Anxiety disorders

Abstract Anxiety disorders have the highest prevalence of any class of psychiatric disorder in community samples and are often comorbid with substance use disorders, suicidal behavior, and serious mental illness, including affective and psychotic disorders. Comorbidity is associated with higher symptom counts and worse overall outcomes, including higher health service utilization. These findings have relevance to correctional populations, where resources can be scarce. Despite being highly prevalent, anxiety disorders are not often emphasized in correctional treatment settings. Correct diagnosis and treatment of underlying anxiety disorders decrease morbidity and mortality; a firm grasp of pathology underlying anxiety is therefore important to the correctional psychiatrist. The Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision (DSM-5-TR), made several important changes in categorization and conceptualization of anxiety disorders. The chapter on anxiety disorders included two new disorders, separation anxiety disorder and selective mutism, which had previously been classified as disorders of childhood. This change is consistent with the new emphasis within the DSM-5-TR on a lifespan perspective and recognition that anxiety disorders emerge early and tend to persist throughout life. This chapter describes the anxiety disorders as they present in a correctional setting using clinical vignettes to illustrate treatment challenges. The current knowledge available regarding epidemiology of the various disorders in correctional settings, best practices for treatment, and comorbidity are also discussed.