Skip to main content Accessibility help
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 15
  • Print publication year: 2009
  • Online publication date: May 2010

4 - Anxiety Disorders And PTSD

from Part Two - Psychopathology After Disasters


This chapter focuses on the prevalence and etiology of anxiety disorders, including posttraumatic stress disorder (PTSD), following disasters. Recently a number of large national mental health surveys have estimated the prevalence of psychiatric disorders. The anxiety disorders that have been associated with disasters are generalized anxiety disorder, panic disorder, obsessive-compulsive disorder (OCD), social phobia, and specific phobia. The discussion of these matters is influenced by the fact that the conventions for recording patterns of comorbidity have changed between Diagnostic and Statistical Manual (DSM)-III and DSM-IV. The relationship between PTSD and the associated comorbidities with other anxiety and depressive disorders is important in determining the chronicity of morbidity following disasters. Anxiety disorders other than PTSD have been looked at in more detail in children, in part because of the potential developmental impact of disorders such as separation anxiety.

Related content

Powered by UNSILO


American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders, 3rd ed. Washington, DC: Author.
American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders, 4th ed. Washington, DC: Author.
Armagan, E., Engindeniz, Z., Devay, A. O., Erdur, B., & Ozcakir, A. (2006). Frequency of post-traumatic stress disorder among relief force workers after the tsunami in Asia: Do rescuers become victims? Prehospital and Disaster Medicine, 21(3), 168–172.
Benight, C. C., McFarlane, A. C., & Norris, F. H. (2006). Formulating questions about post-disaster mental health. In F. Norris, S. Galea, M. Friedman & P. Watson (Eds.), Methods for disasters mental health research. New York: The Guilford Press
Bolton, D., O’Ryan, D., Udwin, O., Boyle, S., & Yule, W. (2000). The long-term psychological effects of a disaster experienced in adolescence: II: General psychopathology. Journal of Child Psychology and Psychiatry, 41(4), 513–523.
Breslau, N., Peterson, E. L., Poisson, L. M., Schultz, L. R., & Lucia, V. C. (2004). Estimating post-traumatic stress disorder in the community: Lifetime perspective and the impact of typical traumatic events. Psychological Medicine, 34(5), 889–898.
Brewin, C. R., Andrews, B., & Valentine, J. D. (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology, 68(5), 748–766.
Brown, G. W. (1993). Life events and affective disorder: Replications and limitations. Psychosomatic Medicine, 55(3), 248–259.
Bryant, R., Creamer, M., O’ Donnell, M., Silove, D., & McFarlane, A. C. (2008). A multi-site study of the capacity of acute stress disorder diagnosis to predict posttraumatic stress disorder. Journal of Clinical Psychiatry, 69(11), 1694–1701.
Bryant, R. A. (2005). Predicting posttraumatic stress disorder from acute reactions. Journal of Trauma and Dissociation, 6(2), 5–15.
Bystritsky, A., Vapnik, T., Maidment, K., Pynoos, R. S., & Steinberg, A. M. (2000). Acute responses of anxiety disorder patients after a natural disaster. Depression and Anxiety, 11(1), 43–44.
Centers for Disease Control, and Prevention (CDC). (2004). Mental health status of World Trade Center rescue and recovery workers and volunteers – New York City, July 2002–August 2004. MMWR Morbidity and Mortality Weekly Report, 53(35), 812–815.
Chou, F. H., Wu, H. C., Chou, P., Su, C. Y., Tsai, K. Y., Chao, S. S., et al. (2007). Epidemiologic psychiatric studies on post-disaster impact among Chi-Chi earthquake survivors in Yu-Chi, Taiwan. Psychiatry and Clinical Neuroscience, 61(4), 370–378.
Conejo-Galindo, J., Medina, O., Fraguas, D., Teran, S., Sainz-Corton, E., & Arango, C. (2007). Psychopathological sequelae of the 11 March terrorist attacks in Madrid: An epidemiological study of victims treated in a hospital. European Archives of Psychiatry and Clinical Neuroscience, 258(1), 28–34.
