ABC of mental health: Anxiety

Introduction

Anxiety is an unpleasant emotional state characterised by fearfulness and unwanted and distressing physical symptoms. It is a normal and appropriate response to stress but becomes pathological when it is disproportionate to the severity of the stress, continues after the stressor has gone, or occurs in the absence of any external stressor. Neurotic disorders with anxiety as a prominent symptom are common: a recent British survey found that 16% of the population suffered from some form of pathological anxiety.

Anxiety disorders should be differentiated from stress reactions, in which anxiety may be a prominent feature. These include acute stress reactions–a rapid response (in minutes or hours) to sudden stressful life events, leading to anxiety with autonomic arousal and some disorientation–and adjustment reactions–slower responses to life events (such as loss of job, moving house, or divorce) that occur days or weeks later as symptoms of anxiety, irritability, and depression (without biological symptoms). These are generally self limiting and are helped by reassurance, ventilation, and problem solving. A more profound stress reaction, post-traumatic stress disorder, is described below.

Until recently, the commonest response to a presentation of anxiety has been to prescribe a benzodiazepine. This has been much criticised and alternatives have been evaluated, including almost all the available antidepressants and psychological treatments, especially cognitive behaviour therapy. For most general practitioners, constraints on resources are likely to mean that drugs remain the mainstay of treatment.