Special Report: Anxiety Disorders Across the Life Span

The focus of this Special Report on anxiety disorders is not accidental. Anxiety disorders are, probably next to substance abuse, the most common mental disorders in the general population, and definitely the most common mental disorders among children and adolescents. Over the last several decades, we have seen tremendous developments in conceptualization, classification and treatment of these disorders. The time when benzodiazepines occupied the central stage in the treatment of these disorders is gone. Selective serotonin reuptake inhibitors and various forms of therapy, especially cognitive-behavioral therapy (CBT) are now considered first-line treatments in many, if not all, anxiety disorders. As child and adolescent psychopharmacology is coming of age, a large body of research data is emerging, and we are approaching treatment of children and adolescents more systematically. Research into anxiety disorders is focusing on the role of serotonin, amygdala, early experiences and many other issues.

The articles in this Special Report illustrate these developments, covering important problems such as: treating anxiety disorders during various stages of life; the relationship between pediatric anxiety disorders and adult psychopathology; differences between childhood and adolescent anxiety presentation from that in adults; issues associated with risk of relapse in panic disorder; the rational treatment for pediatric obsessive-compulsive disorder; tools for assessing severity of generalized anxiety disorder; and treatment options and considerations for late-life anxiety. The articles present a wealth of clinical material and lot of food for thought.

Nonetheless, brooding over the articles evokes more questions. Where does the universal experience of normal anxiety end and pathological anxiety begin? How does one decide whether to use CBT or medication in children and adolescents (especially since no medication is approved by the U.S. Food and Drug Administration for pediatric anxiety disorders)? Do benzodiazepines, especially the old ones, deserve the bad name they have received? What is the role of anxiety in healthy development? What is the social function of anxiety? How much does personality makeup contribute to the experience of and coping with anxiety? And there are certainly many others.

Hopefully, this Special Report will help the reader address some of the important decisions in the management of anxiety disorders. It may also help in finding answers to some of the aforementioned questions raised. It reminds us how little we know, how much still has to be done, and how much more our approach to treatment selection still reflects art rather than science.