Cooper, B. (2001). Nature, nurture and mental disorder: Old concepts in the new millennium. British Journal of Psychiatry, 178(Suppl. 40), s91–101.
Creamer, M., Burgess, P., & McFarlane, A. C. (2001). Post-traumatic stress disorder: Findings from the Australian National Survey of Mental Health and Well-being. Psychological Medicine, 31(7), 1237–1247.
Curran, P. S. (1988). Psychiatric aspects of terrorist violence: Northern Ireland 1969–1987. British Journal of Psychiatry, 153, 470–475.
de Bocanegra, H. T., Moskalenko, S., & Kramer, E. J. (2006). PTSD, depression, prescription drug use, and health care utilization of Chinese workers affected by the WTC attacks. Journal of Immigration and Minority Health, 8(3), 203–210.
de Ville de Goyet, C. (2007). Health lessons learned from the recent earthquakes and Tsunami in Asia. Prehospital and Disaster Medicine, 22(1), 15–21.
DeSalvo, K. B., Hyre, A. D., Ompad, D. C., Menke, A., Tynes, L. L., & Muntner, P. (2007). Symptoms of posttraumatic stress disorder in a New Orleans workforce following Hurricane Katrina. Journal of Urban Health, 84(2), 142–152.
Dirkzwager, A. J., van der Velden, P. G., Grievink, L., & Yzermans, C. J. (2007). Disaster-related posttraumatic stress disorder and physical health. Psychosomatic Medicine, 69(5), 435–440.
Duffy, M., Gillespie, K., & Clark, D. M. (2007). Post-traumatic stress disorder in the context of terrorism and other civil conflict in Northern Ireland: Randomised controlled trial. BMJ, 334(7604), 1147.
Faravelli, C., Catena, M., Scarpato, A., & Ricca, V. (2007). Epidemiology of life events: Life events and psychiatric disorders in the Sesto Fiorentino study. Psychotherapy and Psychosomatics, 76(6), 361–368.
Garrison, C. Z., Bryant, E. S., Addy, C. L., Spurrier, P. G., Freedy, J. R., & Kilpatrick, D. G. (1995). Posttraumatic stress disorder in adolescents after Hurricane Andrew. Journal of the American Academy of Child and Adolescent Psychiatry, 34(9), 1193–1201.
Giannopoulou, I., Strouthos, M., Smith, P., Dikaiakou, A., Galanopoulou, V., & Yule, W. (2006). Post-traumatic stress reactions of children and adolescents exposed to the Athens 1999 earthquake. Euopean Psychiatry, 21(3), 160–166.
Goenjian, A. K., Molina, L., Steinberg, A. M., Fairbanks, L. A., Alvarez, M. L., Goenjian, H. A., et al. (2001). Posttraumatic stress and depressive reactions among Nicaraguan adolescents after hurricane Mitch. American Journal of Psychiatry, 158(5), 788–794.
Goenjian, A. K., Pynoos, R. S., Steinberg, A. M., Najarian, L. M., Asarnow, J. R., Karayan, I., et al. (1995). Psychiatric comorbidity in children after the 1988 earthquake in Armenia. Journal of the American Academy of Child Adolescent Psychiatry, 34(9), 1174–1184.
Goenjian, A. K., Walling, D., Steinberg, A. M., Karayan, I., Najarian, L. M., & Pynoos, R. (2005). A prospective study of posttraumatic stress and depressive reactions among treated and untreated adolescents 5 years after a catastrophic disaster. American Journal of Psychiatry, 162(12), 2302–2308.
Green, B. L., Korol, M., Grace, M. C., Vary, M. G., Leonard, A. C., Gleser, G. C., et al. (1991). Children and disaster: Age, gender, and parental effects on PTSD symptoms. Journal of the American Academy of Child and Adolescent Psychiatry, 30(6), 945–951.
