Psychiatry: disorder groups
Anxiety disorders
Anxiety disorders involve fear or worry that is excessive, persistent and disabling, such as generalised anxiety, panic attacks, phobias and social anxiety. Psychiatrists diagnose them, rule out physical causes and treat them with psychological therapy and medication.
Depth by stage, Pre-U → Consultant (details)
What is it?
Everyone feels anxious sometimes. An anxiety disorder is diagnosed when fear or worry is out of proportion, lasts for months, and stops someone living normally — for example avoiding lectures because of panic attacks, or worrying so constantly about many things that sleep and concentration suffer.
The main conditions are generalised anxiety disorder, panic disorder, agoraphobia, social anxiety disorder, specific phobias and separation anxiety disorder. They often begin in childhood or young adulthood and frequently occur together with depression.
Anxiety disorders respond well to treatment, especially cognitive behavioural therapy, and to certain medicines. Many people never seek help because they think it is just their personality.
Why does a psychiatrist need it?
Anxiety is among the most common reasons people see any doctor, often presenting with palpitations, breathlessness or stomach complaints. Psychiatrists need to recognise it, exclude heart, thyroid and other causes, avoid long-term benzodiazepine dependence, and deliver or supervise exposure-based therapies.
What level is expected at each stage?
Scale: 1. Aware → 2. Understands → 3. Applies → 4. Masters / Teaches. What the levels mean.
- Pre-UNot expected
- Pre-clinicalAwareLearns the physiology of the stress response and learning theory behind fears and phobias.
- ClinicalUnderstandsRecognises panic and generalised anxiety in a history and knows CBT and SSRIs as main treatments.
- HousemanshipUnderstandsDistinguishes panic attacks from cardiac or respiratory emergencies in casualty and wards.
- Medical officerAppliesDiagnoses and manages common anxiety disorders, prescribes safely and refers for psychological therapy.
- Psych traineeMasters / TeachesManages comorbid and resistant cases, delivers basic CBT under supervision; examined in all parts.
- Specialist / consultantMasters / TeachesSupervises therapy, leads pathways and handles complex comorbidity.
What are the key topics?
Conditions
- Generalised anxiety disorder
- Panic disorder
- Agoraphobia
- Social anxiety disorder
- Specific phobias (e.g. blood-injection-injury, heights, animals)
- Separation anxiety disorder and selective mutism
- Anxiety due to substances (caffeine, stimulants, withdrawal) or medical conditions
Causes and mechanisms
- Fight-or-flight physiology: sympathetic nervous system, adrenaline, HPA axis
- Amygdala and fear circuits
- Learning theory: classical conditioning and avoidance maintaining fear
- Cognitive models: catastrophic misinterpretation in panic, intolerance of uncertainty in worry
- Temperament (behavioural inhibition), family patterns, life stress
Assessment
- Detailed history of triggers, avoidance and impact
- Screening tools such as GAD-7; other scales such as HAM-A
- Physical causes: hyperthyroidism, arrhythmias, asthma, hypoglycaemia, phaeochromocytoma (rare)
- Substance use, including caffeine and alcohol
- Comorbid depression and suicide risk
Treatment
- Psychoeducation and self-help
- CBT including exposure, cognitive restructuring and applied relaxation
- SSRIs and SNRIs as first-line medicines; pregabalin in some guidelines for GAD
- Short-term role and dependence risk of benzodiazepines
- Beta-blockers for physical symptoms of performance anxiety
How is it learned and assessed?
- Pre-clinical physiology and behavioural science
- Undergraduate psychiatry and family medicine postings
- MO clinics; MMed Part I (psychology, learning theory) and Part II
- MRCPsych Paper A (learning theory, psychology), Paper B, CASC stations (e.g. panic disorder history, explaining CBT)
Typical textbooks and resources
- Shorter Oxford Textbook of Psychiatry — Oxford University Press
- Cognitive Behaviour Therapy for Psychiatric Problems — Hawton, Salkovskis, Kirk & Clark (eds), Oxford University Press
- The Maudsley Prescribing Guidelines in Psychiatry — Wiley
- NICE guidance on generalised anxiety disorder and panic disorder — NICE (UK)
Titles are widely used examples; editions change. Use university libraries or legitimate purchases.
Common questions
When does normal anxiety become a disorder?
When it is out of proportion to the situation, lasts a long time (often six months or more for generalised anxiety) and interferes with study, work, relationships or daily life.
Are anxiety disorders treatable without medication?
Yes. Cognitive behavioural therapy is effective for most anxiety disorders and is often the first choice. Medication is added when anxiety is severe, therapy is unavailable, or the person prefers it.