. When people are exposed to their phobia, they may experience trembling, shortness of breath, or rapid heartbeat.[19] Thus meaning that people with specific phobias often go out of their way to avoid encountering their phobia. People understand that their fear is not proportional to the actual potential danger but still are overwhelmed by it.[20] Panic disorder Main article: Panic disorder With panic disorder, a person has brief attacks of intense terror and apprehension, often marked by trembling, shaking, confusion, dizziness, nausea, and/or difficulty breathing. These panic attacks, defined by the APA as fear or discomfort that abruptly arises and peaks in less than ten minutes, can last for several hours.[21] Attacks can be triggered by stress, irrational thoughts, general fear or fear of the unknown, or even exercise. However, sometimes the trigger is unclear and the attacks can arise without warning. To help prevent an attack, one can avoid the trigger. This can mean avoiding places, people, types of behaviors, or certain situations that have been known to cause a panic attack. This being said, not all attacks can be prevented. In addition to recurrent unexpected panic attacks, a diagnosis of panic disorder requires that said attacks have chronic consequences: either worry over the attacks' potential implications, persistent fear of future attacks, or significant changes in behavior related to the attacks. As such, those suffering from panic disorder experience symptoms even outside specific panic episodes. Often, normal changes in heartbeat are noticed by a panic sufferer, leading them to think something is wrong with their heart or they are about to have another panic attack. In some cases, a heightened awareness (hypervigilance) of body functioning occurs during panic attacks, wherein any perceived physiological change is interpreted as a possible life-threatening illness (i.e., extreme hypochondriasis). Agoraphobia Main article: Agoraphobia Agoraphobia is the specific anxiety about being in a place or situation where escape is difficult or embarrassing or where help may be unavailable.[22] Agoraphobia is strongly linked with panic disorder and is often precipitated by the fear of having a panic attack. A common manifestation involves needing to be in constant view of a door or other escape route. In addition to the fears themselves, the term agoraphobia is often used to refer to avoidance behaviors that sufferers often develop.[23] For example, following a panic attack while driving, someone suffering from agoraphobia may develop anxiety over driving and will therefore avoid driving. These avoidance behaviors can have serious consequences and often reinforce the fear they are caused by. In a severe case of agoraphobia, the person may never leave their home. Social anxiety disorder Main article: Social anxiety disorder Social anxiety disorder (SAD; also known as social phobia) describes an intense fear and avoidance of negative public scrutiny, public embarrassment, humiliation, or social interaction. This fear can be specific to particular social situations (such as public speaking) or, more typically, is experienced in most (or all) social interactions. Roughly 7% of American adults have social anxiety disorder, and more than 75% of people experience their first symptoms in their childhood or early teenage years.[24] Social anxiety often manifests specific physical symptoms, including blushing, sweating, rapid heart rate, and difficulty speaking.[25] As with all phobic disorders, those suffering from social anxiety often will attempt to avoid the source of their anxiety; in the case of social anxiety this is particularly problematic, and in severe cases can lead to complete social isolation. Children are also affected by social anxiety disorder, although their associated symptoms are different than that of teenagers and adults. They may experience difficulty processing or retrieving information, sleep deprivation, disruptive behaviors in class, and irregular class participation.[26] Social physique anxiety (SPA) is a subtype of social anxiety, involving concern over the evaluation of one's body by others.[27] SPA is common among adolescents, especially females. Post-traumatic stress disorder Main article: Post-traumatic stress disorder Post-traumatic stress disorder (PTSD) was once an anxiety disorder (now moved to trauma- and stressor-related disorders in DSM-V) that results from a traumatic experience. PTSD affects approximately 3.5% of U.S. adults every year, and an estimated one in eleven people will be diagnosed with PTSD in their lifetime.[28] Post-traumatic stress can result from an extreme situation, such as combat, natural disaster, rape, hostage situations, child abuse, bullying, or even a serious accident. It can also result from long-term (chronic) exposure to a severe stressor—[29]for example, soldiers who endure individual battles but cannot cope with continuous combat. Common symptoms include hypervigilance, flashbacks, avoidant behaviors, anxiety, anger and depression.[30] In addition, individuals may experience sleep disturbances.[31] People who suffer from PTSD often try to detach themselves from their friends and family, and have difficulty maintaining these close relationships. There are a number of treatments that form the basis of the care plan for those with PTSD. Such treatments include cognitive behavioral therapy (CBT), prolonged exposure therapy, stress inoculation therapy, medication, and psychotherapy and support from family and friends.[12] Post-traumatic stress disorder (PTSD) research began with Vietnam veterans, as well as natural and non-natural disaster victims. Studies have found the degree of exposure to a disaster has been found to be the best predictor of PTSD.[32] Separation anxiety disorder Main article: Separation anxiety disorder Separation anxiety disorder (SepAD) is the feeling of excessive and inappropriate levels of anxiety over being separated from a person or place. Separation anxiety is a normal part of development in babies or children, and it is only when this feeling is excessive or inappropriate that it can be considered a disorder.[33] Separation anxiety disorder affects roughly 7% of adults and 4% of children, but the childhood cases tend to be more severe; in some instances, even a brief separation can produce panic.[34][35] Treating a child earlier may prevent problems. This may include training the parents and family on how to deal with it. Often, the parents will reinforce the anxiety because they do not know how to properly work through it with the child. In addition to parent training and family therapy, medication, such as SSRIs, can be used to treat separation anxiety.[36] Obsessive–compulsive disorder Main article: Obsessive–compulsive disorder Obsessive–compulsive disorder (OCD) is not classified as an anxiety disorder by the DSM-5, but is by the ICD-10. It was previously classified as an anxiety disorder in the DSM-IV. It is a condition where the person has obsessions (distressing, persistent, and intrusive thoughts or images) and compulsions (urges to repeatedly perform specific acts or rituals), that are not caused by drugs or physical disorder, and which cause distress or social dysfunction.[37][38] The compulsive rituals are personal rules followed to relieve the feeling of discomfort.[38] OCD affects roughly 1–⁠2% of adults (somewhat more women than men), and under 3% of children and adolescents.[37][38] A person with OCD knows that the symptoms are unreasonable and struggles against both the thoughts and the behavior.[37][39] Their symptoms could be related to external events they fear (such as their home burning down because they forget to turn off the stove) or worry that they will behave inappropriately.[39] It is not certain why some people have OCD, but behavioral, cognitive, genetic, and neurobiological factors may be involved.[38] Risk factors include family history, being single (although that may result from the disorder), and higher socioeconomic class or not being in paid employment.[38] Of those with OCD about 20% of people will overcome it, and symptoms will at least reduce over time for most people (a further 50%).[37] Selective mutism Main article: Selective mutism Selective mutism (SM) is a disorder in which a person who is normally capable of speech does not speak in specific situations or to specific people. Selective mutism usually co-exists with shyness or social anxiety.[40] People with selective mutism stay silent even when the consequences of their silence include shame, social ostracism or even punishment.[41] Selective mutism affects about 0.8% of people at some point in their life.[4] Testing for selective mutism is important because doctors must determine if it is an issue associated with the child's hearing, movements associated with the jaw or tongue, and if the child can understand when others are speaking to them.[42] Diagnosis The diagnosis of anxiety disorders is made by symptoms, triggers, and a person's personal and family histories. There are no objective biomarkers or laboratory tests that can diagnose anxiety.[43] It is important for a medical professional to evaluate a person for other medical and mental causes for prolonged anxiety because treatments will vary considerably.[2] Numerous questionnaires have been developed for clinical use and can be used for an objective scoring system. Symptoms may be vary between each subtype of generalized anxiety disorder. Generally, symptoms must be present for at least six months, occur more days than not, and significantly impair a person's ability to function in daily life. Symptoms may include: feeling nervous, anxious, or on edge; worrying excessively; difficulty concentrating; restlessness; irritability.[2][4] Questionnaires developed for clinical use include the State-Trait Anxiety Inventory (STAI), the Generalized Anxiety Disorder 7 (GAD-7), the Beck Anxiety Inventory (BAI), the Zung Self-Rating Anxiety Scale, and the Taylor Manifest Anxiety Scale.[43] Other questionnaires combine anxiety and depression measurement, such as the Hamilton Anxiety Rating Scale, the Hospital Anxiety and Depression Scale (HADS), the Patient Health Questionnaire (PHQ), and the Patient-Reported Outcomes Measurement Information System (PROMIS).[43] Examples of specific anxiety questionnaires include the Liebowitz Social Anxiety Scale (LSAS), the Social Interaction Anxiety Scale (SIAS), the Social Phobia Inventory (SPIN), the Social Phobia Scale (SPS), and the Social Anxiety Questionnaire (SAQ-A30).[44] Differential diagnosis Anxiety disorders differ from developmentally normal fear or anxiety by being excessive or persisting beyond developmentally appropriate periods. They differ from transient fear or anxiety, often stress-induced, by being persistent (e.g., typically lasting 6 months or more), although the criterion for duration is intended as a general guide with allowance for some degree of flexibility and is sometimes of shorter duration in children.[2] The diagnosis of an anxiety disorder requires first ruling out an underlying medical cause.[6][8] Diseases that may present similar to an anxiety disorder, including certain endocrine diseases (hypo- and hyperthyroidism, hyperprolactinemia),[4][6][45] metabolic disorders (diabetes),[6][46] deficiency states (low levels of vitamin D, B2, B12, folic acid),[6] gastrointestinal diseases (celiac disease, non-celiac gluten sensitivity, inflammatory bowel disease),[47][48][49] heart diseases,[4][6] blood diseases (anemia),[6] and brain degenerative diseases (Parkinson's disease, dementia, multiple sclerosis, Huntington's disease).[6][50][51][52] Several drugs can also cause or worsen anxiety, whether in intoxication, withdrawal, or from chronic use. These include alcohol, tobacco, cannabis, sedatives (including prescription benzodiazepines), opioids (including prescription painkillers and illicit drugs like heroin), stimulants (such as caffeine, cocaine and amphetamines), hallucinogens, and inhalants.[4][2] Prevention Focus is increasing on prevention of anxiety disorders.[53] There is tentative evidence to support the use of cognitive behavioral therapy[53] and mindfulness therapy.[54][55] A 2013 review found no effective measures to prevent GAD in adults.[56] A 2017 review found that psychological and educational interventions had a small benefit for the prevention of anxiety.[57][58] Research indicates that predictors of the emergence of anxiety disorders partly differ from the factors that predict their persistence.[9] Treatment Treatment options include lifestyle changes, therapy, and medications. There is no clear evidence as to whether therapy or medication is most effective; the specific medication decision can be made by a doctor and patient with consideration to the patient's specific circumstances and symptoms.[59] If while on treatment with a chosen medication, the person's anxiety does not improve, another medication may be offered.[59] Specific treatments will vary by subtype of anxiety disorder, a person's other medical conditions, and medications. Lifestyle and diet Lifestyle changes include exercise, for which there is moderate evidence for some improvement, regularizing sleep patterns, reducing caffeine intake, and stopping smoking.[59] Stopping smoking has benefits in anxiety as large as or larger than those of medications.[60] Omega-3 polyunsaturated fatty acids, such as fish oil, may reduce anxiety, particularly in those with more significant symptoms.[61] Psychotherapy Cognitive behavioral therapy (CBT) is effective for anxiety disorders and is a first-line treatment.[59][62][63][64][65][excessive citations] CBT appears to be equally effective when carried out via the internet compared to sessions completed face to face.[65][66] Mindfulness-based programs also appear to be effective for managing anxiety disorders.[67][68] It is unclear if meditation has an effect on anxiety and transcendental meditation appears to be no different than other types of meditation.[69] A 2015 Cochrane review of Morita therapy for anxiety disorder in adults found not enough evidence to draw a conclusion.[70] Medications First-line choices for medications include SSRIs or SNRIs to treat generalized anxiety disorder.[59][71] There is no good evidence supporting which specific medication in the SSRI or SNRI class is best for treating anxiety, so cost often drives drug choice.[59][71] If they are effective, it is recommended that they are continued for at least a year.[72] Stopping these medications results in a greater risk of relapse.[73] Buspirone and pregabalin are second-line treatments for people who do not respond to SSRIs or SNRIs; there is also evidence that benzodiazepines, including diazepam and clonazepam, are effective.[59] Medications need to be used with care among older adults, who are more likely to have side effects because of coexisting physical disorders. Adherence problems are more likely among older people, who may have difficulty understanding, seeing, or remembering instructions.[11] In general, medications are not seen as helpful in specific phobia, but a benzodiazepine is sometimes used to help resolve acute episodes. In 2007, data was sparse for efficacy of any drug.[74] Alternative medicine Other remedies have been used or are under research for treating anxiety disorders. As of 2019, there is little evidence for cannabis in anxiety disorders.[75] Kava is under preliminary research for its potential in short-term use by people with mild to moderate anxiety.[76][77] The American Academy of Family Physicians recommends use of kava for mild to moderate anxiety disorders in people not using alcohol or taking other medicines metabolized by the liver, while preferring remedies thought to be natural.[78] Inositol has been found to have modest effects in people with panic disorder or obsessive-compulsive disorder.[78] There is insufficient evidence to support the use of St. John's wort, valerian or passionflower.[78] Neurofeedback training (NFT) is another form of alternative medicine, where practitioners use monitoring devices to see moment to moment information in relation to the nervous system and the brain. Sensors are placed along the scalp, and the brain responses are recorded and amplified in association with specific brain activity. The practitioners then discuss the responses associated with the client, in an attempt to determine different principles of learning, and practitioner guidance to create changes in brain patterns.[79] Children Both therapy and a number of medications have been found to be useful for treating childhood anxiety disorders.[80] Therapy is generally preferred to medication.[81] Cognitive behavioral therapy (CBT) is a good first therapy approach.[81] Studies have gathered substantial evidence for treatments that are not CBT-based as being effective forms of treatment, expanding treatment options for those who do not respond to CBT.[81] Although studies have demonstrated the effectiveness of CBT for anxiety disorders in children and adolescents, evidence that it is more effective than treatment as usual, medication, or wait list controls is inconclusive.[82] Like adults, children may undergo psychotherapy, cognitive-behavioral therapy, or counseling. Family therapy is a form of treatment in which the child meets with a therapist together with the primary guardians and siblings.[83] Each family member may attend individual therapy, but family therapy is typically a form of group therapy. Art and play therapy are also used. Art therapy is most commonly used when the child will not or cannot verbally communicate, due to trauma or a disability in which they are nonverbal. Participating in art activities allows the child to express what they otherwise may not be able to communicate to others.[84] In play therapy, the child is allowed to play however they please as a therapist observes them. The therapist may intercede from time to time with a question, comment, or suggestion. This is often most effective when the family of the child plays a role in the treatment.[83][85] If a medication option is warranted, antidepressants such as SSRIs and SNRIs can be effective.[80] Minor side effects with medications, however, are common.[80] Epidemiology Globally, as of 2010, approximately 273 million (4.5% of the population) had an anxiety disorder.[86] It is more common in females (5.2%) than males (2.8%).[86] In Europe, Africa and Asia, lifetime rates of anxiety disorders are between 9 and 16%, and yearly rates are between 4 and 7%.[87] In the United States, the lifetime prevalence of anxiety disorders is about 29%[88] and between 11 and 18% of adults have the condition in a given year.[87] This difference is affected by the range of ways in which different cultures interpret anxiety symptoms and what they consider to be normative behavior.[89][90] In general, anxiety disorders represent the most prevalent psychiatric condition in the United States, outside of substance use disorder.[91] Like adults, children can experience anxiety disorders; between 10 and 20 percent of all children will develop a full-fledged anxiety disorder prior to the age of 18,[92] making anxiety the most common mental health issue in young people. Anxiety disorders in children are often more challenging to identify than their adult counterparts, owing to the difficulty many parents face in discerning them from normal childhood fears. Likewise, anxiety in children is sometimes misdiagnosed as attention deficit hyperactivity disorder or, due to the tendency of children to interpret their emotions physically (as stomachaches, headaches, etc.), anxiety disorders may initially be confused with physical ailments.[93] Anxiety in children has a variety of causes; sometimes anxiety is rooted in biology, and may be a product of another existing condition, such as autism spectrum disorder.[94] Gifted children are also often more prone to excessive anxiety than non-gifted children.[95] Other cases of anxiety arise from the child having experienced a traumatic event of some kind, and in some cases, the cause of the child's anxiety cannot be pinpointed.[96] Anxiety in children tends to manifest along age-appropriate themes, such as fear of going to school (not related to bullying) or not performing well enough at school, fear of social rejection, fear of something happening to loved ones, etc. What separates disordered anxiety from normal childhood anxiety is the duration and intensity of the fears involved.[93] See also List of people with an anxiety disorder Exposure Therapy References Peter Aspden (21 April 2012). "So, what does 'The Scream' mean?". Financial Times. Archived from the original on 14 October 2013. Diagnostic and statistical manual of mental disorders 5th edition: DSM-5. Arlington, VA Washington, D.C: American Psychiatric Association,American Psychiatric Association. 2013. p. 189–195. ISBN 978-0-89042-555-8. OCLC 830807378. "Anxiety disorders – Symptoms and causes". Mayo Clinic. Retrieved 23 May 2019. Craske, MG; Stein, MB (24 June 2016). "Anxiety". Lancet. 