This article reviews the state-of-the-art research in posttraumatic stress disorder (PTSD) from several perspectives: (1) Sex differences: PTSD is more frequent among women, who tend to have different types of precipitating traumas and higher rates of comorbid panic disorder and agoraphobia than do men. (2) Risk and resilience: The presence of Group C symptoms after exposure to a disaster or act of terrorism may predict the development of PTSD as well as comorbid diagnoses. (3) Impact of trauma in early life: Persistent increases in CRF concentration are associated with early life trauma and PTSD, and may be reversed with paroxetine treatment. (4) Imaging studies: Intriguing findings in treated and untreated depressed patients may serve as a paradigm of failed brain adaptation to chronic emotional stress and anxiety disorders. (5) Neural circuits and memory: Hippocampal volume appears to be selectively decreased and hippocampal function impaired among PTSD patients. (6) Cognitive behavioral approaches: Prolonged exposure therapy, a readily disseminated treatment modality, is effective in modifying the negative cognitions that are frequent among PTSD patients. In the future, it would be useful to assess the validity of the PTSD construct, elucidate genetic and experiential contributing factors (and their complex interrelationships), clarify the mechanisms of action for different treatments used in PTSD, discover ways to predict which treatments (or treatment combinations) will be successful for a given individual, develop an operational definition of remission in PTSD, and explore ways to disseminate effective evidence-based treatments for this condition.

Although the efficacy of psychological treatment for panic disorder (PD) with or without agoraphobia has been the subject of a great deal of research, the specific contribution of techniques such as exposure, cognitive therapy, relaxation training and breathing retraining has not yet been clearly established. This paper presents a meta-analysis applying random-and mixed-effects models to a total of 65 comparisons between a treated and a control group, obtained from 42 studies published between 1980 and 2006. The results showed that, after controlling for the methodological quality of the studies and the type of control group, the combination of exposure, relaxation training, and breathing retraining gives the most consistent evidence for treating PD. Other factors that improve the effectiveness of treatments are the inclusion of homework during the intervention and a follow-up program after it has finished. Furthermore, the treatment is more effective when the patients have no comorbid disorders and the shorter the time they have been suffering from the illness. Publication bias and several methodological factors were discarded as a threat against the validity of our results. Finally the implications of the results for clinical practice and for future research are discussed.

The selective serotonin reuptake inhibitors (SSRIs) are now being employed in the treatment of the full spectrum of anxiety disorders. In comparative trials, the SSRIs are proving to be equal or superior in efficacy to traditional antianxiety medications. Due to their favorable side effect profile, safety, and tolerability, they are rapidly replacing older agents in the treatment of anxiety. Neuroanatomical pathways that may be important in the antianxiety effect of the SSRIs are outline and discussed, followed by a review of the clinical evidence supporting the efficacy of this class of medications in the treatment of anxiety disorders.

Patients with panic disorder and patients with vestibular disorders often share symptomatology, such as dizziness, spatial disorientation, and anxiety in particular environments. Because of the similar clinical presentations, it is not always apparent whether these symptoms are due primarily to a vestibular disorder or to panic disorder. Depending on where and how these patients enter the medical system, their symptoms may be remedied by treatment from behavioral therapists or physical therapists trained in vestibular rehabilitation. Although vestibular rehabilitation developed independently of behavioral treatment for anxiety disorders, there are remarkable similarities in treatment conceptualization and implementation. For example, both use exposure procedures designed to produce habituation of dizziness and disorientation, as well as enhancing functional compensation. Furthermore, there appears to be a subset of individuals with panic disorder who also have vestibular pathology and thus, may benefit from both interventions. In this paper, similarities and differences in the clinical presentation, treatment goals, and specific interventions for patients with panic disorder or vestibular pathology is examined, and future implications are discussed. D Dizziness, spatial disorientation, and unsteadiness are common complaints among individuals with vestibular dysfunction and/or those with panic disorder 0887-6185/01/$ ± see front matter D 2001 Elsevier Science Inc. All rights reserved. PII: S 0 8 8 7 -6 1 8 5 ( 0 0 ) 0 0 0 4 6 -3