Green, B. L., Lindy, J. D., Grace, M. C., Gleser, G. C., Leonard, A. C., Korol, M., et al. (1990). Buffalo Creek survivors in the second decade: Stability of stress symptoms. American Journal of Orthopsychiatry, 60(1), 43–54.
Green, B. L., Lindy, J. D., Grace, M. C., & Leonard, A. C. (1992). Chronic posttraumatic stress disorder and diagnostic comorbidity in a disaster sample. Journal of Nervous and Mental Diseases, 180(12), 760–766.
Gureje, O., Lasebikan, V. O., Kola, L., & Makanjuola, V. A. (2006). Lifetime and 12-month prevalence of mental disorders in the Nigerian Survey of Mental Health and Well-Being. British Journal of Psychiatry, 188, 465–471.
Helzer, J. E., Robins, L. N., & McEvoy, L. (1987). Post-traumatic stress disorder in the general population. Findings of the epidemiologic catchment area survey. New England Journal of Medicine, 317(26), 1630–1634.
Hobfoll, S. E. (1989). Conservation of resources. A new attempt at conceptualizing stress. American Psychology, 44(3), 513–524.
Hobfoll, S. E., Watson, P., Bell, C. C., Bryant, R. A., Brymer, M. J., Friedman, M. J., et al. (2007). Five essential elements of immediate and mid-term mass trauma intervention: Empirical evidence. Psychiatry, 70(4), 283–315.
Hoven, C. W., Duarte, C. S., Lucas, C. P., Wu, P., Mandell, D. J., Goodwin, R. D., et al. (2005). Psychopathology among New York city public school children 6 months after September 11. Archives of General Psychiatry, 62(5), 545–552.
Hsu, C. C., Chong, M. Y., Yang, P., & Yen, C. F. (2002). Posttraumatic stress disorder among adolescent earthquake victims in Taiwan. Journal of American Academy of Child and Adolescent Psychiatry, 41(7), 875–881.
Hull, A. M., Alexander, D. A., & Klein, S. (2002). Survivors of the Piper Alpha oil platform disaster: Long-term follow-up study. British Journal of Psychiatry, 181, 433–438.
Hyman, S. E. (2007). Can neuroscience be integrated into the DSM-V? National Review of Neuroscience, 8(9), 725–732.
Ironson, G., Wynings, C., Schneiderman, N., Baum, A., Rodriguez, M., Greenwood, D., et al. (1997). Posttraumatic stress symptoms, intrusive thoughts, loss, and immune function after Hurricane Andrew. Psychosomatic Medicine, 59(2), 128–141.
John, P. B., Russell, S., & Russell, P. S. (2007). The prevalence of posttraumatic stress disorder among children and adolescents affected by tsunami disaster in Tamil Nadu. Disaster Management and Response, 5(1), 3–7.
Jones, E., Woolven, R., Durodie, B., & Wessely, S. (2004). Civilian morale during the Second World War: Responses to air raids re-examined. Social History of Medicine, 17, 463–479.
Kar, N., & Bastia, B. K. (2006). Post-traumatic stress disorder, depression and generalised anxiety disorder in adolescents after a natural disaster: A study of comorbidity. Clinical Practice and Epidemiology in Mental Health, 2, 17.
Kar, N., Mohapatra, P. K., Nayak, K. C., Pattanaik, P., Swain, S. P., & Kar, H. C. (2007). Post-traumatic stress disorder in children and adolescents one year after a super-cyclone in Orissa, India: Exploring cross-cultural validity and vulnerability factors. BMC Psychiatry, 7, 8.
Kendler, K. S., Prescott, C. A., Myers, J., & Neale, M. C. (2003). The structure of genetic and environmental risk factors for common psychiatric and substance use disorders in men and women. Archives of General Psychiatry, 60(9), 929–937.
Kessler, R. C., Chiu, W. T., Demler, O., Merikangas, K. R., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 617–627.
