Disorder Comparison Table
Anxiety Disorder Comparison Table
Quick Reference Tool | PsychHQ Source: Module 5, Disorder-Specific Deep Dives (Sections 1–8) | Last Updated: March 2026
At a Glance: Eight Anxiety Disorders Compared
| Disorder | Core Cognitive Driver | Typical Onset | Course | First-Line Psychotherapy | First-Line Pharmacotherapy | Key Distinguishing Feature |
|---|---|---|---|---|---|---|
| GAD | Intolerance of uncertainty; worry as avoidance of emotional imagery | Adolescence to early adulthood | Chronic, relapsing-remitting | CBT matched to model: worry exposure (Borkovec), behavioral experiments for uncertainty (Dugas), or MCT [Metacognitive Therapy] (Wells) | SSRI/SNRI (2025 Cochrane NNT [number needed to treat] = 7; NNH [number needed to harm — how many patients treated before one discontinues due to side effects] = 17) | Worry shifts across domains; neither GAD nor MDD is inherently primary |
| Social anxiety | Catastrophic fear of negative evaluation; self-focused attention | Mean age ~13 | Chronic if untreated; 36% wait 10+ years to seek help | Individual Clark & Wells CBT (behavioral experiments, video feedback, safety behavior cessation) | SSRI (NNT ~4.2–4.7); phenelzine g = 1.14 but reserved for treatment-resistant cases due to dietary and drug interaction constraints | Performance inhibition, not skill deficit; 90-minute sessions outperform 50-minute |
| Panic disorder | Catastrophic misinterpretation of benign body sensations (Clark, 1986) | Late adolescence to mid-30s | Remission 75% uncomplicated / 67% with agoraphobia; relapse 12% / 21% | CBT with interoceptive exposure (IE — deliberately inducing feared body sensations) | SSRI (start at sub-therapeutic dose, titrate slowly — activation syndrome is almost invariably catastrophically misinterpreted in this population) | IE is the highest-efficacy component; including relaxation during exposure associated with reduced efficacy in dismantling data |
| Agoraphobia | Fear of situations where escape is difficult or help unavailable | Often within 12 months of first panic attack; >80% develop agoraphobia in the first year | Chronic without treatment | Systematic in-vivo situational exposure; telehealth CBT produces equivalent large effects | SSRI (same algorithm as panic) | Now independent from panic in DSM-5; ~25% of treatment-seeking youth lose eligibility under more stringent DSM-5 criteria |
| Specific phobias | Conditioned or prepared fear of a specific stimulus | Median age ~8 | Persistent; only 23.1% ever receive treatment | In-vivo exposure; OST (one session, up to 3 hours; pre-to-post g = 1.15 across subtypes [Ollendick & Davis, 2013]; ASPECT trial N = 268: non-inferior to multi-session CBT [Wright et al., 2023]) | Not first-line; propranolol or short-course BZD for single unavoidable events only | Most prevalent, least treated; in 72.6% of comorbid cases, the phobia preceded the onset of later disorders |
| BII phobia | Same as specific phobia + vasovagal syncope risk | Childhood to early adolescence | Persistent | Exposure + Applied Tension (tensing large muscles for 10–15 sec to prevent parasympathetic rebound) | Not first-line | Diphasic (two-phase) autonomic response: sympathetic surge → parasympathetic collapse → vasovagal syncope (fainting from sudden blood pressure drop); unique genetic architecture (81% of genetic variance from a BII-specific factor) |
| Separation anxiety | Anticipatory dread of separation from attachment figure | Bimodal: early childhood and late teens/20s | 36.1% persist to adulthood; 77.5% of adult cases onset in adulthood | Parent-based CBT with accommodation reduction (children); SPACE (parent-only, non-inferior to child CBT); adapted exposure hierarchies (adults) | SSRI (CAMS: combination 80.7% response pooled across SAD/GAD/social phobia) | Person-based avoidance (goes away when the attachment figure is present); BNST (bed nucleus of the stria terminalis — the "extended amygdala" that processes sustained, anticipatory threats)-mediated sustained threat processing |
| Selective mutism | Anxiety-driven freeze of speech production in specific social contexts | Ages 3–6 | Persistent without intervention | School-based behavioral protocols: IBT-SM (75% response in pilot RCT), PCIT-SM, sliding-in technique | Limited evidence; fluoxetine in one small RCT; not first-line | Context-dependent: fluent at home, mute at school; the "rescue cycle" in schools maintains the silence |
Disorder-Specific Clinical Notes
GAD: Model-Matching Matters
Three maintenance models drive different treatment approaches. Borkovec: worry functions as avoidance of emotional imagery — treatment uses sustained imaginal exposure to worst-case scenarios (25–30 min without verbal rumination; d = 1.81 vs non-therapy controls, 57% full recovery at 12 months; Hanrahan et al., 2013). Dugas: intolerance of uncertainty is the catalyst — treatment uses behavioral experiments inducing uncertainty (going to a restaurant without checking reviews, sending an email with a deliberate typo). Wells: metacognitive beliefs about worry maintain the cycle ("I can't stop worrying," "this will drive me crazy") — treatment uses Detached Mindfulness and worry postponement (57.1% recovery at 9 years vs 37.5% for CBT; Solem et al., 2021 — single research group, small samples).
