The DSM-IV diagnostic system includes the following anxiety disorders: separation anxiety disorder, panic disorder, agoraphobia, specific phobias, social phobia, obsessive-compulsive disorder, and generalized anxiety disorders, as well as the previously considered posttraumatic stress disorder and acute stress disorder (see Ref. 164 for review). Separation anxiety disorder is defined by excessive and developmentally inappropriate anxiety about separation from parents or other primary attachment figures. Typically less common in adolescents than younger children, a relationship between separation anxiety disorder and adolescent SUD has not been established. Panic disorder and agoraphobia are rare in adolescent samples. Specific phobias are relatively common but probably not a factor in SUD development. Social phobia is nearly as common in adolescent as in adult samples and may influence SUD development and course. Obsessive-compulsive disorder often begins during adolescence, but a relationship with adolescent SUD has not been established. Generalized anxiety disorder may be one of the more common anxiety disorders in adolescents. The criteria for generalized anxiety disorder, however, have been substantially changed in DSM-IV so the applicability of studies using prior criteria is uncertain.
Relationships with Substance Use Disorders -a
Clinical samples of adults with SUD typically show high rates of social phobia, |
panic disorder, and agoraphobia (165,166; see Ref. 22 for review). Epidemio- .1
logical data also support an association between anxiety disorders and SUD in adults (167). Among adolescents with SUD, high rates of social phobia have been noted (e.g., Refs. 29, 168). In the PAARC analysis comparing adolescents with alcohol dependence to community control adolescents, anxiety disorders other than PTSD were not found to be significantly associated with alcohol dependence (34). Whether there is an association between anxiety disorders other than PTSD and SUD among adolescents remains to be definitively determined.
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