New guidelines call for doctors to screen for anxiety: Why it matters, especially for women
Written by Katie Kindelan ABC News on October 3, 2022
(WASHINGTON) — Jillian Hughes, 33, of Washington, D.C., said she dealt with symptoms of anxiety for more than a decade before getting a diagnosis of and treatment for anxiety disorder in her 20s.
Lanee Higgins, of Baltimore, remembers being labeled a “worrier” as a child, a label she said stuck with her all the way through this year, when, as a 30-year-old, she was diagnosed with generalized anxiety disorder, a condition that “involves a persistent feeling of anxiety or dread that interferes with how you live your life,” according to the National Institute of Mental Health.
In California, Debbie Paperman, who is in her 40s, said she struggled with anxiety for at least two decades before being diagnosed with an anxiety disorder.
“Everyone’s anxiety is different, but I think too many people think anxiety is something you just have to blow off and not think it’s something to address,” Paperman told ABC News. “A lot of times, people think anxiety is something that is happening because of something and not just because it’s part of your brain structure.”
Anxiety is the feeling evoked when someone experiences fear of something bad happening, and it can lead to avoidance, panic attacks, excessive worrying or other symptoms. Anyone can have anxiety at times, but when anxiety becomes overwhelming to the point that it consistently interferes with daily life, it can be an anxiety disorder, according to the National Institute of Mental Health.
In the United States, anxiety disorders affect as many as one in five adults, data shows.
Now, for the first time, a panel of national medical experts has recommended that adults under age 65 get screened for anxiety during routine medical visits.
The draft recommendations issued last week by the U.S. Preventive Services Task Force call on physicians to use standardized anxiety screenings like existing questionnaires to assess whether patients may have some of the signs and symptoms of anxiety.
The recommendations are intended as one way to help prevent mental health conditions from going undetected, according to Lori Pbert, Ph.D., a clinical psychologist and University of Massachusetts Chan Medical School professor, who serves on the task force.
“What we found was that screening for anxiety in adults younger than 65, including people who are pregnant and postpartum, can help identify anxiety early so people can be connected to the care they need,” Pbert told ABC News. “This recommendation is specifically for individuals who do not have a mental health diagnosis and are not showing recognized signs or symptoms of an anxiety disorder.”
People who have signs and symptoms of anxiety should proactively reach out to a doctor for help, she added.
The first-of-its-kind anxiety screening recommendation is seen as of particular importance to women, who suffer from anxiety disorder at greater rates than men, according to the National Institute of Mental Health.
Women are more than twice as likely as men to get an anxiety disorder in their lifetime, according to the U.S. Office on Women’s Health. Risk factors for anxiety disorders can include genetics, hormonal changes and traumatic events, according to the office.
All three women who spoke with ABC News about their anxiety disorders said they struggled with not having a diagnosis of anxiety for so many years.
All said they believe they would have benefited if their primary health doctors had asked about their mental health, anxiety in particular.
“I definitely would have appreciated at the ages of 13, 14, 15 or in my 20s, a screening and then a referral to resources that I could access,” said Hughes, now executive vice president of communications at Mental Health America, a nonprofit organization that supports mental health advocacy, education and research. “I definitely would have benefited from coping skills and some different framing in my mind of my anxiety and how it affects me.”
Paperman, of California, put it more simply, saying of her decadeslong wait for a diagnosis, “It shouldn’t have taken this long.”
Why women suffer from anxiety disorders at a higher rate than men is a discrepancy not yet completely understood from a medical perspective. Some experts say it may be due, in part, to women’s changing hormones during their menstrual cycle and reproductive years, and women may report symptoms of anxiety more frequently than men.
“I don’t know that anybody has clear evidence,” said Dr. Beth Salcedo, past president of the Anxiety and Depression Association of America and medical director of The Ross Center, a mental health treatment center. “With women’s reproductive changes, they’re a little bit more likely to see anxiety or mood disorders show up, but nobody really has an idea why it’s different among the sexes from a biological perspective.”