Assessment shortcut: Does the patient fear what they're worrying about (Borkovec/Dugas) or fear the worry itself (Wells)?
Buspirone niche: 5-HT1A partial agonist (a serotonin receptor that regulates anxiety without affecting GABA receptors used by benzodiazepines); no sedation, no dependence risk. Best for older adults at fall risk, patients with substance use histories, or SSRI partial responders needing augmentation. Onset 2–4 weeks — entirely ineffective as PRN.
Social Anxiety: Behavioral Experiments, Not Just Habituation
The Clark & Wells protocol has the largest point estimate in the anxiety psychotherapy literature (SMD = −1.56 in a sub-model analysis; Mayo-Wilson et al., 2014, 101 RCTs, 13,164 pts — this is a sub-model estimate without separate CIs; the aggregate individual CBT class effect is −1.19, 95% CrI [credible interval — the Bayesian equivalent of a confidence interval]: −1.56 to −0.81). The key insight: behavioral experiments test catastrophic predictions rather than waiting for fear to habituate. A patient who believes "if I sweat visibly, people will laugh" might spray water on their underarms before presenting.
Session length matters: English trials using 90-minute sessions averaged 6 behavioral experiments per course; German/Swedish trials using 50-minute sessions averaged 1.7. This is observational, not randomized, but it means that standard 50-minute hours may be a structural barrier to delivering the active ingredient.
Social skills training additive benefit is inconsistent. Most patients have adequate skills that are suppressed by anxiety — when the anxiety is treated, the skills emerge. Exception: comorbid Autism Spectrum Disorder, where genuine skill deficits may require separate intervention.
Panic: The Suffocation False Alarm and Activation Syndrome
Clark's model explains expected panic; Klein's suffocation false alarm (SFA) theory explains spontaneous and nocturnal attacks — the brain's CO2 monitor is set too sensitively, triggering a suffocation alarm from normal breathing variation.
Alprazolam publication bias: Turner & Ahn-Horst (2023) found that of 5 phase 2/3 trials for alprazolam XR, the FDA deemed only 1 (20%) genuinely positive. Two negative trials were suppressed; two published with post-hoc analyses conveying false positive outcomes. True effect size g = 0.33 vs published g = 0.47 (42% inflation).
Prescriber alert — activation syndrome: SSRIs frequently cause an initial spike in agitation during weeks 1–2. In panic patients specifically, this is catastrophically misinterpreted as the medication "making things worse." Pre-framing this for the patient before it occurs reduces early dropout.
Specific Phobias: One Session Can Be Enough
OST (Ost, 1989) consolidates the entire treatment into a single session of up to 3 hours: graduated in-vivo exposure, participant modeling (therapist touches the spider first), behavioral experiments, and reinforcement. Response rates ≥76%; pre-to-post effect size g = 1.15 across phobia subtypes and age groups (Ollendick & Davis, 2013). At 4-year follow-up, 90% of adults remain improved. The ASPECT trial (N = 268, ages 7–16) confirmed non-inferiority to multi-session CBT (Wright et al., 2023).