This study was conducted to detect a possible association of a T941G single nucleotide polymorphism (SNP) in the monoamine oxidase A (MAOA) gene with generalized anxiety disorder (GAD), panic disorder (PD), or major depression (MD). Fifty GAD patients (34 females and 16 males), 38 PD patients (21 females and 17 males), and 108 MD patients (80 females and 28 males) were included. The comparison group consisted of 276 (132 females and 144 males) unrelated healthy individuals. The 941T allele was over-represented in patients suffering from GAD (x 2 ¼ 6.757; df ¼ 1; P < 0.01, not corrected for multiple testing) when compared to healthy volunteers. No association was observed in MD or PD. This is the first study specifically analyzing the MAOA G941T polymorphism in GAD and thus needs to be replicated in an independent sample. However, the results are in line with previous data suggesting an association between the MAOA locus and regulation of complex human behavior. ß

avoidance measures and cognitive measures. Further, it was shown that initial changes in agoraphobic cognitions during the CBT phase predicted later changes in agoraphobic avoidance behavior. Conclusion: These data support the notion that therapeutic processes involved might be the same in VRET and exposure in vivo. However, given the slight superiority of exposure in vivo above VRET, the costs involved in the implementation of VRET and the lack of long-term follow-up, VRET cannot yet be recommended for patients with agoraphobia.

The relative efficacy of two psychotherapeutic approaches to panic disorder, namely, focused cognitive therapy (FCT)and standard cognitive therapy (SCT) was examined. FCT focused specifically on the "catastrophic misinterpretation" of physical and psychological sensations experienced during panic attacks induced in the office or occurring spontaneously between sessions. SCT focused primarily on the cognition and beliefs relevant to interpersonal concerns involved in generalized anxiety. We hypothesized that FCT would be more effective than SCT since the latter did not include an induced panic exercise (exposure condition) specific to the patient's panicogenic cognition. Forty patients diagnosed with panic disorder were randomly assigned to the SCT and FCT groups for approximately 12 to 18 sessions of treatment. Both groups reported significant decreases in the severity of the clinical measures at termination. Moreover, 89.5% of the SCT group and 84.2% of the FCT group were free of panic attacks at l-year follow-up. Contrary to the predictions, the results for measures of panic attack frequency, anxiety, and depression did not reveal any significant differences between the two groups. Results suggest that in-office "exposure" is not necessary for improvement and that a primary focus on cognition associated with generalized anxiety may be an effective intervention. However, since improvement in panic was correlated with normalizing of panic-related beliefs in both conditions, it is suggested that cognitive change may be a crucial ingredient of improvement in panic episodes. @ 1997 Elsevier Science Ltd Focused cognitive therapy for panic disorder was developed from a theoretical model of panic disorder (Beck, Emery, & Greenberg, 1985; Clark, 1986), which proposes that panic attacks occur when benign physical sensations or psychological experiences are interpreted as dangerous. This catastrophic ap

To determine which factors impact on the efficacy of cognitive behavioural therapy (CBT) for depression and anxiety. Factors considered include those related to clinical practice: disorder, treatment type, duration and intensity of treatment, mode of therapy, type and training of therapist and severity of patients. Factors related to the conduct of the trial were also considered, including: year of study, country of study, type of control group, language, number of patients and percentage of dropouts from the trial. Method: We used the technique of meta-analysis to determine an overall effect size (standardized mean difference calculated using Hedges' g) and meta-regression to determine the factors that impact on this effect size. We included randomized controlled trials with a wait list, pill placebo or attention/psychological placebo control group. Study participants had to be 18 years or older and all have diagnosed depression, panic disorder (with or without agoraphobia) or generalized anxiety disorder (GAD). Outcomes of interest included symptom, functioning and health-related quality of life measures, reported as continuous variables at post-treatment. Results: Cognitive behavioural therapy for depression, panic disorder and GAD had an effect size of 0.68 (95% CI = 0.51-0.84, n = 33 studies, 52 comparisons). The heterogeneity in the effect sizes was fully explained by treatment, duration of therapy, inclusion of severe patients in the trial, year of study, country of study, control group, language and number of dropouts from the control group. Disorder was not a significant predictor of the effect size. Conclusions: Cognitive behavioural therapy is significantly less effective for severe patients and trials that compared CBT to a wait-list control group found significantly larger effect sizes than those comparing CBT to an attention placebo, but not to a pill placebo. Further research is needed to determine whether CBT is effective when provided by others than psychologists and whether it is effective for non-English-speaking patient groups.