Kessler, R. C., Demler, O., Frank, R. G., Olfson, M., Pincus, H. A., Walters, E. E., et al. (2005). Prevalence and treatment of mental disorders, 1990 to 2003. New England Journal of Medicine, 352(24), 2515–2523.
Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52(12), 1048–1060.
Kumar, M. S., Murhekar, M. V., Hutin, Y., Subramanian, T., Ramachandran, V., & Gupte, M. D. (2007). Prevalence of posttraumatic stress disorder in a coastal fishing village in Tamil Nadu, India, after the December 2004 tsunami. American Journal of Public Health, 97(1), 99–101.
Kuo, H. W., Wu, S. J., Ma, T. C., Chiu, M. C., & Chou, S. Y. (2007). Posttraumatic symptoms were worst among quake victims with injuries following the Chi-chi quake in Taiwan. Journal of Psychosomatic Research, 62(4), 495–500.
La Greca, A., Silverman, W. K., Vernberg, E. M., & Prinstein, M. J. (1996). Symptoms of posttraumatic stress in children after Hurricane Andrew: A prospective study. Journal of Consulting and Clinical Psychology, 64(4), 712–723.
Layton, B., & Krikorian, R. (2002). Memory mechanisms in posttraumatic stress disorder. Journal of Neuropsychiatry and Clinical Neuroscience, 14(3), 254–261.
Magee, W. J. (1999). Effects of negative life experiences on phobia onset. Social Psychiatry and Psychiatric Epidemiology, 34(7), 343–351.
Marshall, G. N., Schell, T. L., Elliott, M. N., Rayburn, N. R., & Jaycox, L. H. (2007). Psychiatric disorders among adults seeking emergency disaster assistance after a wildland-urban interface fire. Psychiatric Services, 58(4), 509–514.
McFarlane, A. (1988). The longitudinal course of post-traumatic morbidity: The range of out- comes and their predictors. Journal of Nervous and Mental Disease, 176(1), 30–39.
McFarlane, A. (2004). The contribution of epidemiology to the study of traumatic stress. Social Psychiatry and Psychiatric Epidemiology, 39(11), 874–882.
McFarlane, A. (2005). Psychiatric morbidity following disasters: Epidemiology, risk and protective factors. In J. J. López-Ibor, G. Christodoulou, M. Maj, N. Sartorius & A. Okasha (Eds.), Disasters and mental health. Chichester, West Sussex, England: John Wiley & Sons.
McFarlane, A., & Van Hooff, M. (2005, November) Adult psychological adjustment following childhood exposure to a disaster: A 20 year longitudinal follow-up of children exposed to the Ash Wednesday Bushfires. Paper presented at ISTSS Conference, Toronto (Currently under second review in Journal of Abnormal Psychology).
McFarlane, A. C. (1986). Posttraumatic morbidity of a disaster. A study of cases presenting for psychiatric treatment. Journal of Nervous and Mental Diseases, 174(1), 4–14.
McFarlane, A. C. (1989). The aetiology of post-traumatic morbidity: Predisposing, precipitating and perpetuating factors. British Journal of Psychiatry, 154, 221–228.
McFarlane, A. C. (1998). Epidemiological evidence about the relationship between PTSD and alcohol abuse: The nature of the association. Addictive Behaviors, 23(6), 813–825.
McFarlane, A. C., & Papay, P. (1992). Multiple diagnoses in posttraumatic stress disorder in the victims of a natural disaster. Journal of Nervous and Mental Diseases, 180(8), 498–504.
McMillen, J. C., North, C. S., & Smith, E. M. (2000). What parts of PTSD are normal: Intrusion, avoidance, or arousal? Data from the Northridge, California, earthquake. Journal of Traumatic Stress, 13(1), 57–75.
Milliken, C. S., Auchterlonie, J. L., & Hoge, C. W. (2007). Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war. JAMA, 298(18), 2141–2148.
Mitchell, J. T. (1983). When disaster strikes … the critical incident stress debriefing process. Journal of Emergency Medical Services, 8(1), 36–39.
