Online degree, part 22. Prevalence of Anxiety and Comorbid Conditions.

Prevalence rates of anxiety in community samples are difficult to estimate, especially given the fact that internalizing disorders, such as anxiety, are often difficult to observe and identify. Prevalence estimates for clinical levels of anxiety in children, young and middle-age adults, and older adults range from 5% to 19%, 6% to 8%, and 9% to 11%, respectively. In general, the prevalence of anxiety disorders has been found to increase with age in the child and adolescent population, decline during the young and middle-age adult years, and slightly increase in the older adult years. Gender differences have also been found in the literature. Specifically, females typically report more anxiety symptoms than do males. However, it remains unknown at the present time whether this gender difference is due to females actually experiencing more anxiety symptoms than males or whether females are simply better able to recognize and report their symptoms of anxiety than are males. On the other hand, overall, more females than males are believed to suffer from an anxiety disorder. However, the gender ratios differ based on the type of anxiety disorder diagnosed and the age of the individual. Despite this variability and the need for further research with regard to prevalence rates among different ages and genders, it is clear that anxiety continues to be a major problem for individuals of all ages and one that can potentially lead to significant difficulties within multiple domains of functioning.
Anxiety disorders have high rates of comorbidity with other disorders. The rate of comorbidity between anxiety and depressive disorders may be as high as 55% to 65%. Speculation as to why these rates are so high is that both anxiety and depression share a similar trait known as negative affectivity, or emotional distress. Negative affectivity includes such affective states as worry, self-dissatisfaction, and sadness. High comorbidity rates may also be due to a sequential link between anxiety and depression, with anxiety serving as an early precursor to a depressive disorder. Comorbidity rates are also high between different types of anxiety disorders. It is not uncommon for an individual who has one anxiety disorder to be diagnosed with another anxiety disorder. Other common comorbid conditions include substance use disorders and disruptive behavior disorders, such as attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder.

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From a trait model perspective, anxiety is viewed as a stable personality characteristic. Without treatment, anxiety disorders may persist. Approximately 45% to 65% of individuals diagnosed with an anxiety disorder do not show remission of symptoms. However, approximately 35% to 55% of individuals do show remission, but many who show remission develop other disorders, especially other anxiety disorders. Anxiety disorders interfere with the social and emotional well-being of individuals. If individuals are still in school, academic development may be impaired. For adults, work productivity may decline and unemployment may increase.
Developmental Precursors or Etiological Factors
Different theories exist about the development of an anxiety disorder. The three most popular models used to explain the development of an anxiety disorder are the biological, behavioral, and cognitive models. Biological explanations of anxiety focus on genetics, neurotransmitters, differences in structural regions of the brain, abnormalities in the immune system, and behavioral inhibition. Genetics is believed to play a role in the development of an anxiety disorder. Genetic influences account for approximately 30% to 35% of the variance in anxiety in most cases, suggesting that anxiety is moderately inheritable. The neuro-transmitter gamma aminobutyric acid (GABA) has received some attention as a possible risk factor in the-development of an anxiety disorder. GABA may increase excitatory responses to real or perceived threats, or it may fail to send messages to inhibit these responses. Perturbations in the hypothalamic-pituitary-adrenal axis indicate structural brain differences in individuals with an anxiety disorder. Behavioral inhibition may be another possible etiological factor. Behavioral inhibition characterizes a child's temperament. Children with this type of temperament are shy and exhibit inhibited behaviors in response to novel stimuli. These individuals are also highly physiologically reactive to such stimuli.

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Behavioral explanations for the development of an anxiety disorder focus on learned behaviors. According to behaviorists, anxiety is a learned behavior that is acquired and maintained through a combination of classical and operant conditioning, operant conditioning alone, or modeling. From a classical and operant conditioning perspective, anxiety problems result when a neutral stimulus, such as a large dog, is paired repeatedly with an aversive stimulus (i.e., an unconditioned stimulus), such as a loud noise, to produce an unconditioned response, such as a startled reaction. Through repeated pairings with the unconditioned stimulus, the neutral stimulus becomes a conditioned stimulus, and this conditioned stimulus will produce a conditioned response. In other words, the presence of a large dog will result in a startled response without the loud noise being present on a regular basis. The conditioned stimulus (i.e., a large dog) will then be avoided, and by avoiding the conditioned stimulus, an individual's anxiety is reduced. The avoidance behavior demonstrated by the individual in response to the large dog is an example of operant conditioning. In operant conditioning, the stimulus, task, or situation feared is maintained by a negative reinforcement con-tingency. The feared stimulus, task, or situation is avoided, and the avoidant behavior is maintained because it reduces the individual's anxiety. In modeling, the individual observes the behavior of significant others in response to aversive stimuli, tasks, or situations. When significant others exhibit avoidance behavior and anxiety in response to aversive stimuli, the individual learns to model these behaviors. Exposure to similar aversive stimuli, tasks, or situations will produce similar behaviors.
The cognitive approach to anxiety disorders assumes that distorted cognitions are responsible for symptom manifestation. According to cognitive psychologists, individuals who have an anxiety disorder or experience high levels of anxiety exhibit threat-related attentional and interpretative biases. These individuals attend to threat-related stimuli, and they interpret ambiguous or neutral stimuli as threatening.

EDITOR Neil J. Salkind
Copyright © 2008 by SAGE Publications, Inc.