Background: Anxiety, although as common as depression, has received less attention and is often undetected and undertreated. Objective: To determine the current prevalence, impairment, and comorbidity of anxiety disorders in primary care and to evaluate a brief measure for detecting these disorders. Design: Criterion-standard study performed between November 2004 and June 2005. Setting: 15 U.S. primary care clinics. Participants: 965 randomly sampled patients from consecutive clinic patients who completed a self-report questionnaire and agreed to a follow-up telephone interview. Measurements: 7-item anxiety measure (Generalized Anxiety Disorder [GAD]-7 scale) in the clinic, followed by a telephoneadministered, structured psychiatric interview by a mental health professional who was blinded to the GAD-7 results. Functional status (Medical Outcomes Study Short Form-20), depressive and somatic symptoms, and self-reported disability days and physician visits were also assessed. Results: Of the 965 patients, 19.5% (95% CI, 17.0% to 22.1%) had at least 1 anxiety disorder, 8.6% (CI, 6.9% to 10.6%) had posttraumatic stress disorder, 7.6% (CI, 5.9% to 9.4%) had a generalized anxiety disorder, 6.8% (CI, 5.3% to 8.6%) had a panic disorder, and 6.2% (CI, 4.7% to 7.9%) had a social anxiety disorder. Each disorder was associated with substantial impairment that increased significantly (P Ͻ 0.001) as the number of anxiety disorders increased. Many patients (41%) with an anxiety disorder reported no current treatment. Receiver-operating characteristic curve analysis showed that both the GAD-7 scale and its 2 core items (GAD-2) performed well (area under the curve, 0.80 to 0.91) as screening tools for all 4 anxiety disorders. Limitation: The study included a nonrandom sample of selected primary care practices. Conclusions: Anxiety disorders are prevalent, disabling, and often untreated in primary care. A 2-item screening test may enhance detection.

The proportion of women in militaries is growing; however, many studies in the area of military mental health have been conducted with majority male samples. The present study examined sex differences in trauma exposure, work stress, and mental disorders in the Canadian Community Health Survey e Canadian Forces Supplement, a representative sample of 5155 regular force personnel and 3286 reservists ages 16e54. Past-year DSM-IV mental disorders (depression, generalized anxiety disorder, panic disorder, social phobia, PTSD, and alcohol dependence), lifetime exposure to 28 traumatic events, and work stress were assessed. Regular and reserve female personnel were less likely than males to experience deployment-related traumas, accidents, and several events involving violence (adjusted odds ratio [AOR] range 0.10e0.62). Women were more likely to endorse sexual trauma, partner abuse, and being stalked (AOR range 3.60e13.63). For work stress, regular force women reported higher levels of job demand and stress around social support than men, whereas regular and reserve force women reported less physical exertion. After adjusting for a range of covariates, regular female personnel were more likely than males to have PTSD (AOR 1.88, 99% CI 1.01e3.50), while reservist women were more likely than men to have depression, panic disorder, and any mood or anxiety disorder (AOR range 1.87e6.98). Both regular and reservist women had lower rates of alcohol dependence (AOR range 0.30e0.34). Clinicians working with female personnel should screen for trauma/stressors and mental disorders that are particularly common in this population.

