Anxiety Disorders Need Different Approaches Throughout Life Cycle

Whether patients are young, old, or in the prime of life, anxiety disorders reflect developmental stages and influence diagnosis and therapy across the lifespan.

Three researchers offered updated views on anxiety treatment and diagnosis from a developmental perspective at the annual conference of the Anxiety Disorders Association of America in Baltimore in March.

Among children, anxiety disorder is at least as common as depression and ADHD, according to Ron Rapee, Ph.D., a professor of psychology at Macquarie University in Sydney, Australia.

There are few demographic correlates to the disorder, he said. Socioeconomic status, marital status, education level, ethnicity, and family size do not seem to play a role in prevalence. The condition appears more often in girls, but boys are more likely to be in treatment.

The prime risk factors appear to be anxious, overprotective parents who model fearful reactions and an inhibited temperament with an avoidant/withdrawal coping style, she said.

One laboratory experiment placed 24 mother-child pairs in a room. The babies were between 12 and 14 months old; half had anxious temperaments, half did not.

The mothers were trained to act either anxious or not anxious. Then the researchers sent a strange man into the room to talk to the mother for a few minutes. The man then turned and approached the child. If the mother had acted confident, both anxious and nonanxious babies responded equally. But anxious behavior by the mother set off high avoidance behavior in the children, and more so in the more fearful cohort.

Preventing anxiety disorders appears to be possible by intervening with the parents, said Rapee. He described an Australian program using cognitive-behavioral therapy that involves both children and parents. It has reduced symptoms by teaching parents to be less protective, allowing their children greater exposure to potentially stressful situations, and using psychoeducation and cognitive restructuring, he said.

{pagebreak}

Hormones Complicate Women's Treatment

Once children become adults, risk factors change. Margaret Altemus, M.D., an associate professor of psychiatry at Weill Medical College of Cornell University in New York, has studied the hormonal and sex-related issues of anxiety in women.

As women move through their life cycle, there is much hormonal variation during their menstrual cycles and childbearing years, said Altemus.

Anxiety may present only in the luteal phase or more generally as an exacerbation of preexisting illness, she said. Several treatments can be used for luteal-phase symptoms like tension, hypersensitivity to stimuli, or irritability.

Both SSRI antidepressants and placebos lower premenstrual symptoms within three hours of administration, said Altemus, but only SSRI treatment maintains that reduction beyond three hours.