They have been hypothesized to provide critical modulating effects within the CNS that may influence the presentation, course, and treatment response of anxiety disorders in women. Female reproductive hormones, especially estrogen and progesterone, may also have a critical role in the neurobiology of anxiety disorders.
There are significant brain structural and functional differences between men and women in areas relevant to anxiety, including the prefrontal cortex, hippocampus, and the extended amygdala complex. Various factors including genetic, neurodevelopmental, environmental, and neurobiological, are hypothesized to be responsible for the sex differences reported in anxiety disorders. The same study also reported that women are more likely than men to have a comorbid anxiety disorder (44.8% versus 34.2%). Sex differences in these comorbidities are also notable with MDD and Bulimia Nervosa (BN) being more prevalent in women and substance use disorder, Attention Deficit Disorder with Hyperactivity (ADHD), or intermittent explosive disorder being more likely to be present in men. Additionally, anxiety disorders are also associated with several comorbid psychiatric diagnoses, especially mood disorders like Major Depressive Disorder (MDD). They are associated with increased utilization of emergency medical and mental health services and have also been linked to elevated rates of teenage pregnancy and parenthood. Īnxiety disorders can lead to the development of several adverse consequences including reduced educational and occupational opportunities, greater functional impairment and overall increase in morbidity and mortality rates as compared to those without an anxiety disorder. It is hypothesized that several factors can contribute to these findings including cumulative effects of anxiety-related mortality, difficulty differentiating between cognitive impairment and an anxiety disorder, and the impact of female reproductive hormone cycle cessation. Although these disorders are more prevalent in women throughout their lifespan, there is a notable narrowing in the differences among the two sexes after the age of 65. The emergence of anxiety disorders is typically during childhood, adolescence or early adulthood, with a peak occurring in middle age and a subsequent decline in older individuals. Lifetime prevalence rates in the NCS for individual anxiety disorders like Panic Disorder (PD), Agoraphobia (AG), Specific Phobia (SP), and Social Anxiety Disorder (SAD), were also greater in women. Results from the National Comorbidity Survey (NCS) conducted in 1990-1992 and the National Institute of Mental Health (NIMH) Collaborative Psychiatric Epidemiology Studies (CPES) from 2002-2003 revealed that women were more likely than men to develop an anxiety disorder, with 30.5-33% women being diagnosed vs 19-22% men. INTRODUCTIONĪnxiety disorders are one of the most commonly occurring psychiatric illnesses, with nearly one-fourth of adults in the United States meeting criteria during their lifetime. We also provide a brief overview of the potential genetic and neurobiological factors, discuss biological sex differences in medication metabolism and the potential relevance of these differences in the pharmacologic management of women with anxiety disorders. We have incorporated the changes in nosology made in the DSM-5 and have reviewed available data on the potential impact of sex on the epidemiology, phenomenology, course, and treatment response of these anxiety disorders. In this article, we provide a review of existing literature describing the unique characteristics of primary anxiety disorders in women, including Generalized Anxiety Disorder (GAD), Social Anxiety Disorder (SAD), and Panic Disorder (PD). In spite of these noteworthy differences, there are limited systematic reports describing the effects of biological sex on the development, course, comorbidity, and response to treatment of anxiety disorders.
There is also evidence of differences in brain structures responsible for anxiety and panic related circuitry.
Studies investigating this increased vulnerability to and burden of illness in women have implicated the role of female reproductive hormones and related cycles, physiologic differences leading to differences in symptomatology and metabolism and response to psychotropic medications. Prior research has demonstrated that presence of an anxiety disorder confers significant risk for the subsequent development of other psychiatric disorders including another anxiety disorder and major depression. Women have consistently shown to be more likely than men to meet criteria for the diagnosis of an anxiety disorder during their lifetime.
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