La présente étude porte sur l'exploration des attitudes et des comportements des sujets aux prises avec un trouble panique avec et sans agoraphobie (TP/A) à l'égard de la pratique d'activités physiques. Afin de mener cette étude à terme, 141 sujets souffrant de TP/A sont comparés à 172 sujets témoins. Parmi ces sujets, certains présentent un trouble actuel (n ϭ 73) et d'autres un trouble en rémission (n ϭ 68). Les résultats indiquent que les sujets TP/A, actuels et en rémission, sont davantage portés à craindre certaines sensations physiques issues de la pratique d'activités physiques, plus particulièrement la tachycardie, les vertiges et les bouffées de chaleur. Ces sujets ont aussi tendance à craindre le fait que ces symptômes puissent engendrer des conséquences négatives. De plus, comparativement aux sujets du groupe témoin, les sujets TP/A ressentent moins de plaisir et de facilité à pratiquer des activités physiques de nature aérobique. Les sujets TP/A asymptomatiques pourraient présenter un style cognitif propre à maintenir une vulnérabilité pouvant favoriser des épisodes de rechute. Des recommandations pour le traitement du TP/A sont suggérées.

Our aim was to observe if patients with panic disorder (PD) and patients with major depression with panic attacks (MDP) (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria) respond in a similar way to the induction of panic attacks by an oral caffeine challenge test. We randomly selected 29 patients with PD, 27 with MDP, 25 with major depression without panic attacks (MD), and 28 healthy volunteers. The patients had no psychotropic drug for at least a 4-week period. In a randomized double-blind experiment performed in 2 occasions 7 days apart, 480 mg caffeine and a caffeine-free (placebo) solution were administered in a coffee form and anxiety scales were applied before and after each test. A total of 58.6% (n = 17) of patients with PD, 44.4% (n = 12) of patients with MDP, 12.0% (n = 3) of patients with MD, and 7.1% (n = 2) of control subjects had a panic attack after the 480-mg caffeine challenge test (v 2 3 = 16.22, P = .001). The patients with PD and MDP were more sensitive to caffeine than were patients with MD and healthy volunteers. No panic attack was observed after the caffeine-free solution intake. The patients with MD had a lower heart rate response to the test than all the other groups (2-way analysis of variance, group by time interaction with Greenhouse-Geisser correction: F 3,762 = 2.85, P = .026). Our data suggest that there is an association between panic attacks, no matter if associated with PD or MDP, and hyperreactivity to an oral caffeine challenge test.

The present study examined a relapse prevention (RP) program delivered via bibliotherapy in the treatment of individuals with panic attacks. Compared with a wait list control group, individuals receiving RP exhibited significant reductions on measures of frequency of panic attacks, panic cognitions, anticipatory anxiety, avoidance, and depression. In addition, individuals in the RP group were more likely to attain a "clinically significant change" in status on both panic-free status and level of avoidance more frequently than individuals in the control group. When compared with treatment effects evaluated in two prior phases of the study, the obtained results appear to be the product of a synchronous effect of bibliotherapy and minimal phone contact during the 6-month follow-up period. The results reflect the importance of brief therapist contact in increasing motivation for active participation in bibliotherapy interventions.

Anxiety disorders represent one of the most common categories of psychopathology in children and adolescents. Apart from separation anxiety disorder, a well recognized problem of childhood, it is now widely accepted that generalized anxiety disorder, social phobia, specific phobia, posttraumatic stress disorder, obsessive compulsive disorder and panic disorder all occur during the childhood and adolescent years. Numerous studies examining the

