Anxiety disorders, post-traumatic stress disorder and obsessive–compulsive disorder

Anxiety symptoms and disorders are common in community settings and primary and secondary care. Symptoms can be mild and transient, but many people are troubled by severe symptoms causing great personal distress and impairing social and occupational function. The societal burden from anxiety disorders is considerable, but many who might benefit from treatment are not recognized or treated. Recognition relies on a keen awareness of the psychological and physical symptoms of all anxiety disorders, and accurate diagnosis on identifying the specific features of particular disorders. All anxiety disorders have a range of contributory causes. The need for treatment is determined by the severity and persistence of symptoms, level of associated disability, impact on everyday life, presence of coexisting depressive symptoms and other features such as good response to or poor tolerability of previous treatments. The choice of treatment is influenced by patient characteristics and patient and doctor preferences. There is much overlap between different anxiety disorders in evidence-based and effective therapies (e.g. prescription of a selective serotonin reuptake inhibitor, course of cognitive behavioural therapy), but there are important differences. It thus helps to become familiar with the characteristic features and evidence base for each disorder.