388 (10063): 3048–3059. doi:10.1016/S0140-6736(16)30381-6. PMID 27349358. S2CID 208789585. "Anxiety Disorders". NIMH. March 2016. Archived from the original on 27 July 2016. Retrieved 14 August 2016. Testa A, Giannuzzi R, Daini S, Bernardini L, Petrongolo L, Gentiloni Silveri N (2013). "Psychiatric emergencies (part III): psychiatric symptoms resulting from organic diseases" (PDF). European Review for Medical and Pharmacological Sciences (Review). 17 (s1): 86–99. PMID 23436670. Archived (PDF) from the original on 10 March 2016. open access Kessler; et al. (2007). "Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization's World Mental Health Survey Initiative". World Psychiatry. 6 (3): 168–76. PMC 2174588. PMID 18188442. World Health Organization (2009). Pharmacological Treatment of Mental Disorders in Primary Health Care (PDF). Geneva. ISBN 978-92-4-154769-7. Archived (PDF) from the original on 20 November 2016. Hovenkamp-Hermelink; et al. (2021). "Predictors of persistence of anxiety disorders across the lifespan: a systematic review". The Lancet Psychiatry. 8 (5): 428–443. Schacter, D. L., Gilbert, D. T., & Wegner, D.M. (2011). Psychology: Second Edition. New York, NY: Worth. Calleo J, Stanley M (2008). "Anxiety Disorders in Later Life: Differentiated Diagnosis and Treatment Strategies". Psychiatric Times. 26 (8). Archived from the original on 4 September 2009. Phil Barker (7 October 2003). Psychiatric and mental health nursing: the craft of caring. London: Arnold. ISBN 978-0-340-81026-2. Archived from the original on 27 May 2013. Retrieved 17 December 2010. Psychology, Michael Passer, Ronald Smith, Nigel Holt, Andy Bremner, Ed Sutherland, Michael Vliek (2009) McGrath Hill Education, UK: McGrath Hill Companies Inc. p 790 "All About Anxiety Disorders: From Causes to Treatment and Prevention". Archived from the original on 17 February 2016. Retrieved 18 February 2016. Psychiatry, Michael Gelder, Richard Mayou, John Geddes 3rd ed. Oxford; New York: Oxford University Press, c 2005 p. 75 Varcarolis. E (2010). Manual of Psychiatric Nursing Care Planning: Assessment Guides, Diagnoses and Psychopharmacology. 4th ed. New York: Saunders Elsevier. p 109. Keeton, CP; Kolos, AC; Walkup, JT (2009). "Pediatric generalized anxiety disorder: epidemiology, diagnosis, and management". Paediatric Drugs. 11 (3): 171–83. doi:10.2165/00148581-200911030-00003. PMID 19445546. S2CID 39870253. "NIMH » Anxiety Disorders". www.nimh.nih.gov. Retrieved 16 November 2020. U.S. Department of Health & Human Services (2017). "Phobias". www.mentalhealth.gov. Archived from the original on 13 May 2017. Retrieved 1 December 2017. Psychology. Michael Passer, Ronald Smith, Nigel Holt, Andy Bremner, Ed Sutherland, Michael Vliek. (2009) McGrath Hill Higher Education; UK: McGrath Hill companies Inc. "Panic Disorder". Center for the Treatment and Study of Anxiety, University of Pennsylvania. Archived from the original on 27 May 2015. Craske 2003 Gorman, 2000 Jane E. Fisher; William T. O'Donohue (27 July 2006). Practitioner's Guide to Evidence-Based Psychotherapy. Springer. pp. 754. ISBN 978-0387283692. "Social Anxiety Disorder". Mental Health America. Retrieved 16 November 2020. "NIMH » Social Anxiety Disorder: More Than Just Shyness". www.nimh.nih.gov. Retrieved 1 December 2020. "Managing Anxiety in the Classroom". Mental Health America. Retrieved 16 November 2020. The Oxford Handbook of Exercise Psychology. Oxford University Press. 2012. p. 56. ISBN 9780199930746. "What Is PTSD?". www.psychiatry.org. Retrieved 16 November 2020. Post-Traumatic Stress Disorder and the Family. Veterans Affairs Canada. 2006. ISBN 978-0-662-42627-1. Archived from the original on 14 February 2009. Retrieved 8 September 2017. Psychological Disorders Archived 4 December 2008 at the Wayback Machine, Psychologie Anglophone Shalev, Arieh; Liberzon, Israel; Marmar, Charles (2017). "Post-Traumatic Stress Disorder". New England Journal of Medicine. 376 (25): 2459–2469. doi:10.1056/nejmra1612499. PMID 28636846. Fullerton, Carol (1997). Posttraumatic Stress Disorder. Washington, D.C.: American Psychiatric Press Inc. pp. 8–9. ISBN 978-0-88048-751-1. Siegler, Robert (2006). How Children Develop, Exploring Child Develop Student Media Tool Kit & Scientific American Reader to Accompany How Children Develop. New York: Worth Publishers. ISBN 0-7167-6113-0. Arehart-Treichel, Joan (2006). "Adult Separation Anxiety Often Overlooked Diagnosis – Arehart-Treichel 41 (13): 30 – Psychiatr News". Psychiatric News. 41 (13): 30. doi:10.1176/pn.41.13.0030. Shear, K.; Jin, R.; Ruscio, AM.; Walters, EE.; Kessler, RC. (June 2006). "Prevalence and correlates of estimated DSM-IV child and adult separation anxiety disorder in the National Comorbidity Survey Replication". Am J Psychiatry. 163 (6): 1074–1083. doi:10.1176/appi.ajp.163.6.1074. PMC 1924723. PMID 16741209. Mohatt, Justin; Bennett, Shannon M.; Walkup, John T. (1 July 2014). "Treatment of Separation, Generalized, and Social Anxiety Disorders in Youths". American Journal of Psychiatry. 171 (7): 741–748. doi:10.1176/appi.ajp.2014.13101337. ISSN 0002-953X. PMID 24874020. National Collaborating Centre for Mental Health, (UK) (2006). Obsessive-Compulsive Disorder: Core Interventions in the Treatment of Obsessive-Compulsive Disorder and Body Dysmorphic Disorder. NICE Clinical Guidelines. ISBN 9781854334305. PMID 21834191. Archived from the original on 29 May 2013. Retrieved 21 November 2015. Soomro, GM (18 January 2012). "Obsessive compulsive disorder". BMJ Clinical Evidence. 2012. PMC 3285220. PMID 22305974. Institute for Quality and Efficiency in Health Care (IQWiG). "Obsessive-compulsive disorder: overview". PubMed Health. Institute for Quality and Efficiency in Health Care (IQWiG). Retrieved 21 November 2015. Viana, A. G.; Beidel, D. C.; Rabian, B. (2009). "Selective mutism: A review and integration of the last 15 years". Clinical Psychology Review. 29 (1): 57–67. doi:10.1016/j.cpr.2008.09.009. PMID 18986742. "The Child Who Would Not Speak a Word" Archived 3 April 2015 at the Wayback Machine "Selective Mutism". American Speech-Language-Hearing Association. Retrieved 16 November 2020. Rose M, Devine J (2014). "Assessment of patient-reported symptoms of anxiety". Dialogues Clin Neurosci (Review). 16 (2): 197–211 (Table 1). doi:10.31887/DCNS.2014.16.2/mrose. PMC 4140513. PMID 25152658.open access Rose M, Devine J (2014). "Assessment of patient-reported symptoms of anxiety". Dialogues Clin Neurosci (Review). 16 (2): 197–211 (Table 2). doi:10.31887/DCNS.2014.16.2/mrose. PMC 4140513. PMID 25152658.open access Samuels MH (2008). "Cognitive function in untreated hypothyroidism and hyperthyroidism". Current Opinion in Endocrinology, Diabetes and Obesity (Review). 15 (5): 429–33. doi:10.1097/MED.0b013e32830eb84c. PMID 18769215. S2CID 27235034. Grigsby AB, Anderson RJ, Freedland KE, Clouse RE, Lustman PJ (2002). "Prevalence of anxiety in adults with diabetes: a systematic review". Journal of Psychosomatic Research (Systematic Review). 53 (6): 1053–60. doi:10.1016/S0022-3999(02)00417-8. PMID 12479986. Zingone F, Swift GL, Card TR, Sanders DS, Ludvigsson JF, Bai JC (April 2015). "Psychological morbidity of celiac disease: A review of the literature". United European Gastroenterology Journal (Review). 3 (2): 136–45. doi:10.1177/2050640614560786. PMC 4406898. PMID 25922673. Molina-Infante J, Santolaria S, Sanders DS, Fernández-Bañares F (May 2015). "Systematic review: noncoeliac gluten sensitivity". Alimentary Pharmacology & Therapeutics (Systematic Review). 41 (9): 807–20. doi:10.1111/apt.13155. PMID 25753138. S2CID 207050854. Neuendorf R, Harding A, Stello N, Hanes D, Wahbeh H (2016). "Depression and anxiety in patients with Inflammatory Bowel Disease: A systematic review". Journal of Psychosomatic Research (Systematic Review). 87: 70–80. doi:10.1016/j.jpsychores.2016.06.001. PMID 27411754. Zhao QF, Tan L, Wang HF, Jiang T, Tan MS, Tan L, et al. (2016). "The prevalence of neuropsychiatric symptoms in Alzheimer's disease: Systematic review and meta-analysis". Journal of Affective Disorders (Systematic Review). 190: 264–71. doi:10.1016/j.jad.2015.09.069. PMID 26540080. Wen MC, Chan LL, Tan LC, Tan EK (2016). "Depression, anxiety, and apathy in Parkinson's disease: insights from neuroimaging studies". European Journal of Neurology (Review). 23 (6): 1001–19. doi:10.1111/ene.13002. PMC 5084819. PMID 27141858. Marrie RA, Reingold S, Cohen J, Stuve O, Trojano M, Sorensen PS, et al. (2015). "The incidence and prevalence of psychiatric disorders in multiple sclerosis: a systematic review". Multiple Sclerosis Journal (Systematic Review). 21 (3): 305–17. doi:10.1177/1352458514564487. PMC 4429164. PMID 25583845. Bienvenu, OJ; Ginsburg, GS (December 2007). "Prevention of anxiety disorders". International Review of Psychiatry. Abingdon, England. 19 (6): 647–54. doi:10.1080/09540260701797837. PMID 18092242. S2CID 95140. Khoury B, Lecomte T, Fortin G, et al. (August 2013). "Mindfulness-based therapy: a comprehensive meta-analysis". Clinical Psychology Review. 33 (6): 763–71. doi:10.1016/j.cpr.2013.05.005. PMID 23796855. Sharma M, Rush SE (July 2014). "Mindfulness-based stress reduction as a stress management intervention for healthy individuals: a systematic review". J Evid Based Complementary Altern Med. 19 (4): 271–86. doi:10.1177/2156587214543143. PMID 25053754. Patel, G; Fancher, TL (3 December 2013). "In the clinic. Generalized anxiety disorder" (PDF). Annals of Internal Medicine. 159 (11): ITC6–1, ITC6–2, ITC6–3, ITC6–4, ITC6–5, ITC6–6, ITC6–7, ITC6–8, ITC6–9, ITC6–10, ITC6–11, quiz ITC6–12. doi:10.7326/0003-4819-159-11-201312030-01006. PMID 24297210. S2CID 42889106. Archived (PDF) from the original on 4 January 2015. currently there is no evidence on the effectiveness of preventive measures for GAD in adult Moreno-Peral, P; Conejo-Cerón, S; Rubio-Valera, M; Fernández, A; Navas-Campaña, D; Rodríguez-Morejón, A; Motrico, E; Rigabert, A; Luna, JD; Martín-Pérez, C; Rodríguez-Bayón, A; Ballesta-Rodríguez, MI; Luciano, JV; Bellón, JÁ (1 October 2017). "Effectiveness of Psychological and/or Educational Interventions in the Prevention of Anxiety: A Systematic Review, Meta-analysis, and Meta-regression". JAMA Psychiatry. 74 (10): 1021–1029. doi:10.1001/jamapsychiatry.2017.2509. PMC 5710546. PMID 28877316. Schmidt, Norman B.; Allan, Nicholas P.; Knapp, Ashley A.; Capron, Dan (2019). "8 - Targeting anxiety sensitivity as a prevention strategy". The Clinician's Guide to Anxiety Sensitivity Treatment and Assessment. Academic Press. pp. 145–178. ISBN 978-0-12-813495-5. Stein, MB; Sareen, J (19 November 2015). "Clinical Practice: Generalized Anxiety Disorder". The New England Journal of Medicine. 373 (21): 2059–68. doi:10.1056/nejmcp1502514. PMID 26580998. Taylor, G.; McNeill, A.; Girling, A.; Farley, A.; Lindson-Hawley, N.; Aveyard, P. (13 February 2014). "Change in mental health after smoking cessation: systematic review and meta-analysis". BMJ. 348 (feb13 1): g1151. doi:10.1136/bmj.g1151. PMC 3923980. PMID 24524926. Su, Kuan-Pin; Tseng, Ping-Tao; Lin, Pao-Yen; Okubo, Ryo; Chen, Tien-Yu; Chen, Yen-Wen; Matsuoka, Yutaka J. (2018). "Association of Use of Omega-3 Polyunsaturated Fatty Acids With Changes in Severity of Anxiety Symptoms". JAMA Network Open. 1 (5): e182327. doi:10.1001/jamanetworkopen.2018.2327. ISSN 2574-3805. PMC 6324500. PMID 30646157. Cuijpers, P; Sijbrandij, M; Koole, S; Huibers, M; Berking, M; Andersson, G (March 2014). "Psychological treatment of generalized anxiety disorder: A meta-analysis". Clinical Psychology Review. 34 (2): 130–140. doi:10.1016/j.cpr.2014.01.002. PMID 24487344. Otte, C (2011). "Cognitive behavioral therapy in anxiety disorders: current state of the evidence". Dialogues in Clinical Neuroscience. 13 (4): 413–21. doi:10.31887/DCNS.2011.13.4/cotte. PMC 3263389. PMID 22275847. Pompoli, A; Furukawa, TA; Imai, H; Tajika, A; Efthimiou, O; Salanti, G (13 April 2016). "Psychological therapies for panic disorder with or without agoraphobia in adults: a network meta-analysis" (PDF). The Cochrane Database of Systematic Reviews. 4: CD011004. doi:10.1002/14651858.CD011004.pub2. PMC 7104662. PMID 27071857. Olthuis, JV; Watt, MC; Bailey, K; Hayden, JA; Stewart, SH (12 March 2016). "Therapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults". The Cochrane Database of Systematic Reviews. 2016 (3): CD011565. doi:10.1002/14651858.cd011565.pub2. PMC 7077612. PMID 26968204. E, Mayo-Wilson; P, Montgomery (9 September 2013). "Media-delivered Cognitive Behavioural Therapy and Behavioural Therapy (Self-Help) for Anxiety Disorders in Adults". The Cochrane Database of Systematic Reviews (9): CD005330. doi:10.1002/14651858.CD005330.pub4. PMID 24018460. Roemer L, Williston SK, Eustis EH (November 2013). "Mindfulness and acceptance-based behavioral therapies for anxiety disorders". Curr Psychiatry Rep. 15 (11): 410. doi:10.1007/s11920-013-0410-3. PMID 24078067. S2CID 23278447. Lang AJ (May 2013). "What mindfulness brings to psychotherapy for anxiety and depression". Depress Anxiety. 30 (5): 409–12. doi:10.1002/da.22081. PMID 23423991. S2CID 25705284. Krisanaprakornkit, T; Krisanaprakornkit, W; Piyavhatkul, N; Laopaiboon, M (25 January 2006). "Meditation therapy for anxiety disorders". The Cochrane Database of Systematic Reviews (1): CD004998. doi:10.1002/14651858.CD004998.pub2. PMID 16437509. Wu, Hui; Yu, Dehua; He, Yanling; Wang, Jijun; Xiao, Zeping; Li, Chunbo (19 February 2015). "Morita therapy for anxiety disorders in adults". Cochrane Database of Systematic Reviews (2): CD008619. doi:10.1002/14651858.CD008619.pub2. PMID 25695214. Baldwin, David S; Anderson, Ian M; Nutt, David J; Allgulander, Christer; Bandelow, Borwin; Boer, Johan A den; Christmas, David M; Davies, Simon; Fineberg, Naomi (8 April 2014). "Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: A revision of the 2005 guidelines from the British Association for Psychopharmacology" (PDF). Journal of Psychopharmacology. 28 (5): 403–439. doi:10.1177/0269881114525674. PMID 24713617. S2CID 28893331. Batelaan, Neeltje M; Bosman, Renske C; Muntingh, Anna; Scholten, Willemijn D; Huijbregts, Klaas M; van Balkom, Anton J L M (13 September 2017). "Risk of relapse after antidepressant discontinuation in anxiety disorders, obsessive-compulsive disorder, and post-traumatic stress disorder: systematic review and meta-analysis of relapse prevention trials". BMJ. 358: j3927. doi:10.1136/bmj.j3927. PMC 5596392. PMID 28903922. Batelaan, NM; Bosman, RC; Muntingh, A; Scholten, WD; Huijbregts, KM; van Balkom, AJLM (13 September 2017). "Risk of relapse after antidepressant discontinuation in anxiety disorders, obsessive-compulsive disorder, and post-traumatic stress disorder: systematic review and meta-analysis of relapse prevention trials". BMJ (Clinical Research Ed.). 358: j3927. doi:10.1136/bmj.j3927. PMC 5596392. PMID 28903922. Choy, Y; Fyer, AJ; Lipsitz, JD (April 2007). "Treatment of specific phobia in adults". Clinical Psychology Review. 27 (3): 266–86. doi:10.1016/j.cpr.2006.10.002. PMID 17112646. Black, Nicola; Stockings, Emily; Campbell, Gabrielle; Tran, Lucy T; Zagic, Dino; Hall, Wayne D; Farrell, Michael; Degenhardt, Louisa (October 2019). "Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: a systematic review and meta-analysis". The Lancet Psychiatry. 6 (12): 995–1010. doi:10.1016/S2215-0366(19)30401-8. PMC 6949116. PMID 31672337. Pittler MH, Ernst E (2003). Pittler MH (ed.). "Kava extract for treating anxiety". Cochrane Database of Systematic Reviews (1): CD003383. doi:10.1002/14651858.CD003383. PMC 6999799. PMID 12535473. Witte S, Loew D, Gaus W (March 2005). "Meta-analysis of the efficacy of the acetonic kava-kava extract WS1490 in patients with non-psychotic anxiety disorders". Phytother Res. 19 (3): 183–188. doi:10.1002/ptr.1609. PMID 15934028. S2CID 39260703. Saeed, SA; Bloch, RM; Antonacci, DJ (15 August 2007). "Herbal and dietary supplements for treatment of anxiety disorders". American Family Physician. 76 (4): 549–56. PMID 17853630. "What Is NeuroregulationTraining?". ISNR. 8 June 2019. Retrieved 16 November 2020. Wang, Zhen; Whiteside, Stephen P. H.; Sim, Leslie; Farah, Wigdan; Morrow, Allison S.; Alsawas, Mouaz; Barrionuevo, Patricia; Tello, Mouaffaa; Asi, Noor; Beuschel, Bradley; Daraz, Lubna; Almasri, Jehad; Zaiem, Feras; Larrea-Mantilla, Laura; Ponce, Oscar J.; LeBlanc, Annie; Prokop, Larry J.; Murad, Mohammad Hassan (31 August 2017). "Comparative Effectiveness and Safety of Cognitive Behavioral Therapy and Pharmacotherapy for Childhood Anxiety Disorders". JAMA Pediatrics. 171 (11): 1049–1056. doi:10.1001/jamapediatrics.2017.3036. PMC 5710373. PMID 28859190. Higa-McMillan, CK; Francis, SE; Rith-Najarian, L; Chorpita, BF (18 June 2015). "Evidence Base Update: 50 Years of Research on Treatment for Child and Adolescent Anxiety". Journal of Clinical Child and Adolescent Psychology. 45 (2): 91–113. doi:10.1080/15374416.2015.1046177. PMID 26087438. James, Anthony C.; James, Georgina; Cowdrey, Felicity A.; Soler, Angela; Choke, Aislinn (18 February 2015). "Cognitive behavioural therapy for anxiety disorders in children and adolescents". The Cochrane Database of Systematic Reviews (2): CD004690. doi:10.1002/14651858.CD004690.pub4. ISSN 1469-493X. PMC 6491167. PMID 25692403. Creswell, Cathy; Cruddace, Susan; Gerry, Stephen; Gitau, Rachel; McIntosh, Emma; Mollison, Jill; Murray, Lynne; Shafran, Rosamund; Stein, Alan (25 May 2015). "Treatment of childhood anxiety disorder in the context of maternal anxiety disorder: a randomised controlled trial and economic analysis". Health Technology Assessment. 19 (38): 1–184. doi:10.3310/hta19380. PMC 4781330. PMID 26004142. Kozlowska K.; Hanney L. (1999). "Family assessment and intervention using an interactive are exercise". Australian and New Zealand Journal of Family Therapy. 20 (2): 61–69. doi:10.1002/j.1467-8438.1999.tb00358.x. Bratton, S.C., & Ray, D. (2002). Humanistic play therapy. In D.J. Cain (Ed.), Humanistic psychotherapies: Handbook of research and practice (pp. 369-402). Washington, DC: American Psychological Association. Vos, T; Flaxman, AD; Naghavi, M; Lozano, R; Michaud, C; Ezzati, M; Shibuya, K; Salomon, JA; Abdalla, S; et al. (15 December 2012). "Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010". Lancet. 380 (9859): 2163–96. doi:10.1016/S0140-6736(12)61729-2. PMC 6350784. PMID 23245607. Simpson, Helen Blair, ed. (2010). Anxiety disorders : theory, research, and clinical perspectives (1. publ. ed.). Cambridge, UK: Cambridge University Press. p. 7. ISBN 978-0-521-51557-3. Archived from the original on 6 May 2016. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE (June 2005). "Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication". Arch. Gen. Psychiatry. 62 (6): 593–602. doi:10.1001/archpsyc.62.6.593. PMID 15939837. Brockveld, Kelia C.; Perini, Sarah J.; Rapee, Ronald M. (2014). "6". In Hofmann, Stefan G.; DiBartolo, Patricia M. (eds.). Social Anxiety: Clinical, Developmental, and Social Perspectives (3 ed.). Elsevier. doi:10.1016/B978-0-12-394427-6.00006-6. ISBN 978-0-12-394427-6. Hofmann, Stefan G.; Asnaani, Anu (December 2010). "Cultural Aspects in Social Anxiety and Social Anxiety Disorder". Depress Anxiety. 27 (12): 1117–1127. doi:10.1002/da.20759. PMC 3075954. PMID 21132847. Fricchione, Gregory (12 August 2004). "Generalized Anxiety Disorder". New England Journal of Medicine. 351 (7): 675–682. doi:10.1056/NEJMcp022342. PMID 15306669. Essau, Cecilia A. (2006). Child and Adolescent Psychopathology: Theoretical and Clinical Implications. Hove, East Sussex: Routledge. p. 79. AnxietyBC (14 November 2014). "GENERALIZED ANXIETY". AnxietyBC. AnxietyBC. Archived from the original on 12 June 2015. Retrieved 11 June 2015. Merrill, Anna. "Anxiety and Autism Spectrum Disorders". Indiana Resource Center for Autism. Indiana Resource Center for Autism. Archived from the original on 11 June 2015. Retrieved 10 June 2015. Guignard, Jacques-Henri; Jacquet, Anne-Yvonne; Lubart, Todd I. (2012). "Perfectionism and Anxiety: A Paradox in Intellectual Giftedness?". PLOS ONE. 7 (7): e41043. Bibcode:2012PLoSO...741043G. doi:10.1371/journal.pone.0041043. PMC 3408483. PMID 22859964. Rapee, Ronald M.; Schniering, Carolyn A.; Hudson, Jennifer L. "Anxiety Disorders During Childhood and Adolescence: Origins and Treatment" (PDF). Annual Review of Clinical Psychology. Archived from the original (PDF) on 11 June 2015. External links Classification D ICD-10: F40-F42ICD-9-CM: 300MeSH: D001008DiseasesDB: 787 External resources eMedicine: med/152 Support Group Providers for Anxiety disorder at Curlie vte Mental and behavioral disorders Authority control Edit this at Wikidata Categories: Anxiety disorders Navigation menu Not logged in Talk Contributions Create account Log in ArticleTalk ReadEditView history Search Search Wikipedia Main page Contents Current events Random article About Wikipedia Contact us Donate Contribute Help Learn to edit Community portal Recent changes Upload file Tools What links here Related changes Special pages Permanent link Page information Cite this page Wikidata item Print/export Download as PDF Printable version In other projects Wikimedia Commons Languages العربية Español 한국어 हिन्दी Bahasa Indonesia Bahasa Melayu Português Русский 中文 41 more Edit links This page was last edited on 28 November 2021, at 09:24 (UTC). 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Anxiety disorder

