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Original Research

The Spectrum of Anxiety Disorders in the Medically Ill

Giovanni A. Fava, MD; Piero Porcelli, PhD; Chiara Rafanelli, MD, PhD; Lara Mangelli, PhD; and Silvana Grandi, MD

Published: June 1, 2010

Article Abstract

Objective: The purpose of this cross-sectional study was to assess the prevalence and characteristics of anxiety disorders in the medically ill.

Method: A sample of 1,660 medical patients was recruited from different medical settings in different periods from 1996 to 2007. All patients underwent detailed semistructured interviews with the Structured Clinical Interview for DSM-IV (SCID) and the Structured Interview for Diagnostic Criteria for Psychosomatic Research (DCPR).

Results: Generalized anxiety disorder was the most frequent anxiety disturbance (10.3%) and was associated with DCPR somatization syndromes, Type A behavior, and irritable mood. Panic disorder with agoraphobia and agoraphobia without history of panic disorder had almost identical prevalence (about 4.5%), but differed in some patterns of somatization. Agoraphobia without panic attacks was related to illness denial, persistent somatization, anniversary reactions, and demoralization. Much lower prevalence rates were reported for social phobia and obsessive-compulsive disorder.

Conclusions: The findings indicate that anxiety disorders are common in the setting of medical disease and are associated with several types of psychosomatic presentations. The links between agoraphobia without history of panic disorder and illness denial may provide an explanation for some discrepancies that have occurred in the literature as to the prevalence of agoraphobia in clinical samples compared to epidemiologic studies.

J Clin Psychiatry 2010;71(7):910-914

Submitted: January 25, 2010; accepted March 16, 2010.

Online ahead of print: June 1, 2010 (doi:10.4088/JCP.10m06000blu).

Corresponding author: Giovanni A. Fava, MD, Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy (

Volume: 71

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