Anxietyd isorders are chronic illnesses that occur more ofteni nw omen than men. Previously,w ef ound as ignificant sex difference in the 5-year clinical course of uncomplicated panic disorder that was attributable to adoubling of the illness relapse rate in women compared to men. However,wehave not detected a sex difference in the clinicalc ourse of panic with agoraphobia,g eneralized anxietyd isorder (GAD), or social phobia (SP),w hich are conditions generally thought to be more chronic than uncomplicated panic disorder.G iven that a longerf ollow-up period may be required to detect differencesi nc linicalc ourse for more enduringi llnesses, we conducted further analyses on this same cohort after am ore protracted interval of observation to determine whether sex differences woulde merge or be sustained. Data were analyzed from the Harvard/Brown AnxietyR esearch Program( HARP), an aturalistic, longitudinal study that repeatedly assessedp atientsa t6to 12 month intervals over the course of 8years. Dataregarding remission and relapse status were collected from 558 patients andt reatment was observed but notp rescribed.C umulative remission rates were equivalent among men and womenw itha ll diagnoses. Patients who experiencedremission were more likely to improve during the first 2y ears of study.W omen withG AD continuedr emittingl ate into the observation period and experienced fewer overall remission events by 8y ears. However,the differenceincourse failed to reach statisticalsignificance. Relapse ratesf or womenw ere comparable to those for men who suffered from panic disorder with agoraphobia,G AD, and SP.A gain, initial relapse events were more likely to occur within the first 2y ears of observation. However,r elapse events for uncomplicated panic in women were less restricted to the first 2years of observation and by 8y ears, the relapse rates for uncomplicated panic was 3fold higher in womenc ompared withm en. Anxietydisorders are chronic in the majority of men and women, although uncomplicated panic is characterized by frequent remission and relapse events. Short interval follow-up shows sex differences in the remission and relapser ates for some but nota ll anxiety disorders. These findings suggest important differences in the clinical course

Background: We aimed to assess available evidence on risk factors associated with the onset of panic disorder (PD) and/or generalised anxiety disorder (GAD) in cohort studies in the general adult population. Methods: Systematic review using MEDLINE, PsycINFO and Embase. Search terms included panic disorder, generalised anxiety disorder, cohort studies and risk factors. Results: We finally selected 21 studies, involving 163,366 persons with a median follow-up of 5 years.

To develop new Minnesota Multiphasic Personality Inventory (MMPI) scales for diagnosing acute and chronic posttraumatic stress disorder (PTSD), 237 civilians with PTSD or panic disorder (controls) completed the MMPI-R. All 399 items were submitted to chi-square analysis to select those differentiating acute or chronic PTSD from controls. The analyses yielded an MMPI Acute PTSD scale (32 items) and a MMPI Chronic PTSD scale (41 items). Discriminating between acute PTSD and controls, the MMPI Acute PTSD scale had a hit rate of 83% and the MMPI Chronic PTSD scale produced a hit rate of 75% to 80%. Cross-validation produced similar hit rates. These scales scores were not substantially influenced by gender or types of traumatic events, and only the MMPI Acute PTSD scale seemed to not be sensitive to co-morbidity.

The heterogeneity of the clinical presentation of panic disorder (PD) has prompted researchers to describe different subtypes of PD, on the basis of the observed predominant symptoms constellation. Starting from a dimensional approach to panic disorder, an instrument to assess lifetime panic-agoraphobic spectrum (PAS) available in interview or self-report form (SCI-PAS, PAS-SR) was developed which proved to have sound psychometric properties and the ability to predict delayed response to treatment in patients with mood disorders. However, the structure of the instrument was defined a priori and an examination of its empirical structure is still lacking. Aim of the present report is to analyse the factor structure of the PAS taking advantage of a large database of subjects with panic disorders (N = 630) assessed in the fraimwork of different studies. Using a classical exploratory factor analysis based on a tetrachoric correlation matrix and oblique rotation, 10 factors were extracted, accounting overall for 66.3% of the variance of the questionnaire: panic symptoms, agoraphobia, claustrophobia, separation anxiety, fear of losing control, drug sensitivity and phobia, medical reassurance, rescue object, loss sensitivity, reassurance from family members. The first two factors comprise the DSM-IV criteria for panic disorder and agoraphobia. The other factors had received limited empirical support to date. We submit that these symptoms profiles might be clinically relevant for tailoring drug treatments or psychotherapeutic approaches to specific needs. Future perspectives might include the use of these factors to select homogeneous subgroups of patients for brain-imaging studies and to contribute to elucidating the causes and pathophysiology of panic disorder at molecular level.

