Except for specific phobia, anxiety disorder is rare before puberty. Some men diagnosed as alcoholics have underlying anxiety disorder and self-medicate with alcohol. Desensitization is fantasizing increasing doses of the phobic situation while relaxed until the full dose of the phobia can be fantasized without anxiety. In vivo exposure desensitizes the patient in the actual feared situation. Biggest problem with behavior therapy is that a sizeable number of persons cannot be trained to relax by way of progressive muscle relaxation.
Benzodiazepines are only effective during acute anxiety attacks.
Most patients have associated nonmelancholic depression, and many develop some agoraphobia. The patient fears humiliation. May lead to agoraphobia. It is associated with nonmelancholic depression. An event that would be traumatic to most persons results in prolonged recurrent and intrusive distressing recollections of the event, dreams of the event, persistent avoidance of stimuli associated with the event, hyperarousal, anxiety, withdrawal from social and other interests.