National Drug Strategy
National Drug Strategy

Comorbidity of mental disorders and substance use: a brief guide for the primary care clinician

6.1 Anxiety

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In contrast to fear, which is a response to a realistic immediate danger, anxiety is a fearful response occurring in the absence of a specific danger or real threat. According to the National Survey of Mental Health and Wellbeing, anxiety disorders are the most common form of mental disorder in the population with a one-year prevalence of 9.7% in Australian adults(68).

The fear and worry associated with anxiety arises in response to a variety of specific triggers (fear of heights) more general triggers (e.g. crowds, shopping centres, being in trains or buses, meeting new people, or having to speak in public) or sometimes in response to general issues including finances, health or relationships and personal safety. In some cases, anxiety can arise suddenly and spontaneously without a discernable trigger, as is the case with panic disorder.

People with anxiety may find it hard to relax, concentrate and sleep, and may suffer physical symptoms such as heart palpitations, tension and muscle pain, sweating, hyperventilation, dizziness, faintness, headaches, nausea, indigestion, bowel disturbance and loss of sexual pleasure. These symptoms are accompanied by changes in thoughts, emotions and behaviour that substantially interfere with the person's ability to live and work.

More women than men experience anxiety disorders(68, 119, 121, 201). Anxiety usually begins in early adulthood and is often, but not always, triggered by a series of significant life events.

6.1.1 Anxiety disorder subtypes

Panic disorder

This is characterised by recurrent panic attacks, which occur unexpectedly over at least a month. Panic attacks are diagnosed if there is a period in which there is a sudden onset of intense apprehension, fearfulness or terror commonly associated with feelings of impending doom. Symptoms such as shortness of breath, palpitations, chest pain or discomfort, smothering or choking sensations along with fear of losing control are experienced during these attacks.

Agoraphobia

This is characterised by anxiety about, or avoidance of, places and situations from which escape may be difficult (e.g. elevators, buses, trains or trams or shopping centres), or in which help may not be available in the instance of experiencing a panic attack or panic like symptoms.

Social phobia

This is characterised by clinically significant anxiety provoked by being exposed to certain types of social situations, commonly leading to avoidance of situations requiring socialising.

Obsessive compulsive disorder (OCD)

This is characterised by obsessions that cause significant anxiety or distress and compulsions which serve to neutralise the associated anxiety or distress.

Post traumatic stress disorder (PTSD)

This is characterised by re-experiencing of an extremely traumatic event accompanied by symptoms of increased arousal and avoidance of stimuli associated with the trauma.

Generalised anxiety disorder (GAD)

This is characterised by at least six months of persistent and excessive anxiety or worry.
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6.1.2 Management approaches to anxiety disorders

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