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Anxiety disorder
The Scream.jpg
The Scream (Norwegian: Skrik) a painting by Norwegian artist Edvard Munch[1]
SpecialtyPsychiatry, clinical psychology
SymptomsWorrying, fast heart rate, shakiness[2]
ComplicationsDepression, trouble sleeping, poor quality of life, suicide[3]
Usual onset15–35 years old[4]
Duration> 6 months[2][4]
CausesGenetic, environmental, and psychological factors[5]
Risk factorsChild abuse, family history, poverty[4]
Diagnostic methodPsychological assessment
Differential diagnosisHyperthyroidism; heart disease; caffeine, alcohol, cannabis use; withdrawal from certain drugs[4][6]
TreatmentLifestyle changes, counselling, medications[4]
MedicationAntidepressants, anxiolytics, beta blockers[5]
Frequency12% per year[4][7]

Anxiety disorders are a cluster of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear[2] such that a person's social, occupational, and personal function are significantly impaired.[2] Anxiety may cause physical and cognitive symptoms, such as restlessness, irritability, easy fatiguability, difficulty concentrating, increased heart rate, chest pain, abdominal pain, and a variety of other symptoms that may vary based on the individual.[2]

In casual discourse, the words anxiety and fear are often used interchangeably. In clinical usage, they have distinct meanings: anxiety is defined as an unpleasant emotional state for which the cause is either not readily identified or perceived to be uncontrollable or unavoidable, whereas fear is an emotional and physiological response to a recognized external threat.[8] The umbrella term anxiety disorder refers to a number of specific disorders that include fears (phobias) or anxiety symptoms.[2]

There are several types of anxiety disorders, including generalized anxiety disorder, specific phobia, social anxiety disorder, separation anxiety disorder, agoraphobia, panic disorder, and selective mutism.[2] The individual disorder can be diagnosed using the specific and unique symptoms, triggering events, and timing.[2] If a person is diagnosed with an anxiety disorder, a medical professional must have evaluated the person to ensure the anxiety cannot be attributed to another medical illness or mental disorder.[2] It is possible for an individual to have more than one anxiety disorder during their life or at the same time[2] and anxiety disorders are marked by a typical persistent course.[9] For individuals with anxiety, there are numerous treatments and strategies that can improve their mood, behaviors, and ability to function in daily life.