Morgan, L., Scourfield, J., Williams, D., Jasper, A., & Lewis, G. (2003). The Aberfan disaster: 33-year follow-up of survivors. British Journal of Psychiatry, 182, 532–536.
Neria, Y., Gross, R., Olfson, M., Gameroff, M. J., Wickramaratne, P., Das, A., et al. (2006). Posttraumatic stress disorder in primary care one year after the 9/11 attacks. General Hospital Psychiatry, 28(3), 213–222.
Neria, Y., Nandi, A., & Galea, S. (2007). Post-traumatic stress disorder following disasters: A systematic review. Psychology and Medicine, 38(4), 467–480.
Neuner, F., Schauer, E., Catani, C., Ruf, M., & Elbert, T. (2006). Post-tsunami stress: A study of posttraumatic stress disorder in children living in three severely affected regions in Sri Lanka. Journal of Traumatic Stress, 19(3), 339–347.
Norris, F. H. (2006). Disaster research methods: Past progress and future directions. Journal of Traumatic Stress, 19(2), 173–184.
Norris, F. H., Friedman, M. J., & Watson, P. J. (2002). 60,000 disaster victims speak: Part II. Summary and implications of the disaster mental health research. Psychiatry, 65(3), 240–260.
Norris, F. H., Friedman, M. J., Watson, P. J., Byrne, C. M., Diaz, E., & Kaniasty, K. (2002). 60,000 disaster victims speak: Part I. An empirical review of the empirical literature, 1981–2001. Psychiatry, 65(3), 207–239.
Norris, F. H., Murphy, A. D., Baker, C. K., & Perilla, J. L. (2004). Post-disaster PTSD over four waves of a panel study of Mexico’s 1999 flood. Journal of Traumatic Stress, 17(4), 283–292.
North, C. S., Kawasaki, A., Spitznagel, E. L., & Hong, B. A. (2004). The course of PTSD, major depression, substance abuse, and somatization after a natural disaster. Journal of Nervous and Mental Diseases, 192(12), 823–829.
North, C. S., Pfefferbaum, B., Tivis, L., Kawasaki, A., Reddy, C., & Spitznagel, E. L. (2004). The course of posttraumatic stress disorder in a follow-up study of survivors of the Oklahoma City bombing. Annals of Clinical Psychiatry, 16(4), 209–215.
O’ Donnell, M. L., Creamer, M., Bryant, R. A., Schnyder, U., & Shalev, A. (2003). Posttraumatic disorders following injury: An empirical and methodological review. Clinical Psychology Reviews, 23(4), 587–603.
Onder, E., Tural, U., Aker, T., Kilic, C., & Erdogan, S. (2006). Prevalence of psychiatric disorders three years after the 1999 earthquake in Turkey: Marmara Earthquake Survey (MES). Social Psychiatry and Psychiatric Epidemiology, 41(11), 868–874.
Orcutt, H. K., Erickson, D. J., & Wolfe, J. (2004). The course of PTSD symptoms among Gulf War veterans: A growth mixture modeling approach. Journal of Traumatic Stress, 17(3), 195–202.
Ozer, E. J., Best, S. R., Lipsey, T. L., & Weiss, D. S. (2003). Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis. Psychological Bulletin, 129(1), 52–73.
Peleg, T., & Shalev, A. Y. (2006). Longitudinal studies of PTSD: Overview of findings and methods. CNS Spectrums, 11(8), 589–602.
Person, C., Tracy, M., & Galea, S. (2006). Risk factors for depression after a disaster. Journal of Nervous and Mental Disease, 194(9), 659–666.
Peters, L., Slade, T., & Andrews, G. (1999). A comparison of ICD10 and DSM-IV criteria for posttraumatic stress disorder. Journal of Traumatic Stress, 12(2), 335–343.
Post, R. M., Weiss, S. R., Li, H., Leverich, G. S., & Pert, A. (1999). Sensitization components of post-traumatic stress disorder: Implications for therapeutics. Seminars in Clinical Neuropsychiatry, 4(4), 282–294.