Salcedo, a practicing psychiatrist, said she applauds the task force’s recommendation for more frequent and accessible anxiety screenings, but said it’s only a first step in the process of getting care to people who need it.
“It’s a value-add overall, but the medical system needs to change to be able to manage these things,” Salcedo said. “If the government was willing to put a trained clinician in every one of these offices to look at the screens and evaluate the patients and make recommendations for therapy and give access to good treatment, that would be ideal, but that’s not what this is, unfortunately.”
Pbert said that with the recommendation that doctors include anxiety screenings in appointments, the hope is that people who may have vague symptoms they don’t recognize as anxiety can be helped early.
Symptoms of anxiety disorders can include physical symptoms like restlessness, fatigue and even sometimes chest discomfort or trouble breathing, as well as mental symptoms such as fear and dread about things that may happen, according to the Office on Women’s Health.
“Screening for anxiety disorders is not the only step. It’s the first step,” Pbert said, adding that if a person shows signs of an anxiety disorder on the screener, “they then can be linked up with appropriate treatment and follow-up care.”
Pbert said the task force’s recommendation will not be finalized until after the panel reviews public comments, which could take several months.
While the task force’s recommendation would not be mandatory for doctors, it carries enormous weight in the medical community and its recommendations often change the way doctors practice medicine.
What to know about anxiety disorders
Like most mental health conditions, anxiety falls on a spectrum, with differing degrees of severity.
There are four main types of anxiety disorders.
Generalized anxiety disorder, or GAD, is described as worrying “excessively about ordinary, day-to-day issues, such as health, money, work, and family,” according to the OWH. Women with GAD may be anxious about just getting through the day, may have difficulty doing everyday tasks and may have stress-related physical symptoms, like difficulty sleeping or stomachaches, according to the Office on Women’s Health.
Panic disorder, also twice as common in women as in men, may see people having panic attacks, described by the Office on Women’s Health as “sudden attacks of terror when there is no actual danger.” People having panic attacks may feel like they’re having a heart attack, dying or losing their minds.
A third type of anxiety disorder, social anxiety disorder, is diagnosed when people “become very anxious and self-conscious in everyday social situations,” including embarrassing easily, according to the Office on Women’s Health. People with social anxiety disorder can often have panic attack symptoms around social situations.
The fourth type of disorder, specific phobia, is an intense fear of something, such as heights, water, animals or specific situations, that possess “little or no actual danger,” according to the Office on Women’s Health.
Each type of anxiety disorder can bring with it different symptoms, but they all involve a “fear and dread about things that may happen now or in the future,” according to the Office on Women’s Health.
Treatment for anxiety disorders often includes a combination of counseling and medication — and both together are often most effective.
When it comes to counseling, cognitive behavioral therapy (CBT) is often used to help people change thinking patterns around their fears, according to the Office on Women’s Health. With medication, a prescription medication to treat and prevent future episodes of anxiety on a long-term basis is different than a medication such as Xanax or Valium that is intended for infrequent treatment of acute anxiety.
Treatment options for anxiety are shown here.
Other factors such as physical activity, nutrition and mindfulness can also play a role in coping with anxiety, although less is known about the role they play in treating anxiety disorders, according to the National Center for Complementary and Integrative Health, an entity of the National Institutes of Health (NIH).
Melissa Presser, a mom of three in south Florida, said it took a combination of many therapies for her to learn how to cope with the anxiety she said she’s lived with for much of her life.
“Exercises that are quieting the mind, that has been a big part of my healing,” said Presser, also an attorney and writer. “Another big part of my recovery has been a peer group. That was so overwhelmingly helpful, to sit with peers who were also suffering to varying degrees.”
Presser said she has learned that anxiety disorders are not a condition you can diagnose by looking at someone, which is why she said it’s important for doctors to talk with patients about the condition and empower them to get care.
“People who suffer from anxiety, you would never know it for most people from the outside,” she said. “If you saw me on the street, you’d have no idea that I was suffering. I’m a person who functions with anxiety.”
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