Review articleAnxiety disorders in women
Section snippets
Generalized anxiety disorder (GAD)
Population surveys estimate that the lifetime prevalence rate for GAD is between 5% and 6% [10], [71], [72], [73]. Women have a two to three times higher lifetime risk for GAD compared with men [71], [74], [75]. Although the prevalence of most anxiety disorders decreases with advanced age, GAD remains at a constant prevalence rate throughout life. As a result, GAD is one of the most prevalent anxiety disorders in the elderly (age greater than 60 years) [17], [41], [76]. In addition to female
Women and GAD
Kendler and colleagues [53] used data obtained from female twin pairs (n = 1008) to examine the potential impact of parental loss or parental marital disruption during childhood as a risk factor for subsequent development of GAD during adulthood. Women who reported a childhood history of parental marital separation or a childhood history of separation from their mother or father were more likely to have GAD as adults [53]. Women with GAD are also more likely to have comorbid psychiatric disorders
GAD and the female reproductive cycle
Women with GAD often report premenstrual worsening in GAD symptoms. A prospective comparison of women with GAD (n = 21), women with GAD and PMS (n = 41), and women controls (n = 19) revealed that the women with GAD and premenstrual syndrome (PMS) had more symptoms than the controls during both phases of the menstrual cycle and during the premenstrual period. However, there was no significant change in symptom severity during the menstrual cycle in the women with GAD alone [95]. Further information
Panic disorder and agoraphobia
Panic disorder (PD) was one of the most prevalent psychiatric disorders identified in the ECA population survey. The lifetime prevalence for panic disorder was estimated at 2.2%, and women were two and a half to three times more likely than men to meet criteria for panic disorder during their lifetime (3.4% versus 0.9%) [9]. The ECA data also demonstrated an increased risk for panic disorder in those under the age of 45 years [96]. The lifetime prevalence rate for panic disorder (3.5%) was even
Women and panic disorder
In addition to the finding that panic disorder is two to three times more common in women, panic attacks also occur more frequently in women than in men [120]. Though panic attacks do not appear to be associated with the same degree of morbidity as panic disorder, their occurrence may still herald serious consequences [121]. The lifetime prevalence estimate for panic attacks (4.3%) by DSM-IV criteria was twice that estimated for panic disorder (1.6%) in a large-scale (n = 3000) community survey
Panic disorder and the female reproductive cycle
The dramatic fluctuations in reproductive hormone cycles that occur throughout the female lifecycle appear to have a substantial impact on the clinical course of panic disorder in women. The dramatic decline in estrogen and progesterone levels that characterizes the midluteal phase of the menstrual cycle has been linked to the emergence or worsening of anxiety symptoms in general, and panic disorder in particular [144]. Several reports suggest that women with panic disorder experience an
Simple phobia
Estimates based on the ECA and NCS data confirm that simple phobia is one of the most common psychiatric disorders, with an 11% lifetime prevalence rate [10], [172]. Women are twice as likely as men to meet criteria for simple phobias (see references [15], [39], [173], [174]). Simple phobias encompass a wide range of fears, including situation-related phobias (eg, claustrophobia, acrophobia), animal-related phobias (eg, fear of spiders, insects, snakes), and health care-related phobias (eg,
Women and simple phobia
Women have a twofold higher lifetime risk for simple phobia than men (26% versus 12%). In addition, results from a population survey conducted in over 700 adults revealed that women were also much more likely than men to meet lifetime criteria for situational phobias (17% versus 8.5%) and animal phobias (12% versus 3%) [175]. Health-related phobias were reported to have a similar prevalence rate in men and women (3.2% versus 2.7%). Women reported higher fear ratings for all objects and
Social anxiety disorder (SAD)
Social anxiety disorder is one of the most common psychiatric disorders. Estimates based on the NCS data suggest that the lifetime prevalence rate for social anxiety disorder exceeds 13% [10], [39], [179], [180], [181]. Although the ECA study failed to detect a significant sex difference in social anxiety disorder prevalence rates [39], subsequent population surveys conducted in the United States and abroad indicate a higher prevalence rate for women than men (see references [10], [14], [16],
Women and social anxiety disorder
Evidence of significant gender differences has been reported in patients with SAD. Women's risk for SAD (15.5%) is slightly higher than that of men (11.1%). Despite this finding, there have been few studies that have specifically examined the potential impact of gender on the presentation or course of SAD. Turk and colleagues [202] investigated potential gender differences in a clinical sample of patients with SAD. According to their report, women had greater SAD symptom severity than men. Some
Obsessive-compulsive disorder (OCD)
Results from the ECA study and the Cross-National OCD Collaborative Group Study estimate that the lifetime prevalence rate for OCD is between 2% and 3% worldwide. These large-scale population surveys also demonstrate that women are one and a half times more likely than men to meet lifetime criteria for OCD [11], [209]. The onset of OCD is early—usually during adolescence or young adulthood. Peak ages of onset appear to be from 10 to 19, closely followed by the ages of 20 and 29 [210]. The most
Women and OCD
In addition to the consistent finding that women have a greater lifetime prevalence rate for OCD than men, a number of other gender differences have been identified in OCD. Most evidence suggests that men (mean age, 20 years) have a significantly earlier onset of OCD than women (mean age, 25 years). Women are also much less likely than men to develop OCD during childhood. Onset of OCD before the age of 10 is associated with male gender, tic disorder, and a positive family history [272]. After
OCD and female reproductive cycle events
The marked increase in OCD prevalence after menarche, as well as evidence suggesting a more acute onset and a more episodic course for women with OCD, suggests that OCD may be substantially influenced by the female reproductive cycle. Several reports have examined the potential relationship between the menstrual cycle and OCD symptom severity. Undergraduate women without demonstrable OCD are reported to engage in more OCD-like behaviors, such as “excessive cleaning or cleaning of things not
Posttraumatic stress disorder (PTSD)
Although many individuals are exposed to trauma, only one of four will develop PTSD [10], [294], [295]. Population surveys have consistently demonstrated a twofold greater lifetime prevalence rate for PTSD in women (12.5%) than men (6.2%) [10], [295]. Respondents meeting criteria for PTSD in the ECA study had significantly greater job instability, family history of psychiatric illness, parental poverty, child abuse, and separation or divorce of parents before age 10 [22]. PTSD can occur at any
Women and PTSD
The gender difference in prevalence rate for PTSD has been linked to a differential rate of exposure to trauma. However, this assumption appears to be incorrect. In a sample of over 1000 young adults, Breslau and colleagues found similar rates of exposure to traumatic events, but substantially more women than men met criteria for PTSD [67], [68]. Potential confounding factors, such as the increased prevalence of preexisting anxiety or major depressive disorders in women, were examined but
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