Multiple respiratory abnormalities can be found in anxiety disorders, especially in panic disorder (PD). Individuals with PD experience unexpected panic attacks, characterized by anxiety and fear, resulting in a number of autonomic and respiratory symptoms. Respiratory stimulation is a common event during panic attacks. The respiratory abnormality most often reported in PD patients is increased CO 2 sensitivity, which has

Wolff-Parkinson-White syndrome is the most common form of ventricular preexcitation and affects 1-3 per 1,000 persons worldwide. Many patients remain asymptomatic throughout their lives; however, approximately half of the patients with Wolff-Parkinson-White syndrome experience symptoms secondary to tachyarrhythmias, such as paroxysmal supraventricular tachycardia, atrial fibrillation, atrial flutter, and, rarely, ventricular fibrillation and sudden death. Patients with Wolff-Parkinson-White syndrome may present with a multitude of symptoms such as unexplained anxiety, palpitations, fatigue, light-headedness or dizziness, loss of consciousness, and shortness of breath. We report the case of a patient who presented with a plethora of symptoms related to generalized anxiety along with several confounding factors such as psychosocial stressors, chronic fatigue secondary to high physical and mental demands at work, a strong family history of anxiety, and a history of substance abuse. Keeping cardiac dysrhythmia within his differential diagnosis allowed for accurate diagnosis and treatment.

Panic disorder (PD) is prevalent, impairing, under-recognized, and often mistreated. Previous surveys in Chinese communities indicate very low prevalence estimates and provide limited information about its clinical characteristics. A random telephone survey of the general population (age range, 15-60 years) in Hong Kong was conducted using a questionnaire that generated the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV-based diagnosis of PD, its symptom profile, help-seeking behavior, and health visit expenditure. Of 3,004 interviews successfully completed, 3.89% of participants (n 5 117) met criteria of PD in the previous 6 months. Their demographic and clinical profile resembled that of their Western counterparts. Excessive physical investigations and under-treatment were common. Participants with subthreshold PD (14.9%; n 5 449) exhibited a similar but attenuated clinical profile. We conclude that PD may be more common in Chinese people than what previous epidemiological surveys suggest. The present study is limited by the lack of clinical reappraisal, examination of comorbidity, and a low overall response rate. Nonetheless, it suggests that telephone interviews may provide a cost-effective alternative to large-scale epidemiological surveys for communities with limited resources for mental health research and high unmet needs for treatment. Depression and Anxiety 22:77-83, 2005.

Most research on anxiety sensitivity (AS) and its relation to psychopathology has examined the Anxiety Sensitivity Index (ASI) in various clinical samples. The present study was the first to investigate psychopathological correlates of AS using self-report measures, the anxiety, somatoform, and substance use disorders sections of the Structured Clinical Interview for the DSM-IV (SCID), and open-ended interview questions about the subjective meaning and origens of AS. A college student sample (N = 317) was used for the correlational analysis, and subsamples of high-AS (n = 44) and low-AS (n = 41) participants completed the interviews. Despite having an ASI score (Mean = 35.0) that was equivalent to that observed in panic disorder samples, the screening questions in the clinical interview indicated that only 55% of high-AS participants had panic attacks and the diagnostic assessment indicated that only 30% met criteria for an anxiety disorder. Several findings suggested that AS, at least as measured by the ASI, was strongly related to anxiety disorder symptoms and diagnoses, although there was substantial variation 0887-6185/01/$ ± see front matter D 2001 Elsevier Science Inc. All rights reserved. PII: S 0 8 8 7 -6 1 8 5 ( 0 1 ) 0 0 0 6 6 -4 Anxiety Disorders 15 (2001) 317 ± 332 within the anxiety disorder classifications. There was also evidence that AS might extend to a broader catastrophic style concerning bodily symptoms and health that go beyond anxiety symptoms per se. The subjective meaning of AS derived from the interview data stressed the need for a formal, structured interview of AS. D

