Which of the Following is Not an Anxiety Disorder

xi.2.2

Comorbidity between SUD and anxiety disorders

Anxiety disorders are amid the most common psychiatric disorders in the general population, affecting up to 20% of adolescents. Anxiety disorders tend to be more common among females than males (Essau, Lewinsohn, Olaya, & Seeley, 2014). Adolescents meeting the criteria of feet disorders have been described as generally withdrawn, fearful of situations or objects, afraid of being in a social situation, and are inhibited (APA, 2013
). In DSM-5, there have been some changes in the
classification of anxiety disorders. Obsessive-compulsive disorder (included in the obsessive-compulsive and related disorders), acute stress disorder, and posttraumatic stress disorder (included in the trauma and stress-related disorders) are no longer considered anxiety disorders in DSM-v. Anxiety disorders which normally occur in adolescents include social phobia (i.eastward., an irrational fear of being judged in social situations), specific phobia (i.east., a fearfulness of specific objects or situations), generalized anxiety disorder (i.e., excessive and uncontrollable worry most life events), and panic disorder (i.e., discrete fear attacks that are associated with cognitive and physical symptoms).

Of all the feet disorders, social feet disorder is the one that most commonly co-occurs with AUD, with about 13% of those with social feet disorder having AUD (Buckner, Heimberg, Ecker, & Vinci, 2013;
Schneier et al., 2010). Information technology is estimated that eighty% of the comorbid cases had social feet disorder earlier AUD; the presence of social anxiety disorder at baseline is associated with four times the odds of having AUD at follow-up (Schneier et al., 2010). Some authors consider drug consumption equally a “means to an cease” (Bulley, Miloyan, Brilot, Gullo, & Suddendorf, 2016, p. 64) such as managing a social state of affairs. Indeed, one of the motivations to drink among individuals with social anxiety disorder is to provide relief or to reduce tension that arises in social situations and to facilitate social interactions. For instance, a study past
Battista, MacDonald, and Stewart (2012)
showed that participants with social anxiety disorder spoke longer with an interaction partner after drinking alcohol; the interaction partner as well showed more positive social behavior to participants with social anxiety disorder who drank alcohol compared to those who consumed a nonalcoholic beverage.

Well-nigh of the studies in comorbidity betwixt SUD and anxiety disorders were conducted in Western countries. These findings, while informative, may not exist generalizable to adolescents in non-Western countries. To make up this gap,
Stapinski, Montgomery, and Araya (2016)
conducted a written report among adolescents in Chile to examine the extent to which low, generalized anxiety, social anxiety, and panic symptoms independently predict new cases of cannabis use as well as to predict the frequency of use 18 months after. The findings showed a high comorbidity among the various types of substances such as between cannabis, tobacco, and alcohol utilise frequency. After adjusting for the employ of cannabis at baseline, generalized feet, panic, and depressive symptoms were associated with a college frequency of cannabis use 18 months afterward. However, afterward because all predictors simultaneously, merely generalized anxiety symptoms were independently associated with the frequency of subsequent cannabis use. Their finding also showed that amongst adolescents with high levels of generalized anxiety symptoms, the predicted probability of occasional and recurrent cannabis apply was 39.8% and 5.ix%, respectively. Among adolescents with depression levels of generalized anxiety symptoms, the predicted probability of occasional and recurrent cannabis use was 21.one% and 1.vi%, respectively. These findings were interpreted as supporting the internalizing pathway to substance use (Hussong, Jones, Stein, Baucom, & Boeding, 2011) in that adolescents with generalized anxiety, panic, and depression tend to use cannabis to cope with negative affects and tension and anxiety symptoms.

Nomenclature of Anxiety Disorders

Diagnosis

Anxiety disorders take been plant to cooccur at highly variable rates, xi–84%, with ASD individuals (White et al., 2009). This variability may exist due in part to the highly heterogeneous presentation of ASD as well every bit the complexity of the manifestations of anxiety in the ASD population, not to mention the biases which may be present for or against diagnosis in those with comorbid ASD. Nosotros continue to recommend use of the terms
unproblematic and broken-hearted avoidance
to help differentiate betwixt stimuli and situations that may constitute an
anxiety disorder
in individuals with and without ASD. However, the electric current
Diagnostic and Statistical Manual of Mental Disorders, 5th edition
(DSM-five;
American Psychiatric Association, 2013) classifies
feet
equally the “anticipation of future threat” and furthermore, diverse anxiety disorders can be differentiated by the “specific content of the thoughts and behavior that may induce the fear or anxiety.” Given this definition, how tin can the electric current diagnostic classifications of anxiety disorders exist applied to those individuals with limited cerebral and/or verbal abilities? Early studies conducted on ASD suggested approximately half of those individuals diagnosed were incapable of oral communication acquisition (Rutter, 1978). Recent estimates have shown a marked decrease in these estimates due in part to earlier assessment and detection techniques (Klingler et al., 2003); however, the fact remains that some individuals with ASD never develop functional voice communication.