Sub-types[edit]

Facial expression of someone with chronic anxiety

Generalized anxiety disorder[edit]

Main article: Generalized anxiety disorder

Generalized anxiety disorder (GAD) is a common disorder, characterized by long-lasting anxiety which is not focused on any one object or situation. Those suffering from generalized anxiety disorder experience non-specific persistent fear and worry, and become overly concerned with everyday matters. Generalized anxiety disorder is "characterized by chronic excessive worry accompanied by three or more of the following symptoms: restlessness, fatigue, concentration problems, irritability, muscle tension, and sleep disturbance".[10] Generalized anxiety disorder is the most common anxiety disorder to affect older adults.[11] Anxiety can be a symptom of a medical or substance use disorder problem, and medical professionals must be aware of this. A diagnosis of GAD is made when a person has been excessively worried about an everyday problem for six months or more.[12] These stresses can include family life, work, social life, or their own health. A person may find that they have problems making daily decisions and remembering commitments as a result of lack of concentration and/or preoccupation with worry.[13] A symptom can be a strained appearance, with increased sweating from the hands, feet, and axillae,[14] and they may be tearful, which can suggest depression.[15] Before a diagnosis of anxiety disorder is made, physicians must rule out drug-induced anxiety and other medical causes.[16]

In children, GAD may be associated with headaches, restlessness, abdominal pain, and heart palpitations.[17] Typically it begins around 8 to 9 years of age.[17]

Specific phobias[edit]

Main article: Specific phobia

The single largest category of anxiety disorders is that of specific phobias, which includes all cases in which fear and anxiety are triggered by a specific stimulus or situation. Between 5% and 12% of the population worldwide suffer from specific phobias.[12] According to the National Institute of Mental Health, a phobia is an intense fear of or aversion to specific objects or situations.[18] Sufferers typically anticipate terrifying consequences from encountering the object of their fear, which can be anything from an animal to a location to a bodily fluid to a particular situation. Common phobias are flying, blood, water, highway driving, and tunnels. When people are exposed to their phobia, they may experience trembling, shortness of breath, or rapid heartbeat.[19] Thus meaning that people with specific phobias often go out of their way to avoid encountering their phobia. People understand that their fear is not proportional to the actual potential danger but still are overwhelmed by it.[20]

Panic disorder[edit]

Main article: Panic disorder

With panic disorder, a person has brief attacks of intense terror and apprehension, often marked by trembling, shaking, confusion, dizziness, nausea, and/or difficulty breathing. These panic attacks, defined by the APA as fear or discomfort that abruptly arises and peaks in less than ten minutes, can last for several hours.[21] Attacks can be triggered by stress, irrational thoughts, general fear or fear of the unknown, or even exercise. However, sometimes the trigger is unclear and the attacks can arise without warning. To help prevent an attack, one can avoid the trigger. This can mean avoiding places, people, types of behaviors, or certain situations that have been known to cause a panic attack. This being said, not all attacks can be prevented.

In addition to recurrent unexpected panic attacks, a diagnosis of panic disorder requires that said attacks have chronic consequences: either worry over the attacks' potential implications, persistent fear of future attacks, or significant changes in behavior related to the attacks. As such, those suffering from panic disorder experience symptoms even outside specific panic episodes. Often, normal changes in heartbeat are noticed by a panic sufferer, leading them to think something is wrong with their heart or they are about to have another panic attack. In some cases, a heightened awareness (hypervigilance) of body functioning occurs during panic attacks, wherein any perceived physiological change is interpreted as a possible life-threatening illness (i.e., extreme hypochondriasis).

Agoraphobia[edit]

Main article: Agoraphobia

Agoraphobia is the specific anxiety about being in a place or situation where escape is difficult or embarrassing or where help may be unavailable.[22] Agoraphobia is strongly linked with panic disorder and is often precipitated by the fear of having a panic attack. A common manifestation involves needing to be in constant view of a door or other escape route. In addition to the fears themselves, the term agoraphobia is often used to refer to avoidance behaviors that sufferers often develop.[23] For example, following a panic attack while driving, someone suffering from agoraphobia may develop anxiety over driving and will therefore avoid driving. These avoidance behaviors can have serious consequences and often reinforce the fear they are caused by. In a severe case of agoraphobia, the person may never leave their home.

Social anxiety disorder[edit]

Main article: Social anxiety disorder

Social anxiety disorder (SAD; also known as social phobia) describes an intense fear and avoidance of negative public scrutiny, public embarrassment, humiliation, or social interaction. This fear can be specific to particular social situations (such as public speaking) or, more typically, is experienced in most (or all) social interactions. Roughly 7% of American adults have social anxiety disorder, and more than 75% of people experience their first symptoms in their childhood or early teenage years.[24] Social anxiety often manifests specific physical symptoms, including blushing, sweating, rapid heart rate, and difficulty speaking.[25] As with all phobic disorders, those suffering from social anxiety often will attempt to avoid the source of their anxiety; in the case of social anxiety this is particularly problematic, and in severe cases can lead to complete social isolation.

Children are also affected by social anxiety disorder, although their associated symptoms are different than that of teenagers and adults. They may experience difficulty processing or retrieving information, sleep deprivation, disruptive behaviors in class, and irregular class participation.[26]

Social physique anxiety (SPA) is a subtype of social anxiety, involving concern over the evaluation of one's body by others.[27] SPA is common among adolescents, especially females.

Post-traumatic stress disorder[edit]

Main article: Post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) was once an anxiety disorder (now moved to trauma- and stressor-related disorders in DSM-V) that results from a traumatic experience. PTSD affects approximately 3.5% of U.S. adults every year, and an estimated one in eleven people will be diagnosed with PTSD in their lifetime.[28] Post-traumatic stress can result from an extreme situation, such as combat, natural disaster, rape, hostage situations, child abuse, bullying, or even a serious accident. It can also result from long-term (chronic) exposure to a severe stressor—[29]for example, soldiers who endure individual battles but cannot cope with continuous combat. Common symptoms include hypervigilance, flashbacks, avoidant behaviors, anxiety, anger and depression.[30] In addition, individuals may experience sleep disturbances.[31] People who suffer from PTSD often try to detach themselves from their friends and family, and have difficulty maintaining these close relationships. There are a number of treatments that form the basis of the care plan for those with PTSD. Such treatments include cognitive behavioral therapy (CBT), prolonged exposure therapy, stress inoculation therapy, medication, and psychotherapy and support from family and friends.[12]

Post-traumatic stress disorder (PTSD) research began with Vietnam veterans, as well as natural and non-natural disaster victims. Studies have found the degree of exposure to a disaster has been found to be the best predictor of PTSD.[32]

Separation anxiety disorder[edit]

Main article: Separation anxiety disorder

Separation anxiety disorder (SepAD) is the feeling of excessive and inappropriate levels of anxiety over being separated from a person or place. Separation anxiety is a normal part of development in babies or children, and it is only when this feeling is excessive or inappropriate that it can be considered a disorder.[33] Separation anxiety disorder affects roughly 7% of adults and 4% of children, but the childhood cases tend to be more severe; in some instances, even a brief separation can produce panic.[34][35] Treating a child earlier may prevent problems. This may include training the parents and family on how to deal with it. Often, the parents will reinforce the anxiety because they do not know how to properly work through it with the child. In addition to parent training and family therapy, medication, such as SSRIs, can be used to treat separation anxiety.[36]

Obsessive–compulsive disorder[edit]

Main article: Obsessive–compulsive disorder

Obsessive–compulsive disorder (OCD) is not classified as an anxiety disorder by the DSM-5, but is by the ICD-10. It was previously classified as an anxiety disorder in the DSM-IV. It is a condition where the person has obsessions (distressing, persistent, and intrusive thoughts or images) and compulsions (urges to repeatedly perform specific acts or rituals), that are not caused by drugs or physical disorder, and which cause distress or social dysfunction.[37][38] The compulsive rituals are personal rules followed to relieve the feeling of discomfort.[38] OCD affects roughly 1–⁠2% of adults (somewhat more women than men), and under 3% of children and adolescents.[37][38]

A person with OCD knows that the symptoms are unreasonable and struggles against both the thoughts and the behavior.[37][39] Their symptoms could be related to external events they fear (such as their home burning down because they forget to turn off the stove) or worry that they will behave inappropriately.[39]

It is not certain why some people have OCD, but behavioral, cognitive, genetic, and neurobiological factors may be involved.[38] Risk factors include family history, being single (although that may result from the disorder), and higher socioeconomic class or not being in paid employment.[38] Of those with OCD about 20% of people will overcome it, and symptoms will at least reduce over time for most people (a further 50%).[37]

Selective mutism[edit]

Main article: Selective mutism

Selective mutism (SM) is a disorder in which a person who is normally capable of speech does not speak in specific situations or to specific people. Selective mutism usually co-exists with shyness or social anxiety.[40] People with selective mutism stay silent even when the consequences of their silence include shame, social ostracism or even punishment.[41] Selective mutism affects about 0.8% of people at some point in their life.[4]

Testing for selective mutism is important because doctors must determine if it is an issue associated with the child's hearing, movements associated with the jaw or tongue, and if the child can understand when others are speaking to them.[42]

Diagnosis[edit]

The diagnosis of anxiety disorders is made by symptoms, triggers, and a person's personal and family histories. There are no objective biomarkers or laboratory tests that can diagnose anxiety.[43] It is important for a medical professional to evaluate a person for other medical and mental causes for prolonged anxiety because treatments will vary considerably.[2]

Numerous questionnaires have been developed for clinical use and can be used for an objective scoring system. Symptoms may be vary between each subtype of generalized anxiety disorder. Generally, symptoms must be present for at least six months, occur more days than not, and significantly impair a person's ability to function in daily life. Symptoms may include: feeling nervous, anxious, or on edge; worrying excessively; difficulty concentrating; restlessness; irritability.[2][4]

Questionnaires developed for clinical use include the State-Trait Anxiety Inventory (STAI), the Generalized Anxiety Disorder 7 (GAD-7), the Beck Anxiety Inventory (BAI), the Zung Self-Rating Anxiety Scale, and the Taylor Manifest Anxiety Scale.[43] Other questionnaires combine anxiety and depression measurement, such as the Hamilton Anxiety Rating Scale, the Hospital Anxiety and Depression Scale (HADS), the Patient Health Questionnaire (PHQ), and the Patient-Reported Outcomes Measurement Information System (PROMIS).[43] Examples of specific anxiety questionnaires include the Liebowitz Social Anxiety Scale (LSAS), the Social Interaction Anxiety Scale (SIAS), the Social Phobia Inventory (SPIN), the Social Phobia Scale (SPS), and the Social Anxiety Questionnaire (SAQ-A30).[44]

Differential diagnosis[edit]

Anxiety disorders differ from developmentally normal fear or anxiety by being excessive or persisting beyond developmentally appropriate periods. They differ from transient fear or anxiety, often stress-induced, by being persistent (e.g., typically lasting 6 months or more), although the criterion for duration is intended as a general guide with allowance for some degree of flexibility and is sometimes of shorter duration in children.[2]

The diagnosis of an anxiety disorder requires first ruling out an underlying medical cause.[6][8] Diseases that may present similar to an anxiety disorder, including certain endocrine diseases (hypo- and hyperthyroidism, hyperprolactinemia),[4][6][45] metabolic disorders (diabetes),[6][46] deficiency states (low levels of vitamin D, B2, B12, folic acid),[6] gastrointestinal diseases (celiac disease, non-celiac gluten sensitivity, inflammatory bowel disease),[47][48][49] heart diseases,[4][6] blood diseases (anemia),[6] and brain degenerative diseases (Parkinson's disease, dementia, multiple sclerosis, Huntington's disease).[6][50][51][52]

Several drugs can also cause or worsen anxiety, whether in intoxication, withdrawal, or from chronic use. These include alcohol, tobacco, cannabis, sedatives (including prescription benzodiazepines), opioids (including prescription painkillers and illicit drugs like heroin), stimulants (such as caffeine, cocaine and amphetamines), hallucinogens, and inhalants.[4][2]

Prevention[edit]

Focus is increasing on prevention of anxiety disorders.[53] There is tentative evidence to support the use of cognitive behavioral therapy[53] and mindfulness therapy.[54][55] A 2013 review found no effective measures to prevent GAD in adults.[56] A 2017 review found that psychological and educational interventions had a small benefit for the prevention of anxiety.[57][58] Research indicates that predictors of the emergence of anxiety disorders partly differ from the factors that predict their persistence.[9]

Treatment[edit]

Treatment options include lifestyle changes, therapy, and medications. There is no clear evidence as to whether therapy or medication is most effective; the specific medication decision can be made by a doctor and patient with consideration to the patient's specific circumstances and symptoms.[59] If while on treatment with a chosen medication, the person's anxiety does not improve, another medication may be offered.[59] Specific treatments will vary by subtype of anxiety disorder, a person's other medical conditions, and medications.