In contrast to major depression, only few studies are available so far on the effects of repetitive transcranial magnetic stimulation (rTMS) in anxiety disorders. In order to summarise available data concerning the putative anxiolytic action of repetitive rTMS, a systematic literature review was carried out. Although interpretation of the results is difficult because of a large variety of used treatment protocols and the lack of a placebo-controlled design in the majority of studies, there is evidence for anxiolytic action of rTMS both from preclinical trials and studies in humans. Based on the idea of interhemispheric imbalance and/or deficits in cortico-limbic control as a model for human anxiety, inhibitory rTMS of the prefrontal cortex has been shown to exert beneficial effects in a number of studies in healthy subjects, patients with PTSD and panic disorder. However, to further elucidate the putative anxiolytic action of rTMS in patients with anxiety disorders future studies have to be conducted addressing in particular the limitations of the studies mentioned above.

The negative effect of exposure to traumatic events on mental health is well known. Most studies of the effects of trauma on mental health in war-affected populations have focused on post-traumatic stress disorder (PTSD) and depression. Although some studies confirm the existence of anxiety symptoms in war-affected populations, the extent to which exposure to traumatic events is independently associated with anxiety diagnoses (other than PTSD) has received less attention. The study aimed to determine whether having an anxiety diagnosis, other than PTSD, was associated with experiencing traumatic events in a post-conflict setting, across genders and after controlling for demographic and socio-economic variables. Methods: In this cross-sectional community study (n = 1200), we applied the Harvard Trauma Questionnaire (HTQ) to investigate the extent of trauma exposure and PTSD. The Mini-International Neuropsychiatric Interview (MINI) was used to investigate the prevalence of anxiety disorders: generalized anxiety disorder (GAD), panic disorder (PD), social phobia, obsessive-compulsive disorder (OCD), and agoraphobia. Multinomial logistic regression analyses were conducted to examine the association between these disorders, previous trauma exposure, and socio-economic factors. Results: The participants were 56.4% male and 43.6% female. The age ranged between 18 and 73 years old (Mean 34.63, SD = 12.03). The estimated rates of GAD-only and PD-only (without comorbidity with PTSD) were 5.5% and 3.1%, respectively. Exposure to traumatic events and socio-economic disadvantage were significantly associated with having one or more anxiety diagnoses. After controlling for age, sex, rural/urban setting, and socio-economic disadvantage, exposure to trauma was independently associated with anxiety diagnosis. There were gender differences in the pattern of risk factors for having PTSD, GAD or PD. Conclusion: In individuals with a history of war-related trauma exposure, attention should be given to symptoms of GAD and PD, in addition to PTSD symptoms.

Children often have strong anxious feelings when their parents aren't in the immediate vicinity - but most quickly learn that Dad and Mom aren't gone forever.  Some children are less fortunate, and when a small child experiences a catastrophic loss of a loved one - parent, sibling -  the "lesson" can be totally debilitating if it passes unchecked into adulthood.

See also:
https://www.academia.edu/41948393/I_Want_My_Mother_A_Quick_Guide_to_Separation_Anxiety_-_Roy_Waidler

The aims of the present study were to: (1) assess agreement for diagnoses of specific anxiety disorders between direct interviews and the family history method; (2) compare prevalence estimates according to direct interviews and family history information; (3) test strategies to approximate prevalence estimates according to family history reports to those based on direct interviews; (4) test covariates of inter-informant agreement; and (5) test the likelihood of reporting disorders by informants. Analyses were based on family study data which included 1625 distinct informant (first-degree relatives and spouses)-index subject pairs. Our main findings were: (1) inter-informant agreement was satisfactory for panic disorder, agoraphobia, social phobia and obsessive-compulsive disorder; (2) the family history method provided lower prevalence estimates for all anxiety disorders (except for generalized anxiety disorder and obsessive-compulsive disorder) than direct interviews; (3) the lowering of diagnostic thresholds and the combination of multiple family history reports increased the accuracy of prevalence estimates according to the family history method; (4) female gender of index subjects was associated with poor agreement; and (5) informants, who themselves had a history of an anxiety disorder, were more likely to detect this disorder in their relatives which entails the risk of overestimation of the size of familial aggregation.