These deficits in verbal communication in a subpopulation of individuals with ASD may account for some of the variability in comorbidity rates. Researchers have shown college levels of anxiety to be associated with functional language in individuals with ASD (Gadow and Sprafkin, 1998, 2002). Researchers accept also argued these findings may be complicated by diagnostic overshadowing (Mason and Scior, 2004), while data from other studies suggests that individuals with ASD simply practice not meet
cooccurring criteria for other psychiatric conditions (Leyfer et al., 2006; Witmer and Lecavalier, 2010, Kaat et al., 2013). Differential diagnosis of ASD and anxiety, so, requires a conscientious evaluation of those symptoms unique to each disorder besides equally common presentations of symptom patterns for individuals evincing comorbidity. Additionally, findings from a number of studies take shown that fears and behavioral responses common among the typically developing population, are not necessarily replicated in individuals with ASD (e.g.,
Evans et al., 2005;
Kanner, 1943;
Matson and Honey, 1990).

Due to the overlap of symptomology betwixt ASD and feet disorders a number of studies have attempted to differentiate those factors which are inextricably shared from those that may be conceptually differentiable. For instance, social avoidance and a preference to exist alone are shared qualities between both anxiety and ASD (Businesswoman-Cohen et al., 2001; Roberson-Nay et al., 2007; White et al., 2012). However, ASD individuals may be less aware or take less concern for the social rejection component found in social feet disorder (Leyfer et al., 2006; Muris et al., 1998). As well, excessive worries around environmental changes or deviations from a schedule can be mutual in both groups of disorders (generalized anxiety disorder and ASD), as can exist highly rigid behaviors, exact rituals, and compulsions (OCD and ASD). The difficulty comes from determining whether these behaviors occur to reduce distress in the case of OCD or are generalized worry and broad broken-hearted abstention in the case of GAD. Differential diagnosis would also crave the clinician to appraise those behaviors seen less typically in non-ASD populations such equally strict adherence to routine, confining interests, and repetitive behaviors.

Attempts to distinguish between the similarities betwixt anxiety and ASD symptoms have typically supported distinctiveness within areas which practise non necessarily lend themselves to application in those who are minimally verbal or lower functioning. For example,
Farrugia and Hudson (2006)
found the simply divergence between anxiety presentation in typically developing and nontypically developing groups was reported idea patterns of social threat and physical injury, areas which would be hard if not impossible to appraise in a minimally verbal population. Singular presentations of anxiety are besides common in those with ASD and can include social fear without a negative evaluative component, nontraditional specific phobias, and fear of change and novelty (Kerns et al., 2014).
Leyfer et al. (2006)
constitute typical phobias were rarely endorsed in the ASD population; however, fears of loud noises, crowds, and shots/needles were much more
common. Additionally, idiosyncratic fears (due east.grand., flushing toilets, beards, mechanical objects) take besides been found in ASD individuals (Richman et al., 2012). Many of these problematic or avoided stimuli raise additional questions as to whether the problem is fright or anxiety versus altered sensory part. For case, repetitive and ritualistic behaviors seen in obsessive-compulsive disorder (OCD) are also usually observed in many persons with ASD (McDougle et al., 1995), including those individuals that are not suspected of experiencing whatsoever anxiety. In such cases, repetitive behaviors may exist a preferred self-stimulatory action, in contrast to ritualistic beliefs triggered by obsessional thoughts that is the hallmark of OCD. Circumspection should be taken to non immediately characterize these ritualistic or stereotypic behaviors every bit “OCD” based on their repetitive nature. Avoidance is another surface area which may present itself differentially as younger children and those with verbal deficits have been shown to express fear and avoidance in conjunction with other behaviors such as assailment, devastation of property, and cocky-injurious behavior (Hagopian et al., 2001; Ricciardi et al., 2006).

Finally, of particular business concern with the diagnosis of anxiety in minimally verbal ASD populations is that strict adherence to the
DSM-5
diagnostic criteria may miss a meaning proportion of these individuals in need of clinical services due to verbal requirements of the diagnostic criteria. For example, Criterion A for separation anxiety disorder requires endorsement of three out of viii symptoms; yet, 4 of the eight symptoms require the expression of “worry, thematic explanations of nightmares, or complaints” (APA, 2013). Additionally, some disorders such as selective mutism and GAD may inherently be unavailable to the minimally verbal ASD population when adhering to strict diagnostic nomenclature. Given the host of challenges associated with differential diagnosis, thorough cess procedures are considered to be vitally important.

Considerations for future genetic investigations of feet disorders: classification of ecology factors

An idea that was discussed higher up was the
nomenclature of anxiety disorders
according to symptom dimensions equally an culling to diagnostic criteria.

Kendler and others (2003)
summarized findings of the Virginia Twin Registry and classified significant life events according to the nature of the event.
Danger events
were those that were related to an unpleasant adverse consequence.
Humiliation events
were those associated with rejection or failure.
Loss events
included occasions in which there was a real or perceived loss of a person, possession, or respect (Kendler et al., 2003). Given that the well-nigh constructive genetic analyses of feet disorders will involve reliable Yard×Due east models, it is important to adequately define the nature of the life events that may interact with genetic hazard factors to produce anxiety-related phenotypes.

2

Methods

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Moher et al., 2009). Institutional review lath approval was waived every bit no patient data were accessed for the study.

2

Methods