Lifestyle and diet[edit]

Lifestyle changes include exercise, for which there is moderate evidence for some improvement, regularizing sleep patterns, reducing caffeine intake, and stopping smoking.[59] Stopping smoking has benefits in anxiety as large as or larger than those of medications.[60] Omega-3 polyunsaturated fatty acids, such as fish oil, may reduce anxiety, particularly in those with more significant symptoms.[61]

Psychotherapy[edit]

Cognitive behavioral therapy (CBT) is effective for anxiety disorders and is a first-line treatment.[59][62][63][64][65][excessive citations] CBT appears to be equally effective when carried out via the internet compared to sessions completed face to face.[65][66]

Mindfulness-based programs also appear to be effective for managing anxiety disorders.[67][68] It is unclear if meditation has an effect on anxiety and transcendental meditation appears to be no different than other types of meditation.[69]

A 2015 Cochrane review of Morita therapy for anxiety disorder in adults found not enough evidence to draw a conclusion.[70]

Medications[edit]

First-line choices for medications include SSRIs or SNRIs to treat generalized anxiety disorder.[59][71] There is no good evidence supporting which specific medication in the SSRI or SNRI class is best for treating anxiety, so cost often drives drug choice.[59][71] If they are effective, it is recommended that they are continued for at least a year.[72] Stopping these medications results in a greater risk of relapse.[73]

Buspirone and pregabalin are second-line treatments for people who do not respond to SSRIs or SNRIs; there is also evidence that benzodiazepines, including diazepam and clonazepam, are effective.[59]

Medications need to be used with care among older adults, who are more likely to have side effects because of coexisting physical disorders. Adherence problems are more likely among older people, who may have difficulty understanding, seeing, or remembering instructions.[11]

In general, medications are not seen as helpful in specific phobia, but a benzodiazepine is sometimes used to help resolve acute episodes. In 2007, data was sparse for efficacy of any drug.[74]

Alternative medicine[edit]

Other remedies have been used or are under research for treating anxiety disorders. As of 2019, there is little evidence for cannabis in anxiety disorders.[75] Kava is under preliminary research for its potential in short-term use by people with mild to moderate anxiety.[76][77] The American Academy of Family Physicians recommends use of kava for mild to moderate anxiety disorders in people not using alcohol or taking other medicines metabolized by the liver, while preferring remedies thought to be natural.[78] Inositol has been found to have modest effects in people with panic disorder or obsessive-compulsive disorder.[78] There is insufficient evidence to support the use of St. John's wort, valerian or passionflower.[78]

Neurofeedback training (NFT) is another form of alternative medicine, where practitioners use monitoring devices to see moment to moment information in relation to the nervous system and the brain. Sensors are placed along the scalp, and the brain responses are recorded and amplified in association with specific brain activity. The practitioners then discuss the responses associated with the client, in an attempt to determine different principles of learning, and practitioner guidance to create changes in brain patterns.[79]

Children[edit]

Both therapy and a number of medications have been found to be useful for treating childhood anxiety disorders.[80] Therapy is generally preferred to medication.[81]

Cognitive behavioral therapy (CBT) is a good first therapy approach.[81] Studies have gathered substantial evidence for treatments that are not CBT-based as being effective forms of treatment, expanding treatment options for those who do not respond to CBT.[81] Although studies have demonstrated the effectiveness of CBT for anxiety disorders in children and adolescents, evidence that it is more effective than treatment as usual, medication, or wait list controls is inconclusive.[82] Like adults, children may undergo psychotherapy, cognitive-behavioral therapy, or counseling. Family therapy is a form of treatment in which the child meets with a therapist together with the primary guardians and siblings.[83] Each family member may attend individual therapy, but family therapy is typically a form of group therapy. Art and play therapy are also used. Art therapy is most commonly used when the child will not or cannot verbally communicate, due to trauma or a disability in which they are nonverbal. Participating in art activities allows the child to express what they otherwise may not be able to communicate to others.[84] In play therapy, the child is allowed to play however they please as a therapist observes them. The therapist may intercede from time to time with a question, comment, or suggestion. This is often most effective when the family of the child plays a role in the treatment.[83][85]

If a medication option is warranted, antidepressants such as SSRIs and SNRIs can be effective.[80] Minor side effects with medications, however, are common.[80]

Epidemiology[edit]

Globally, as of 2010, approximately 273 million (4.5% of the population) had an anxiety disorder.[86] It is more common in females (5.2%) than males (2.8%).[86]

In Europe, Africa and Asia, lifetime rates of anxiety disorders are between 9 and 16%, and yearly rates are between 4 and 7%.[87] In the United States, the lifetime prevalence of anxiety disorders is about 29%[88] and between 11 and 18% of adults have the condition in a given year.[87] This difference is affected by the range of ways in which different cultures interpret anxiety symptoms and what they consider to be normative behavior.[89][90] In general, anxiety disorders represent the most prevalent psychiatric condition in the United States, outside of substance use disorder.[91]

Like adults, children can experience anxiety disorders; between 10 and 20 percent of all children will develop a full-fledged anxiety disorder prior to the age of 18,[92] making anxiety the most common mental health issue in young people. Anxiety disorders in children are often more challenging to identify than their adult counterparts, owing to the difficulty many parents face in discerning them from normal childhood fears. Likewise, anxiety in children is sometimes misdiagnosed as attention deficit hyperactivity disorder or, due to the tendency of children to interpret their emotions physically (as stomachaches, headaches, etc.), anxiety disorders may initially be confused with physical ailments.[93]

Anxiety in children has a variety of causes; sometimes anxiety is rooted in biology, and may be a product of another existing condition, such as autism spectrum disorder.[94] Gifted children are also often more prone to excessive anxiety than non-gifted children.[95] Other cases of anxiety arise from the child having experienced a traumatic event of some kind, and in some cases, the cause of the child's anxiety cannot be pinpointed.[96]

Anxiety in children tends to manifest along age-appropriate themes, such as fear of going to school (not related to bullying) or not performing well enough at school, fear of social rejection, fear of something happening to loved ones, etc. What separates disordered anxiety from normal childhood anxiety is the duration and intensity of the fears involved.[93]

See also[edit]

References[edit]

