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Anxiety disorders and post-traumatic stress disorder
In every anxiety disorder the basic treatment is the same — CBT and an SSRI or SNRI — and the disorders differ in what triggers the anxiety and in duration; benzodiazepines are a short-term answer only, and a physical cause is excluded before the diagnosis.
Why it matters in the exam
Exam questions ask you to identify the disorder from the description: excessive worry about everything for at least 6 months (generalised anxiety), sudden attacks that peak within minutes followed by a month of fear of another attack (panic disorder), fear of situations that are hard to escape (agoraphobia), fear of others' judgement (social anxiety), and fear of a defined object (specific phobia). Post-traumatic stress disorder is classified separately: a traumatic event, intrusion, avoidance, negative changes in thinking and mood, and hyperarousal, for more than a month.
Before the diagnosis, exclude hyperthyroidism, caffeine and stimulants, withdrawal from alcohol or benzodiazepines, arrhythmias, hypoglycaemia and occasionally phaeochromocytoma; with chest pain in a person at risk, exclude an acute coronary syndrome first. In treatment: SSRIs are started at a low dose because anxiety may worsen at first, and full response takes weeks. Buspirone suits generalised anxiety and causes no dependence. Propranolol suits performance anxiety only. Specific phobia is treated with graded exposure, not drugs. In PTSD the treatment is trauma-focused psychotherapy and an SSRI, and benzodiazepines are avoided.
Key points
- CBT and an SSRI or SNRI are the basis in every anxiety disorder.
- Generalised anxiety: 6 months; panic: a month of worry after an attack.
- Exclude thyroid, substances, withdrawal and the heart.
- Benzodiazepines only short term; buspirone without dependence.
- PTSD: more than a month; trauma-focused psychotherapy and an SSRI.
Summary table
| Disorder | Definition and duration | Treatment | Exam notes |
|---|---|---|---|
| Generalised anxiety disorder (GAD) | Excessive worry most days, at least 6 months, with at least 3 physical symptoms | CBT, SSRI or SNRI; buspirone | Benzodiazepines only short term |
| Panic disorder | Recurrent unexpected attacks, followed by at least a month of worry or behaviour change | CBT and an SSRI | Exclude cardiac and thyroid causes |
| Agoraphobia | Fear of situations that are hard to leave, 6 months | CBT with exposure, SSRI | Can occur with or without panic |
| Social anxiety disorder | Fear of negative evaluation by others, 6 months | CBT and an SSRI; propranolol for performance anxiety only | Differs from avoidant personality in intensity and breadth |
| Specific phobia | Fear of a defined object or situation, 6 months | Graded exposure | Drugs are not the main treatment |
| Post-traumatic stress disorder | After trauma: intrusion, avoidance, thinking and mood, arousal — more than a month | Trauma-focused psychotherapy, SSRI (sertraline, paroxetine) | Less than a month (3 days to a month) = acute stress disorder |
A free exam question
?מהו הסימפטום הגופני אשר מאפיין יותר פוביה חברתית לעומת התקף פאניקה (the question as examined, in Hebrew)
- א. קוצר נשימה
- ב. הסמקה
- ג. מחנק
- ד. סחרחורת
Example question from the licensing exam (IMLE)
Which of the following is true regarding the use of benzodiazepines to treat panic disorder?
- A. During an acute exacerbation, it is recommended to avoid the use of benzodiazepines
- B. With prolonged use of benzodiazepines, most cases will not develop tolerance to the anxiolytic effect
- C. Benzodiazepines can be used without concern of dependence
- D. It is not recommended to combine benzodiazepines with selective serotonin reuptake inhibitors (SSRI)
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Sources
- DSM-5-TR, American Psychiatric Association, 2022 — Anxiety Disorders; Trauma- and Stressor-Related Disorders
- NICE guideline CG113, 2011, updated 2020 — Generalised anxiety disorder and panic disorder in adults: management
- VA/DoD Clinical Practice Guideline for Management of PTSD, 2023 — Treatment of PTSD
- Kaplan and Sadock's Synopsis of Psychiatry, 12th edition (2021) — Anxiety Disorders
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.