Phobias are developmental sentinels: in 72.6% of comorbid cases, the specific phobia preceded all other disorders (Wardenaar et al., 2017). Treating phobias early may interrupt downstream cascades.
Separation Anxiety: Not Just for Kids
Adult-onset SAD is more common than childhood SAD (lifetime prevalence 6.6% vs 4.1%; Shear et al., 2006). The DSM-5 eliminated the requirement for onset before age 18. Adult presentations: excessive worry about a partner's safety, "helicopter parenting," inability to tolerate partner's travel, sleep disruption when separated.
Differential from agoraphobia: Agoraphobia is place-based (fear of situations where escape is hard). SAD is person-based (fear of separation from the attachment figure). The test: an adult with agoraphobia still panics in a stadium with their spouse present. An adult with SAD is fine in that stadium if the spouse is there.
Selective Mutism: Break the Rescue Cycle
The silence is involuntary — an anxiety-driven freeze response, not defiance. The school "rescue cycle" maintains it: child freezes → teacher answers for them → child's anxiety drops → silence is reinforced → teacher's discomfort is relieved → rescuing is reinforced.
Treatment reversal: forced-choice questions (not open-ended demands), 5-second wait time resisting the rescue impulse, labeled praise for any communicative approximation. Defocused communication (side-by-side positioning, parallel activity, no direct eye contact) reduces the interpersonal pressure that triggers the freeze.
Warning: Punishing silence does not treat SM. Reward charts demanding speech without managing the underlying terror are counterproductive. SM requires the same graduated desensitization approach as severe phobias.
Tricky Differentials
| Overlap | How to Distinguish |
|---|---|
| GAD vs. MDD | 4 of 6 GAD somatic criteria are identical to MDD criteria; 59–70% shared heritability. But the temporal relationship is symmetrical (37% anxiety first, 32% depression first, ~30% concurrent; Moffitt et al., 2007). Neuroimaging classifiers can distinguish the two above chance (Hilbert et al., 2017). Treat whichever is more severe at presentation. |
| GAD vs. social anxiety | GAD worry is diffuse and shifts across domains. Social anxiety worry is focused on evaluation by others. The PSWQ (Penn State Worry Questionnaire — a 16-item measure of pathological worry) cutoff of 61–65 reliably separates GAD from SAD. |
| Panic vs. medical emergency | Panic is a diagnosis of exclusion in the acute moment. Standard workup: vitals, ECG, pulse oximetry, metabolic panel. Post-ruling-out, the treatment target is the catastrophic misinterpretation, not the sensations themselves. |
| Separation anxiety vs. agoraphobia | SAD = person-based avoidance (calms when attachment figure present). Agoraphobia = place-based avoidance (persists regardless of companion). |
| Selective mutism vs. oppositional defiance | SM children are typically compliant, eager to please, and highly verbal at home. The silence is context-specific and involuntary. ODD presents with active refusal, arguing, and rule-breaking across settings. |
| Specific phobia vs. normative fear | Average child reports 2–5 fears at any time. Phobia = persistence (≥6 months), disproportionality to actual threat, and functional impairment. ~23% of common childhood fears meet clinical criteria (Muris et al., 2000). |
Key References: Kopcalic et al. (2025, Cochrane — GAD NNT); Mayo-Wilson et al. (2014, Lancet Psychiatry — SAD NMA); Pompoli et al. (2018, Psychol Med — panic dismantling); Wright et al. (2023, JCPP — ASPECT/OST); Wardenaar et al. (2017, Psychol Med — phobia epidemiology); Shear et al. (2006, Am J Psychiatry — adult SAD); Lebowitz et al. (2020, JAACAP — SPACE); Bergman et al. (2013, BRT — IBT-SM); Barlow et al. (2017, JAMA Psychiatry — UP equivalence); Moffitt et al. (2007, Arch Gen Psychiatry — GAD-MDD temporal symmetry); Clark (1986, BRT — panic cognitive model); Turner & Ahn-Horst (2023, Psychol Med — alprazolam publication bias)