  1. ^ Peter Aspden (21 April 2012). "So, what does 'The Scream' mean?". Financial Times. Archived from the original on 14 October 2013.
  2. ^ Jump up to:a b c d e f g h i j k l m n Diagnostic and statistical manual of mental disorders 5th edition: DSM-5. Arlington, VA Washington, D.C: American Psychiatric Association,American Psychiatric Association. 2013. p. 189–195. ISBN 978-0-89042-555-8. OCLC 830807378.
  3. ^ "Anxiety disorders – Symptoms and causes". Mayo Clinic. Retrieved 23 May 2019.
  4. ^ Jump up to:a b c d e f g h i j k Craske, MG; Stein, MB (24 June 2016). "Anxiety". Lancet. 388 (10063): 3048–3059. doi:10.1016/S0140-6736(16)30381-6. PMID 27349358. S2CID 208789585.
  5. ^ Jump up to:a b "Anxiety Disorders". NIMH. March 2016. Archivedfrom the original on 27 July 2016. Retrieved 14 August 2016.
  6. ^ Jump up to:a b c d e f g h Testa A, Giannuzzi R, Daini S, Bernardini L, Petrongolo L, Gentiloni Silveri N (2013). "Psychiatric emergencies (part III): psychiatric symptoms resulting from organic diseases" (PDF). European Review for Medical and Pharmacological Sciences (Review). 17 (s1): 86–99. PMID 23436670. Archived (PDF) from the original on 10 March 2016. open access
  7. ^ Kessler; et al. (2007). "Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization's World Mental Health Survey Initiative". World Psychiatry. 6 (3): 168–76. PMC 2174588. PMID 18188442.
  8. ^ Jump up to:a b World Health Organization (2009). Pharmacological Treatment of Mental Disorders in Primary Health Care (PDF). Geneva. ISBN 978-92-4-154769-7. Archived (PDF) from the original on 20 November 2016.
  9. ^ Jump up to:a b Hovenkamp-Hermelink; et al. (2021). "Predictors of persistence of anxiety disorders across the lifespan: a systematic review". The Lancet Psychiatry. 8 (5): 428–443.
  10. ^ Schacter, D. L., Gilbert, D. T., & Wegner, D.M. (2011). Psychology: Second Edition. New York, NY: Worth.
  11. ^ Jump up to:a b Calleo J, Stanley M (2008). "Anxiety Disorders in Later Life: Differentiated Diagnosis and Treatment Strategies". Psychiatric Times. 26 (8). Archived from the original on 4 September 2009.
  12. ^ Jump up to:a b c Phil Barker (7 October 2003). Psychiatric and mental health nursing: the craft of caring. London: Arnold. ISBN 978-0-340-81026-2. Archived from the original on 27 May 2013. Retrieved 17 December 2010.
  13. ^ Psychology, Michael Passer, Ronald Smith, Nigel Holt, Andy Bremner, Ed Sutherland, Michael Vliek (2009) McGrath Hill Education, UK: McGrath Hill Companies Inc. p 790
  14. ^ "All About Anxiety Disorders: From Causes to Treatment and Prevention". Archived from the original on 17 February 2016. Retrieved 18 February 2016.
  15. ^ Psychiatry, Michael Gelder, Richard Mayou, John Geddes 3rd ed. Oxford; New York: Oxford University Press, c 2005 p. 75
  16. ^ Varcarolis. E (2010). Manual of Psychiatric Nursing Care Planning: Assessment Guides, Diagnoses and Psychopharmacology. 4th ed. New York: Saunders Elsevier. p 109.
  17. ^ Jump up to:a b Keeton, CP; Kolos, AC; Walkup, JT (2009). "Pediatric generalized anxiety disorder: epidemiology, diagnosis, and management". Paediatric Drugs. 11 (3): 171–83. doi:10.2165/00148581-200911030-00003. PMID 19445546. S2CID 39870253.
  18. ^ "NIMH » Anxiety Disorders". www.nimh.nih.gov. Retrieved 16 November 2020.
  19. ^ U.S. Department of Health & Human Services (2017). "Phobias". www.mentalhealth.gov. Archived from the original on 13 May 2017. Retrieved 1 December 2017.
  20. ^ Psychology. Michael Passer, Ronald Smith, Nigel Holt, Andy Bremner, Ed Sutherland, Michael Vliek. (2009) McGrath Hill Higher Education; UK: McGrath Hill companies Inc.
  21. ^ "Panic Disorder". Center for the Treatment and Study of Anxiety, University of Pennsylvania. Archived from the original on 27 May 2015.
  22. ^ Craske 2003 Gorman, 2000
  23. ^ Jane E. Fisher; William T. O'Donohue (27 July 2006). Practitioner's Guide to Evidence-Based Psychotherapy. Springer. pp. 754. ISBN 978-0387283692.
  24. ^ "Social Anxiety Disorder". Mental Health America. Retrieved 16 November 2020.
  25. ^ "NIMH » Social Anxiety Disorder: More Than Just Shyness". www.nimh.nih.gov. Retrieved 1 December 2020.
  26. ^ "Managing Anxiety in the Classroom". Mental Health America. Retrieved 16 November 2020.
  27. ^ The Oxford Handbook of Exercise Psychology. Oxford University Press. 2012. p. 56. ISBN 9780199930746.
  28. ^ "What Is PTSD?". www.psychiatry.org. Retrieved 16 November 2020.
  29. ^ Post-Traumatic Stress Disorder and the Family. Veterans Affairs Canada. 2006. ISBN 978-0-662-42627-1. Archived from the original on 14 February 2009. Retrieved 8 September2017.
  30. ^ Psychological Disorders Archived 4 December 2008 at the Wayback Machine, Psychologie Anglophone
  31. ^ Shalev, Arieh; Liberzon, Israel; Marmar, Charles (2017). "Post-Traumatic Stress Disorder". New England Journal of Medicine. 376 (25): 2459–2469. doi:10.1056/nejmra1612499. PMID 28636846.
  32. ^ Fullerton, Carol (1997). Posttraumatic Stress Disorder. Washington, D.C.: American Psychiatric Press Inc. pp. 8–9. ISBN 978-0-88048-751-1.
  33. ^ Siegler, Robert (2006). How Children Develop, Exploring Child Develop Student Media Tool Kit & Scientific American Reader to Accompany How Children Develop. New York: Worth Publishers. ISBN 0-7167-6113-0.
  34. ^ Arehart-Treichel, Joan (2006). "Adult Separation Anxiety Often Overlooked Diagnosis – Arehart-Treichel 41 (13): 30 – Psychiatr News". Psychiatric News. 41 (13): 30. doi:10.1176/pn.41.13.0030.
  35. ^ Shear, K.; Jin, R.; Ruscio, AM.; Walters, EE.; Kessler, RC. (June 2006). "Prevalence and correlates of estimated DSM-IV child and adult separation anxiety disorder in the National Comorbidity Survey Replication". Am J Psychiatry. 163 (6): 1074–1083. doi:10.1176/appi.ajp.163.6.1074. PMC 1924723. PMID 16741209.
  36. ^ Mohatt, Justin; Bennett, Shannon M.; Walkup, John T. (1 July 2014). "Treatment of Separation, Generalized, and Social Anxiety Disorders in Youths". American Journal of Psychiatry. 171 (7): 741–748. doi:10.1176/appi.ajp.2014.13101337. ISSN 0002-953X. PMID 24874020.
  37. ^ Jump up to:a b c d National Collaborating Centre for Mental Health, (UK) (2006). Obsessive-Compulsive Disorder: Core Interventions in the Treatment of Obsessive-Compulsive Disorder and Body Dysmorphic Disorder. NICE Clinical Guidelines. ISBN 9781854334305. PMID 21834191. Archived from the original on 29 May 2013. Retrieved 21 November 2015.
  38. ^ Jump up to:a b c d e Soomro, GM (18 January 2012). "Obsessive compulsive disorder". BMJ Clinical Evidence. 2012. PMC 3285220. PMID 22305974.
  39. ^ Jump up to:a b Institute for Quality and Efficiency in Health Care (IQWiG). "Obsessive-compulsive disorder: overview". PubMed Health. Institute for Quality and Efficiency in Health Care (IQWiG). Retrieved 21 November 2015.
  40. ^ Viana, A. G.; Beidel, D. C.; Rabian, B. (2009). "Selective mutism: A review and integration of the last 15 years". Clinical Psychology Review. 29 (1): 57–67. doi:10.1016/j.cpr.2008.09.009. PMID 18986742.
  41. ^ "The Child Who Would Not Speak a Word" Archived 3 April 2015 at the Wayback Machine
  42. ^ "Selective Mutism". American Speech-Language-Hearing Association. Retrieved 16 November 2020.
  43. ^ Jump up to:a b c Rose M, Devine J (2014). "Assessment of patient-reported symptoms of anxiety". Dialogues Clin Neurosci(Review). 16 (2): 197–211 (Table 1). doi:10.31887/DCNS.2014.16.2/mrose. PMC 4140513. PMID 25152658.open access
  44. ^ Rose M, Devine J (2014). "Assessment of patient-reported symptoms of anxiety". Dialogues Clin Neurosci (Review). 16(2): 197–211 (Table 2). doi:10.31887/DCNS.2014.16.2/mrose. PMC 4140513. PMID 25152658.open access
  45. ^ Samuels MH (2008). "Cognitive function in untreated hypothyroidism and hyperthyroidism". Current Opinion in Endocrinology, Diabetes and Obesity (Review). 15 (5): 429–33. doi:10.1097/MED.0b013e32830eb84c. PMID 18769215. S2CID 27235034.
  46. ^ Grigsby AB, Anderson RJ, Freedland KE, Clouse RE, Lustman PJ (2002). "Prevalence of anxiety in adults with diabetes: a systematic review". Journal of Psychosomatic Research(Systematic Review). 53 (6): 1053–60. doi:10.1016/S0022-3999(02)00417-8. PMID 12479986.
  47. ^ Zingone F, Swift GL, Card TR, Sanders DS, Ludvigsson JF, Bai JC (April 2015). "Psychological morbidity of celiac disease: A review of the literature". United European Gastroenterology Journal (Review). 3 (2): 136–45. doi:10.1177/2050640614560786. PMC 4406898. PMID 25922673.
  48. ^ Molina-Infante J, Santolaria S, Sanders DS, Fernández-Bañares F (May 2015). "Systematic review: noncoeliac gluten sensitivity". Alimentary Pharmacology & Therapeutics(Systematic Review). 41 (9): 807–20. doi:10.1111/apt.13155. PMID 25753138. S2CID 207050854.
  49. ^ Neuendorf R, Harding A, Stello N, Hanes D, Wahbeh H (2016). "Depression and anxiety in patients with Inflammatory Bowel Disease: A systematic review". Journal of Psychosomatic Research (Systematic Review). 87: 70–80. doi:10.1016/j.jpsychores.2016.06.001. PMID 27411754.
  50. ^ Zhao QF, Tan L, Wang HF, Jiang T, Tan MS, Tan L, et al. (2016). "The prevalence of neuropsychiatric symptoms in Alzheimer's disease: Systematic review and meta-analysis". Journal of Affective Disorders (Systematic Review). 190: 264–71. doi:10.1016/j.jad.2015.09.069. PMID 26540080.
  51. ^ Wen MC, Chan LL, Tan LC, Tan EK (2016). "Depression, anxiety, and apathy in Parkinson's disease: insights from neuroimaging studies". European Journal of Neurology(Review). 23 (6): 1001–19. doi:10.1111/ene.13002. PMC 5084819. PMID 27141858.
  52. ^ Marrie RA, Reingold S, Cohen J, Stuve O, Trojano M, Sorensen PS, et al. (2015). "The incidence and prevalence of psychiatric disorders in multiple sclerosis: a systematic review". Multiple Sclerosis Journal (Systematic Review). 21 (3): 305–17. doi:10.1177/1352458514564487. PMC 4429164. PMID 25583845.
  53. ^ Jump up to:a b Bienvenu, OJ; Ginsburg, GS (December 2007). "Prevention of anxiety disorders". International Review of Psychiatry. Abingdon, England. 19 (6): 647–54. doi:10.1080/09540260701797837. PMID 18092242. S2CID 95140.
  54. ^ Khoury B, Lecomte T, Fortin G, et al. (August 2013). "Mindfulness-based therapy: a comprehensive meta-analysis". Clinical Psychology Review. 33 (6): 763–71. doi:10.1016/j.cpr.2013.05.005. PMID 23796855.
  55. ^ Sharma M, Rush SE (July 2014). "Mindfulness-based stress reduction as a stress management intervention for healthy individuals: a systematic review". J Evid Based Complementary Altern Med. 19 (4): 271–86. doi:10.1177/2156587214543143. PMID 25053754.
  56. ^ Patel, G; Fancher, TL (3 December 2013). "In the clinic. Generalized anxiety disorder" (PDF). Annals of Internal Medicine. 159 (11): ITC6–1, ITC6–2, ITC6–3, ITC6–4, ITC6–5, ITC6–6, ITC6–7, ITC6–8, ITC6–9, ITC6–10, ITC6–11, quiz ITC6–12. doi:10.7326/0003-4819-159-11-201312030-01006. PMID 24297210. S2CID 42889106. Archived (PDF) from the original on 4 January 2015. currently there is no evidence on the effectiveness of preventive measures for GAD in adult
  57. ^ Moreno-Peral, P; Conejo-Cerón, S; Rubio-Valera, M; Fernández, A; Navas-Campaña, D; Rodríguez-Morejón, A; Motrico, E; Rigabert, A; Luna, JD; Martín-Pérez, C; Rodríguez-Bayón, A; Ballesta-Rodríguez, MI; Luciano, JV; Bellón, JÁ (1 October 2017). "Effectiveness of Psychological and/or Educational Interventions in the Prevention of Anxiety: A Systematic Review, Meta-analysis, and Meta-regression". JAMA Psychiatry. 74 (10): 1021–1029. doi:10.1001/jamapsychiatry.2017.2509. PMC 5710546. PMID 28877316.
  58. ^ Schmidt, Norman B.; Allan, Nicholas P.; Knapp, Ashley A.; Capron, Dan (2019). "8 - Targeting anxiety sensitivity as a prevention strategy". The Clinician's Guide to Anxiety Sensitivity Treatment and Assessment. Academic Press. pp. 145–178. ISBN 978-0-12-813495-5.
  59. ^ Jump up to:a b c d e f g Stein, MB; Sareen, J (19 November 2015). "Clinical Practice: Generalized Anxiety Disorder". The New England Journal of Medicine. 373 (21): 2059–68. doi:10.1056/nejmcp1502514. PMID 26580998.
  60. ^ Taylor, G.; McNeill, A.; Girling, A.; Farley, A.; Lindson-Hawley, N.; Aveyard, P. (13 February 2014). "Change in mental health after smoking cessation: systematic review and meta-analysis". BMJ. 348 (feb13 1): g1151. doi:10.1136/bmj.g1151. PMC 3923980. PMID 24524926.
  61. ^ Su, Kuan-Pin; Tseng, Ping-Tao; Lin, Pao-Yen; Okubo, Ryo; Chen, Tien-Yu; Chen, Yen-Wen; Matsuoka, Yutaka J. (2018). "Association of Use of Omega-3 Polyunsaturated Fatty Acids With Changes in Severity of Anxiety Symptoms". JAMA Network Open. 1 (5): e182327. doi:10.1001/jamanetworkopen.2018.2327. ISSN 2574-3805. PMC 6324500. PMID 30646157.
  62. ^ Cuijpers, P; Sijbrandij, M; Koole, S; Huibers, M; Berking, M; Andersson, G (March 2014). "Psychological treatment of generalized anxiety disorder: A meta-analysis". Clinical Psychology Review. 34 (2): 130–140. doi:10.1016/j.cpr.2014.01.002. PMID 24487344.
  63. ^ Otte, C (2011). "Cognitive behavioral therapy in anxiety disorders: current state of the evidence". Dialogues in Clinical Neuroscience. 13 (4): 413–21. doi:10.31887/DCNS.2011.13.4/cotte. PMC 3263389. PMID 22275847.
  64. ^ Pompoli, A; Furukawa, TA; Imai, H; Tajika, A; Efthimiou, O; Salanti, G (13 April 2016). "Psychological therapies for panic disorder with or without agoraphobia in adults: a network meta-analysis" (PDF). The Cochrane Database of Systematic Reviews. 4: CD011004. doi:10.1002/14651858.CD011004.pub2. PMC 7104662. PMID 27071857.
  65. ^ Jump up to:a b Olthuis, JV; Watt, MC; Bailey, K; Hayden, JA; Stewart, SH (12 March 2016). "Therapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults". The Cochrane Database of Systematic Reviews. 2016 (3): CD011565. doi:10.1002/14651858.cd011565.pub2. PMC 7077612. PMID 26968204.
  66. ^ E, Mayo-Wilson; P, Montgomery (9 September 2013). "Media-delivered Cognitive Behavioural Therapy and Behavioural Therapy (Self-Help) for Anxiety Disorders in Adults". The Cochrane Database of Systematic Reviews (9): CD005330. doi:10.1002/14651858.CD005330.pub4. PMID 24018460.
  67. ^ Roemer L, Williston SK, Eustis EH (November 2013). "Mindfulness and acceptance-based behavioral therapies for anxiety disorders". Curr Psychiatry Rep. 15 (11): 410. doi:10.1007/s11920-013-0410-3. PMID 24078067. S2CID 23278447.
  68. ^ Lang AJ (May 2013). "What mindfulness brings to psychotherapy for anxiety and depression". Depress Anxiety. 30 (5): 409–12. doi:10.1002/da.22081. PMID 23423991. S2CID 25705284.
  69. ^ Krisanaprakornkit, T; Krisanaprakornkit, W; Piyavhatkul, N; Laopaiboon, M (25 January 2006). "Meditation therapy for anxiety disorders". The Cochrane Database of Systematic Reviews (1): CD004998. doi:10.1002/14651858.CD004998.pub2. PMID 16437509.
  70. ^ Wu, Hui; Yu, Dehua; He, Yanling; Wang, Jijun; Xiao, Zeping; Li, Chunbo (19 February 2015). "Morita therapy for anxiety disorders in adults". Cochrane Database of Systematic Reviews(2): CD008619. doi:10.1002/14651858.CD008619.pub2. PMID 25695214.
  71. ^ Jump up to:a b Baldwin, David S; Anderson, Ian M; Nutt, David J; Allgulander, Christer; Bandelow, Borwin; Boer, Johan A den; Christmas, David M; Davies, Simon; Fineberg, Naomi (8 April 2014). "Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: A revision of the 2005 guidelines from the British Association for Psychopharmacology" (PDF). Journal of Psychopharmacology. 28 (5): 403–439. doi:10.1177/0269881114525674. PMID 24713617. S2CID 28893331.
  72. ^ Batelaan, Neeltje M; Bosman, Renske C; Muntingh, Anna; Scholten, Willemijn D; Huijbregts, Klaas M; van Balkom, Anton J L M (13 September 2017). "Risk of relapse after antidepressant discontinuation in anxiety disorders, obsessive-compulsive disorder, and post-traumatic stress disorder: systematic review and meta-analysis of relapse prevention trials". BMJ. 358: j3927. doi:10.1136/bmj.j3927. PMC 5596392. PMID 28903922.
  73. ^ Batelaan, NM; Bosman, RC; Muntingh, A; Scholten, WD; Huijbregts, KM; van Balkom, AJLM (13 September 2017). "Risk of relapse after antidepressant discontinuation in anxiety disorders, obsessive-compulsive disorder, and post-traumatic stress disorder: systematic review and meta-analysis of relapse prevention trials". BMJ (Clinical Research Ed.). 358: j3927. doi:10.1136/bmj.j3927. PMC 5596392. PMID 28903922.
  74. ^ Choy, Y; Fyer, AJ; Lipsitz, JD (April 2007). "Treatment of specific phobia in adults". Clinical Psychology Review. 27 (3): 266–86. doi:10.1016/j.cpr.2006.10.002. PMID 17112646.
  75. ^ Black, Nicola; Stockings, Emily; Campbell, Gabrielle; Tran, Lucy T; Zagic, Dino; Hall, Wayne D; Farrell, Michael; Degenhardt, Louisa (October 2019). "Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: a systematic review and meta-analysis". The Lancet Psychiatry. 6 (12): 995–1010. doi:10.1016/S2215-0366(19)30401-8. PMC 6949116. PMID 31672337.
  76. ^ Pittler MH, Ernst E (2003). Pittler MH (ed.). "Kava extract for treating anxiety". Cochrane Database of Systematic Reviews(1): CD003383. doi:10.1002/14651858.CD003383. PMC 6999799. PMID 12535473.
  77. ^ Witte S, Loew D, Gaus W (March 2005). "Meta-analysis of the efficacy of the acetonic kava-kava extract WS1490 in patients with non-psychotic anxiety disorders". Phytother Res. 19 (3): 183–188. doi:10.1002/ptr.1609. PMID 15934028. S2CID 39260703.
  78. ^ Jump up to:a b c Saeed, SA; Bloch, RM; Antonacci, DJ (15 August 2007). "Herbal and dietary supplements for treatment of anxiety disorders". American Family Physician. 76 (4): 549–56. PMID 17853630.
  79. ^ "What Is NeuroregulationTraining?". ISNR. 8 June 2019. Retrieved 16 November 2020.
  80. ^ Jump up to:a b c Wang, Zhen; Whiteside, Stephen P. H.; Sim, Leslie; Farah, Wigdan; Morrow, Allison S.; Alsawas, Mouaz; Barrionuevo, Patricia; Tello, Mouaffaa; Asi, Noor; Beuschel, Bradley; Daraz, Lubna; Almasri, Jehad; Zaiem, Feras; Larrea-Mantilla, Laura; Ponce, Oscar J.; LeBlanc, Annie; Prokop, Larry J.; Murad, Mohammad Hassan (31 August 2017). "Comparative Effectiveness and Safety of Cognitive Behavioral Therapy and Pharmacotherapy for Childhood Anxiety Disorders". JAMA Pediatrics. 171 (11): 1049–1056. doi:10.1001/jamapediatrics.2017.3036. PMC 5710373. PMID 28859190.
  81. ^ Jump up to:a b c Higa-McMillan, CK; Francis, SE; Rith-Najarian, L; Chorpita, BF (18 June 2015). "Evidence Base Update: 50 Years of Research on Treatment for Child and Adolescent Anxiety". Journal of Clinical Child and Adolescent Psychology. 45 (2): 91–113. doi:10.1080/15374416.2015.1046177. PMID 26087438.
  82. ^ James, Anthony C.; James, Georgina; Cowdrey, Felicity A.; Soler, Angela; Choke, Aislinn (18 February 2015). "Cognitive behavioural therapy for anxiety disorders in children and adolescents". The Cochrane Database of Systematic Reviews(2): CD004690. doi:10.1002/14651858.CD004690.pub4. ISSN 1469-493X. PMC 6491167. PMID 25692403.
  83. ^ Jump up to:a b Creswell, Cathy; Cruddace, Susan; Gerry, Stephen; Gitau, Rachel; McIntosh, Emma; Mollison, Jill; Murray, Lynne; Shafran, Rosamund; Stein, Alan (25 May 2015). "Treatment of childhood anxiety disorder in the context of maternal anxiety disorder: a randomised controlled trial and economic analysis". Health Technology Assessment. 19 (38): 1–184. doi:10.3310/hta19380. PMC 4781330. PMID 26004142.
  84. ^ Kozlowska K.; Hanney L. (1999). "Family assessment and intervention using an interactive are exercise". Australian and New Zealand Journal of Family Therapy. 20 (2): 61–69. doi:10.1002/j.1467-8438.1999.tb00358.x.
  85. ^ Bratton, S.C., & Ray, D. (2002). Humanistic play therapy. In D.J. Cain (Ed.), Humanistic psychotherapies: Handbook of research and practice (pp. 369-402). Washington, DC: American Psychological Association.
  86. ^ Jump up to:a b Vos, T; Flaxman, AD; Naghavi, M; Lozano, R; Michaud, C; Ezzati, M; Shibuya, K; Salomon, JA; Abdalla, S; et al. (15 December 2012). "Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010". Lancet. 380 (9859): 2163–96. doi:10.1016/S0140-6736(12)61729-2. PMC 6350784. PMID 23245607.
  87. ^ Jump up to:a b Simpson, Helen Blair, ed. (2010). Anxiety disorders : theory, research, and clinical perspectives (1. publ. ed.). Cambridge, UK: Cambridge University Press. p. 7. ISBN 978-0-521-51557-3. Archived from the original on 6 May 2016.
  88. ^ Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE (June 2005). "Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication". Arch. Gen. Psychiatry. 62 (6): 593–602. doi:10.1001/archpsyc.62.6.593. PMID 15939837.
  89. ^ Brockveld, Kelia C.; Perini, Sarah J.; Rapee, Ronald M. (2014). "6". In Hofmann, Stefan G.; DiBartolo, Patricia M. (eds.). Social Anxiety: Clinical, Developmental, and Social Perspectives (3 ed.). Elsevier. doi:10.1016/B978-0-12-394427-6.00006-6. ISBN 978-0-12-394427-6.
  90. ^ Hofmann, Stefan G.; Asnaani, Anu (December 2010). "Cultural Aspects in Social Anxiety and Social Anxiety Disorder". Depress Anxiety. 27 (12): 1117–1127. doi:10.1002/da.20759. PMC 3075954. PMID 21132847.
  91. ^ Fricchione, Gregory (12 August 2004). "Generalized Anxiety Disorder". New England Journal of Medicine. 351 (7): 675–682. doi:10.1056/NEJMcp022342. PMID 15306669.
  92. ^ Essau, Cecilia A. (2006). Child and Adolescent Psychopathology: Theoretical and Clinical Implications. Hove, East Sussex: Routledge. p. 79.
  93. ^ Jump up to:a b AnxietyBC (14 November 2014). "GENERALIZED ANXIETY". AnxietyBC. AnxietyBC. Archived from the originalon 12 June 2015. Retrieved 11 June 2015.
  94. ^ Merrill, Anna. "Anxiety and Autism Spectrum Disorders". Indiana Resource Center for Autism. Indiana Resource Center for Autism. Archived from the original on 11 June 2015. Retrieved 10 June 2015.
  95. ^ Guignard, Jacques-Henri; Jacquet, Anne-Yvonne; Lubart, Todd I. (2012). "Perfectionism and Anxiety: A Paradox in Intellectual Giftedness?". PLOS ONE. 7 (7): e41043. Bibcode:2012PLoSO...741043G. doi:10.1371/journal.pone.0041043. PMC 3408483. PMID 22859964.
  96. ^ Rapee, Ronald M.; Schniering, Carolyn A.; Hudson, Jennifer L. "Anxiety Disorders During Childhood and Adolescence: Origins and Treatment" (PDF). Annual Review of Clinical Psychology. Archived from the original (PDF) on 11 June 2015.

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아플레이아데스17수장들과 플레이아데스17수장들이 연합담합하여, 자행하는 지구인최초이자마지막으로서플레이아데스인이된자로서의박종권사태 및 부정정사 부정사음 부정정교 부정섹스 부정결혼 부정극상시리즈 부정최극상시리즈 사음사태(용골자리(龍骨-, Carina)사태와 유사한 사태이나 용골자리사태보다 더 심각한 재난을 초래할수 있는 영적범죄로 판단되었다)는 존재의 실존적실체의 근원적기반인 영적근원까지 구속억압제재하여 영적심장 영적의식까지 한손에 거머쥐고 영적근원노예를 만들려는 대단히 심각한 영적범죄이며, 은하계차원의 대대적인 문제확산시 전체 은하계시민의 영적노예화의 무서운 사태가 벌어질수 있으며 전체은하계시민의 안위와 존엄의 문제로서 절대로 방치되어서는 아니되며, 이와같은 사태를 유발시킨 중대책임이 플레이아데스와 아플레이아데스에 있으므로, 민타카 상오리온 연합원로원, 상은하계연합원로원, 상은하계제8대세력연합원로원에 부탁의뢰하여, 플레이아데스를 오리온에서 직접 무력공격하여, 이 문제의 근원을 파괴차단하며, 플레이아데스 특유의 재벌15세의식으로부터 유발된 극단적 차별감과 극단적 오만, 극단적교만, 극단적이기심, 극단적시기질투심, 극단적패권추구, 극단적패덕, 극단적패악, 극단적패악무도, 극단적패륜, 극단적영적범죄들에 대하여 강력하게 제재응징토록 지시명령처리기록되다. 제1우주 남플레이아데스에 만들어진 아플레이아데스전체를 무력공격하여 완전히 멸족파괴토록 지시명령처리기록되다. 제7우주 플레이아데스본성을 직접 무력공격하여, 이들이 가진 문제들을 완전히 파괴소멸시키며 두번 다시 이와같은 영적범죄와 극단적오만교만으로서 은하계전체를 오염시키는 작태를 자행치 못하도록 교훈을 주는 것으로서 지시명령처리기록되다. 플레이아데스본성중 한개의 행성을 선택하여 완전히 파괴시키고 두번 다시 사람이 살지 못하는 죽음의 행성으로 만드는 처벌을 가하도록 지시명령처리기록되다. 아울러서 아플레이아데스17수장들과 플레이아데스본성의 범죄자들이 개발한 부정정사 부정정교 부정사음 부정섹스 사술술수들 및 영적심장거머쥐기술수, 영적영뇌거머쥐기술수, 영적의식의노예화술수들의 원본원, 개발원근원지와 장비, 장치, 기술, 개발집단을 무력공격하여 완전히 파괴제거소멸시키도록 지시명령처리기록되다. 제1우주 아플레이아데스 남플레이아데스 본거지는 완전히 파괴멸족시키며 두번 다시 제1우주까지 내려와서 이와같은 영적범죄를 자행치 못하도록 완전히 파괴제거소멸시키도록 지시명령처리기록되다. 플레이아데스는, 전은하계를 지구차원으로 내려앉히려는 음모를 자행했으며, 오로지 지구차원에서만 가능한 섹스성차별 부귀빈천 부귀영화 부귀호사에 대한 차별과 관념의 현실화들 그리고 사랑연애섹스의 영적근원에 대한 차별과 억압제재를 통해서 상대적 쾌락과 상대적 완전만족즐김(나만 우리만 즐길권리를 가진다는 특권의식,영적오만)을 누리며, 지구차원의 일에 대해서는 잘 모르는 전체은하계시민들을 대상으로 하여 지구차원의 마력들과 매력들과 환각들을 악용하여, 그리고 영적으로 높은 등급을 가지는 희생자들을 악랄하고 악독하고 무서운 술수들을 총동원하여 영적성적섹스노예로 만들어 전면에 내세우는 술수로서 믿고 신뢰하게 만드는 교활하고 교묘하고 치밀한 술수를 병행하면서 영구적으로 이와같은 사기기망영적모독을 자행하고 영적노예화(이 부정정교 부정사음 부정정사 부정섹스 부정결혼 사음술에 걸리면, 아무리 높은 존재라고 해도, 졸지에 어둡고 아둔하고 무지한 지구차원으로 떨어져내려가며 종국에는 영겁의 세월동안 이 더럽고 추잡하고 사악한 무리들의 자지맛 보지맛에 걸려들어서 영원에 가까운 세월을 노예로서 종속굴종되는 문제를 초래할 것이다.)의 술수로서 속이고 기망하는 가운데, 패권을 잡고 군주로 군림하려는 교활하고 악독한 재벌15세적 음모를 치밀하고 교활하게 추진해왔다. 지구차원의 마력과 매력들로서 이에 대해서 잘 모르는 사람들을 유혹하여 끌어들이고, 섹스성연애사랑의 영적근원을 장악하여, 상대적차별심과 상대적우월감 상대적짜릿한영적오만과 교만으로서 만족케하며, 영겁의 세월에 걸쳐서 그와 같은 하등한 지구차원의 노예로서 살게 하며 그렇게 만드는 동시에, 외부에서 전은하계의 노예종속굴종화를 추구하며, 상급상위상천계로 잠입하여 동일한 악행을 자행하려는 무서운 음모를 수립했다. 지구차원의 비천한 재벌관념을 도입하고 이를 정당화하고 이를 통하여 교묘한 차별과 교묘한 상대적우월의식과 교묘한 상대적특권의식으로서 전은하계를 오염시키려 한 것은 플레이아데스놈들의 비천함이다. 이들에게 반드시 교훈을 주도록 지시명령처리기록되다. 아울러서 이들의 배후에 서 있는 안드로메다은하계, 라이라계에 대해서도 제재해야 할 것으로 판단되었다. Pleiades의 문제들은, 이 영역과 차원이 상당히 높은 영역, 차원이라는 점이며, 이 정도 되는 차원영역이라면, 우주원리나 우주법칙의 현현차원에서 굳이 어떤 반원리, 준원리적 실체들 혹은 어떤 지성적실체들이 존재치 아니하더라도, 우주원리차원과 법칙차원에서 일정기간 누군가가 현현하여 필요한 일을 할 것이라는 점이다. 안드로메다은하계와 라이라는, 이러한 우주원리와 법칙을 무시했으며, 그러한 계에 합치되는 합당한 등급지위서열 혹은 그러한 계에 해당되는 원리 법칙을 구현할수 있는 실체들로서의 플레이아데스를 만들지 아니하고 그러한 계에 불합치되고 그러한 계가 도대체 뭘 의미하는지조차도 모르는 재벌15세 비천한 무리들로 하여금 플레이아데스를 생성시킨 책임을 가진다. 물론, 우리가 보면 플레이아데스는 최소한 Jehovah등급이며, 그 이하가 될 경우는 플레이아데스가 아닌데, 다만, 아무리 여호와라고 해도 플레이아데스차원에 이르면 애가 되거나 짐승과 같은 존재 혹은 악마나 마귀같은 실체로 변형될수 있다는 점에서 그런 것이다. 하지만 이 플레이아데스차원이라는 것은, 우리가 여호와 Jehovah의 경우에서 볼수 있듯이, 만일 그들이 정상적인 진화의 코스를 밟아왔다면, 이미 제2우주에서 작별해야 했을 재벌15세관념을 여전히 가지고 있다는 중대문제를 초래한다. 이 재벌15세개념이란, 사실은, 제3우주(아틀란티스, 오베론, 영적쟁패투쟁의 영역)로 진입하는 단계가 되면, 영구작별해야 하는 제1우주, 제2우주차원의 하등한 관념들이다. 그러나 오늘날 보면 이상하게도 플레이아데스 제7우주에서 이 하등하기 이를데 없고 비천하기 이를데 없는 재벌15세개념을 보다 강화시키고 보다 즐기려 한다. 이는 안드로메다은하계의 근본문제들이며, 라이라곤충족의 근본문제들이다 플레이아데스등급이 되려면, 사실상 이 재벌관념은 아주 아주 오래전에 졸업한 상태여야 한다. 플레이아데스레벨에서의 재벌개념이란, 실제로는 먹고 사는 기본문제는 배제되어야 하며, 그것과는 다른 고차원적인 다른 문제로서의 재벌개념이 되어야 하는 것이다. 그러나 이들이 가장 기본적인 성섹스연애사랑문제와 먹고사는 문제를 근본근원차원에서 붙들고 늘어지며, 추태를 부리고 과도한 영적오만과 교만을 부려대고 있다. 성섹스연애사랑도 마찬가지다. 이 문제는 기본적인권리로서 주어진 천상의 계율이다. 아무리 못난 놈이라고 해도 기본적으로 주어진 것들이고, 만일 그렇게 할만한 이유가 없다면 누구든 보장되어야 한다. 여기서 말하는 것은 기본으로서의 권리를 말한다. 하지만 플레이아데스는 이 기본권리마저 인정하지 않으며, 이 기본권리 자체를 미끼로 해서, 실체들의 영적근원까지 통제지배하려는 야욕을 가진다. 이는, 이들이 그러한 영역 차원에서 살기에는 매우 부적합한 자들이라는 증거들이다. 또한 이들은, 기본적으로는 그 단계까지 오면, 그 자신만의 무언가를 가져야 한다. 그리고 남의 것으로서 무언가를 하려고 하는 의도 자체를 가지지 않아야 한다. 그러나 이들을 보면, 거의100% 남의 것으로만 하려고 하고, 자신의 행위에 대해서 책임을 지려하지 아니하며, 자신이 즐기거나 행한 일의 결과를 하위종족 혹은 무력하고 아는 것 없고 무지하고 힘없는 존재들에게 떠넘기며, 특정부분에서 능력과 자질이 우수한 자들을 시기질투하여 이용의 대상으로 삼고, 노예화하며 굴종굴속시키는 가운데, 그러한 자가 죽기로서 한 일들의 결과를 제 놈이 한 것으로 능수능란하게 위조하여 제것으로 만드는 파렴치한 짓을 하는 것이다. 그리고는 어마어마한 (영적인 혹은 보다 고차원적인 의미로서의)부귀사치 부귀호화 부귀쾌락 섹스쾌락열락과 최상위최극상고급보지를 즐기는 대가를 가로챈다. 게다가 최극상고급보지들의 사랑을 독점하고 그렇게 할만한 자격이 없는데도 그렇게 하고 큰소리를 치는 추태를 만발한다. 그리고 그렇게 하기 위해서 심지어는 영적근원 영적심장 영적의식까지 잡아채고 노예화하고 굴종시키려 하는 악랄함을 보이는 것이다. 이들의 극단적 영적교만과 오만 우월감은 끝이 없는데, 이는 그러한 위치로 오기에는 매우 부적합한 자들이 벼락출세를 하고 벼락부자가 되어 미친놈처럼 지랄거리며 오만무도하게 자행하는 짓과 다를바가 없다. 이러한 패악무도 패덕 패륜 패악함의 실체들로서의 플레이아데스에 무거운 처벌을 가하고 무서운 교훈을 주어야 한다로서 지시명령처리기록되다. 무르데크연합원로원, 말데크연합원로원 상은하계연합원로원 상은하계제8대세력종족연합원로원 민타카연합원로원 창조의 원리 현상계의 창조 엘리멘탈우주(법칙과 원리의 우주들) 아수라스우주/데바스의 우주(天神들과 아수라 惡魔의 宇宙) 원시우주 : 반원리, 준원리로서의 사전예행연습들(이건희,이재용부류로서의 반원리들) 제1우주 : 기본개념확립/ 예로서 재벌개념, 차별개념/사람의 길에 대한 이해의 시작 제2우주 : 영적실체로서의 개념확립/휴머니즘에 대한 이해/영적원리들에 대한 이해 제3우주 : 영적인 투쟁, 영적인 승리/영적인이기심의 극복단계/난경속에서의 쟁패와 투쟁 제4우주 : 신적인 투쟁, 신들의 세계에서의 승리와 영광들 제5우주 : 지나간 과거의 회상, 나와의 투쟁, 나와의 싸움들 제6우주 : 우주신으로의 도약단계와 제1과정의 완성단계(하위우주) 제7우주 : 새로운 도전, 중위우주로의 진입을 위한 준비단계/상위사람으로서의 새로운 시작 제8우주 : 제9우주: 제10우주: 제11우주: 제12우주: 중위우주의 시작(안드로메다은하계등급)인간의 길에 대한 이해의 시작 플레이아데스차원과 인간차원의 차이점중 하나는, 시공간개념과 그에 따른 의식과 감정정서영적인각성측면들에 대한 차이들이다. 플레이아데스차원에서는, 시공간개념이 다른데, 만일 인간차원에서 본다면 영원의 시간으로 느껴질 머나먼 과거의 일들이 플레이아데스에서는 바로 어제의 일로서 감각되는 것이다. 인간의 차원에서는, 너무도 멀고도 먼 과거의 일들, 아득한 과거에서 일어난 동경속의 세계의 일들이 플레이아데스에서는 현실로서 바로 옆에서 느껴지는 것이다. 영국왕이된 이건희 미국대통령에당선된이건희

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 아플레이아데스17수장들과 플레이아데스17수장들이 연합담합하여, 자행하는 지구인최초이자마지막으로서플레이아데스인이된자로서의박종권사태 및 부정정사 부정사음 부정정교 부정섹스 부정결혼 부정극상시리즈 부정최극상시리즈 사음사태(용골자리(龍骨-, Carina)사태와 유사한 사태이나 용골자리사태보다 더 심각한 재난을 초래할수 있는 영적범죄로 판단되었다)는 존재의 실존적실체의 근원적기반인 영적근원까지 구속억압제재하여 영적심장 영적의식까지 한손에 거머쥐고 영적근원노예를 만들려는 대단히 심각한 영적범죄이며, 은하계차원의 대대적인 문제확산시 전체 은하계시민의 영적노예화의 무서운 사태가 벌어질수 있으며 전체은하계시민의 안위와 존엄의 문제로서 절대로 방치되어서는 아니되며, 이와같은 사태를 유발시킨 중대책임이 플레이아데스와 아플레이아데스에 있으므로, 민타카 상오리온 연합원로원, 상은하계연합원로원, 상은하계제8대세력연합원로원에 부탁의뢰하여, 플레이아데스를 오리온에서 직접 무력공격하여, 이 문제의 근원을 파괴차단하며, 플레이아데스 특유의 재벌15세의식으로부터 유발된 극단적 차별감과 극단적 오만, 극단적교만, 극단적이기심, 극단적시기질투심, 극단적패권추구, 극단적패덕, 극단적패악, 극단적패악무도, 극단적패륜, 극단적영적범죄들에 대하여 강력하게 제재응징토록 지시명령처리기록되다. 제1우주 남플레이아데스에 만들어진 아플레이아데스전체를 무력공격하여 완전히 멸족파괴토록 지시명령처리기록되다. 제7우주 플레이아데스본성을 직접 무력공격하여, 이들이 가진 문제들을 완전히 파괴소멸시키며 두번 다시 이와같은 영적범죄와 극단적오만교만으로서 은하계전체를 오염시키는 작태를 자행치 못하도록 교훈을 주는 것으로서 지시명령처리기록되다. 플레이아데스본성중 한개의 행성을 선택하여 완전히 파괴시키고 두번 다시 사람이 살지 못하는 죽음의 행성으로 만드는 처벌을 가하도록 지시명령처리기록되다. 아울러서 아플레이아데스17수장들과 플레이아데스본성의 범죄자들이 개발한 부정정사 부정정교 부정사음 부정섹스 사술술수들 및 영적심장거머...
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drawatheLee Kun-hee李健熙1942年1月9日－2020年10月25日三星创始人李秉喆三子三星集团第二任会长authorityhypostasisanatomy drawatheLee Kun-hee李健熙1942年1月9日－2020年10月25日三星创始人李秉喆三子三星集团第二任会长authorityhypostasisanatomy drawatheLee Kun-hee-ive李健熙-ive1942年1月9日－2020年10月25日-ive三星创始人李秉喆三子三星集团第二任会长authorityhypostasisanatomy drawatheLee Kun-hee-ic李健熙-ic1942年1月9日－2020年10月25日三星创始人李秉喆三子三星集团第二任会长-icauthorityhypostasisanatomy drawathe지구인박진영地球人朴辰英박진영개종족朴辰英authorityhypostasisanatomy drawathe지구인地球人박진호朴辰晧quasi-reptilaquasithedevil박진호authorityhypostasisanatomy drawatheLee Kun-hee-ical李健熙-ical1942年1月9日－2020年10月25日三星创始人李秉喆三子三星集团第二任会-ical长authorityhypostasisanatomy drawatheThe Atlantid race or North-Atlantidauthorityhypostasisanatomy drawatheScythiaScythicaPontic Scythiaauthorityhypostasisanatomy drawatheTheCaucasianracealsoCaucasoidorEuropidEuropoidauthorityhypostasisanatomy drawathe李健熙이건희1942年1月9日－2020年10月25日三星创始人李秉喆三子三星集团第二任会长projectauthorityhypostasisanatomy drawatheTheSevenSistersMessier45authorityhypostasisanatomy drawatheLyralyreλύραauthorityhypostasisanatomy drawathe니비루(Nibiru)authorityhypostasisanatomy drawathe第2次銀河大戰委員會委員長authorityhypostasisanatomy drawathePhaetonPhaethonPhaëtonMaldekauthorityhypostasisanatomy drawathe地球人박종권朴鐘權6301281067814박종권authorityhypostasisanatomy 李 健煕（イ・ゴンヒ、韓国語：이건희、1942年1月9日 - 2020年10月25日 ）は、大韓民国の実業家。サムスン電子の元会長。 大戰 일본식 표현(자본주의국가) - 민간기업가로서 소개하였다. 일반민간인,사업가 수준의 표현 李健熙（韩语：이건희／李健煕 I Geon-hui；1942年1月9日－2020年10月25日），韓國企业家，三星创始人李秉喆三子，三星集团第二任会长[2]:22-23 集团军群[註 1]是由若干个军團组成的单位，一个集团军群通常包括40万到100万士兵，集团军群的指挥官通常由大将或元帅担任 An army group is a military organization consisting of several field armies, which is self-sufficient for indefinite periods. It is usually responsible for a particular geographic area. 집단군(集團軍, 영어: Army group)또는 군집단(軍集團)은 다수의 야전군으로 구성되어 무기한으로 자급자족이 가능한 군사 조직의 부대 단위이다. 지금까지 제2차 세계 대전 중 주요 국가만이 운용한 경험이 있다. NATO의 두 집단군 편제는 북부집단군(NORTHAG)과 중앙집단군(CENTAG)이 있다 집단군은 보통 특정 지리적 전쟁 지역을 책임지고 있다. 집단군은 단일 지휘관 - 보통 원수 또는 대장 - 이 지휘하는 가장 큰 야전 조직으로, 일반적으로 400,000명에서 1,500,000명으로 이루어져 있다. 또한 이 집단군은 하나의 국가가 갖는 총 병력과 맞먹는 규모이기도 하다. 소비에트 붉은 군대와 공산주의 폴란드군의 집단군은 전선군(Front), 일본 제국 육군은 총군(일본어: 総軍そうぐん 소군[*]), 영어: General Army)이었다. 집단군은 다국적 군대의 편제로 구성될 수도 있다. 예를 들면, 제2차 세계 대전 기간 동안, 미국 제6집단군은 미국 제7군단과 프랑스 제1군단으로 구성되었고, 영국 제21집단군은 영국 제2군단, 캐나다 제1군단 그리고 미국 제9군단으로 구성되었다. 중국식표현(공산사회주의국가) 집단군 총사령관 표현, 민간기업체가 군대에 대한 표현법, 회사가 민간자유시장경제에 의한 민간기업이 아니라, 군대방식의 총지휘자에 의하여 주도되는 군대방식의 명령,지휘,통제체제로서의 군규율체제하의 조직인 것처럼 표현. 군조직은 상명하복(군조직,검경조직), 명령에 죽고 명령에 살지만, 민간기업은 그렇지 않다. 공산사회주의에서는 이러한 용어는 적합하지 않다. 협동농장, 협동회사식의 표현이 적합하다. 표현방법을 바꾸도록 지시명령처리기록되다. 아버지박원규를 파문처리토록 지시명령처리기록되다. 아울러서, 반평생동안 아버지 박원규와 함께 하면서 아버지 역할까지 하며 박종권이를 학대탄압하고 가져야 할 것들을 모조리 탈취도적질한 이건희를 동시 파문토록 지시명령처리기록되다. 이건희는 항상 반드시 언제나 박종권이가 사는 집 위에 또 하나의 집을 짓고, 그 아들 이재용이를 박종권이로 이중영체,이중환전생등을 통하여 만들어놓고, 이중다중적관계를 유지하면서, 박원규와 협조하여, 증평이후부터는 아버지역할을 대행하는등 아버지가 아닌 도적놈으로서 아버지역할을 하였으며, 아버지박원규는, 아버지임에도 불구하고, 아버지로서의 의무와 책임 그리고 믿음과 신의를 배반하고 이건희가 하자는 대로 행하며, 고돌궐 부수장직을 맡으며, 박종권이를 이용의 대상으로 삼은 것은 있을수 없는 부도덕하고 파렴치한 처사이므로, 당연파문토록 지시명령처리기록되다. 이로서 부자관계가 완전히 해제되는 것으로서 지시명령처리기록되다. 안드로메다은하계연합원로원 지시명령서제10호 안드로메다은하계와 준동급의 타계 지시명령서 제2호 Lyra연합원로원, Vega연합원로원, Pleiades연방원로원, 과거Pleiades연합원로원, 제2차은하대전연합원로원, 제2차은하대전가오리종족원로원, 제2차은하대전돌핀돌고래종족원로원, 제1차은하대전연합원로원, 성단Pleiades연합원로원, Atlantis연합원로원, 상Atlantis연합원로원, Vega-Atlantis연합원로원, 성단Pleiades-Atlantis연합원로원, 상천연합원로원, 지구태양계영단원로원, 토성연합재판부원로원, 경고 하나같이 지구인박종권이자, AD2015년 PLEIADES인으로서 정식인증된 박종권이로 위위형, 위변형, 위모조, FALSE INJECTION되어진 NIBIRU인들(안드로메다은하계곤충종족수장놈 냉기치와 제2차은하대전위원장 냉기치놈이 MALDEK파괴를 위해서 만든 플레이아데스집단체, 수십억 플레이아데스인들을 한사람으로 만들어서 대단히 커다란 대원신체, 대공격체를 만드는데, 지구인삼성이재용이 놈을 이용해서 박종권이를 거의 대부분 잡아 처 먹고, 박종권 소유능력,실력,잠재력등 모든 것들을 전부 잡아 처 먹은후, 7번에 걸쳐서 대우주주기를 살고 거의 완벽하게 박종권이로 위변신한 아루쓰, 프타, 미마쓰, 오자와 및 플레이아데스1대조사,2대조사(이재용),3대조사,4대조사등과 이들로부터 데이터를 전달받은 라이라최고주신놈과 제2차은하대전계장군놈들이 안드로메다은하계와 안드로메다은하계배후지원단으로부터 기술지원을 받고, 일거에 MALDEK를 내파 파멸시키기 위하여 현재 여기에 있는 박종권이를 이재용이 놈의 아종으로 격하시켜놓고, 은밀하게 공격준비를 하며, 지구인으로도 위위형되어 들어가 있는 MALDEK전체를 노리고 있다. 경고)이 거대한 전투체를 만들고 라이라 최고주신놈과 연합한 제2차은하대전위원장 냉기치놈이 안드로메다은하계배후지원단 놈들로부터 지원된 최고도의 최강의 무기로 무장하고, 박종권이를 이재용이 놈의 아종으로 격하시켜 놓고 완전히 잡아 처 먹은 상태에서, MALDEK, MURDEK파멸파괴를 위한 공격준비를 하고 있으므로 대단히 주의를 요하는 것으로 경고지시명령처리기록되다. 현재 라이라최고주신놈이, 지구인으로 위위형된 MALDEK수장체를 치려고 안간힘을 쓰고 있는 광경이 목격되고, 아주 거대한 이재용이 형상을 한 니비루 놈 한놈이 나타나는데, 이 새끼 체구가 얼마나 큰지, 게자리성운의 약 1/20을 차지할 정도로 거대함이 목격관찰되다. 말데크 경고, 무르데크 경고 최고도의 경계상태를 유지하며, 역공태세로 들어가서 일전을 벌린 준비를 갖추는데, 먼저 라이라 놈들을 제압시켜야 할 것으로 판단 지시명령처리기록되다. 이들이 과거에 우리가 말데크와 일전을 벌릴때 썼던 기술들을 마구잡이로 빼앗고 그 기술과 전략으로서 말데크를 공격하여 파멸시키려 할 것으로 반드시 예측되므로, 박종권이의 내면기술 노우하우에 대한 최대의 경계방어가 요구되는 것으로서 지시명령처리기록되다. 항성군대장과 대항성군단은 최고도의 전투태세를 유지하고, 먼저 라이라성단계를 공격하여 라이라를 괴멸시키도록 지시명령처리기록되다. 이 작전명령서는 이재용이 놈에게 살인당한 박종권이가 작성하였으나, 이 개새끼가 이미 지구인박종권을 살인하여 그 전체를 차지하고 무엇을 하든 제 놈이 한 것으로 표현되도록 만들고(라이라최고주신놈이 살인하여 죽이다) 있으므로 상관하지 말고 참조토록 지시명령처리기록되다. MURDEK연합원로원 제출 MALDEK연합원로원 제출 작전지시명령서 제1호

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 drawatheLee Kun-hee李健熙1942年1月9日－2020年10月25日三星创始人李秉喆三子三星集团第二任会长authorityhypostasisanatomy drawatheLee Kun-hee李健熙1942年1月9日－2020年10月25日三星创始人李秉喆三子三星集团第二任会长authorityhypostasisanatomy drawatheLee Kun-hee-ive李健熙-ive1942年1月9日－2020年10月25日-ive三星创始人李秉喆三子三星集团第二任会长authorityhypostasisanatomy drawatheLee Kun-hee-ic李健熙-ic1942年1月9日－2020年10月25日三星创始人李秉喆三子三星集团第二任会长-icauthorityhypostasisanatomy drawathe지구인박진영地球人朴辰英박진영개종족朴辰英authorityhypostasisanatomy drawathe지구인地球人박진호朴辰晧quasi-reptilaquasithedevil박진호authorityhypostasisanatomy drawatheLee Kun-hee-ical李健熙-ical1942年1月9日－2020年10月25日三星创始人李秉喆三子三星集团第二任会-ical长authorityhypostasisanatomy drawatheThe Atlantid race or North-Atlantidauthorityhypostasisanatomy drawatheScythiaScythicaPontic Scythiaauthorityhypostasisanatomy drawatheTheCaucasianracealsoCaucasoidorEuropidEuropoidauthorityhypostasisanatomy  drawathe李健熙이건희1942年1月9日－2020年10月25日三星创始人李秉喆三子三星集团第二任会长projectauthorityhypostasisanatomy drawatheTheSevenSistersMessier45authorityhypostasisanatomy drawatheLyraly...
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