Pynoos, R. S., Frederick, C., Nader, K., Arroyo, W., Steinberg, A., Eth, S., et al. (1987). Life threat and posttraumatic stress in school-age children. Archives of General Psychiatry, 44(12), 1057–1063.
Quarantelli, L. E., & Dynes, R. R. (1977). Response to social crisis and disaster. Annual Review in Sociology, 3, 23–49.
Shalev, A. Y. (2000). Biological responses to disasters. Psychiatry Quarterly, 71(3), 277–288.
Shannon, M. P., Lonigan, C. J., Finch, A. J., Jr., & Taylor, C. M. (1994). Children exposed to disaster: I. Epidemiology of post-traumatic symptoms and symptom profiles. Journal of the American Academy of Child and Adolescent Psychiatry, 33(1), 80–93.
Shephard, B. (2001). A war of nerves. Cambridge, MA: Harvard University Press.
Smit, F., Cuijpers, P., Oostenbrink, J., Batelaan, N., de Graaf, R., & Beekman, A. (2006). Costs of nine common mental disorders: Implications for curative and preventive psychiatry. Journal of Mental Health Policy and Economics, 9(4), 193–200.
Soldatos, C. R., Paparrigopoulos, T. J., Pappa, D. A., & Christodoulou, G. N. (2006). Early post-traumatic stress disorder in relation to acute stress reaction: An ICD-10 study among help seekers following an earthquake. Psychiatry Research, 143(2–3), 245–253.
Solomon, Z., & Mikulincer, M. (2006). Trajectories of PTSD: A 20-year longitudinal study. American Journal of Psychiatry, 163(4), 659–666.
Stein, M. B., Walker, J. R., Hazen, A. L., & Forde, D. R. (1997). Full and partial posttraumatic stress disorder: Findings from a community survey. American Journal of Psychiatry, 154(8), 1114–1119.
Stuber, J., Galea, S., Boscarino, J. A., & Schlesinger, M. (2006). Was there unmet mental health need after the September 11, 2001 terrorist attacks? Social Psychiatry and Psychiatric Epidemiology, 41(3), 230–240.
Stuber, J., Resnick, H., & Galea, S. (2006). Gender disparities in posttraumatic stress disorder after mass trauma. Gender and Medicine, 3(1), 54–67.
Tang, C. S. (2007). Trajectory of traumatic stress symptoms in the aftermath of extreme natural disaster: A study of adult Thai survivors of the 2004 Southeast Asian earthquake and tsunami. Journal of Nervous and Mental Disease, 195(1), 54–59.
Thienkrua, W., Cardozo, B. L., Chakkraband, M. L., Guadamuz, T. E., Pengjuntr, W., Tantipiwatanaskul, P., et al. (2006). Symptoms of posttraumatic stress disorder and depression among children in tsunami-affected areas in southern Thailand. JAMA, 296(5), 549–559.
van Griensven, F., Chakkraband, M. L., Thienkrua, W., Pengjuntr, W., Lopes Cardozo, B., Tantipiwatanaskul, P., et al. (2006). Mental health problems among adults in tsunami-affected areas in southern Thailand. JAMA, 296(5), 537–548.
Wang, P. S., Aguilar-Gaxiola, S., Alonso, J., Angermeyer, M. C., Borges, G., Bromet, E. J., et al. (2007). Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet, 370(9590), 841–850.
Wang, P.S., Lane, M., Olfson, M., Pincus, H.A., Wells, K.B., & Kessler, R.C.(2005).Twelve-month use of mental health services in the United States: Results from the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 629–640.
Weisaeth, L., & Van der Kolk, B., (1996). History. In A. McFarlane, B.V.D. Kolk &L. Weisaeth, Traumatic stress- the effects of overWhelming experience on mind, body and society. New York: The Guilford Press.
Yule, W., Bolton, D., Udwin, O., Boyle, S., O’Ryan, D., & Nurrish, J. (2000).The long-term psychological effects of a disaster experienced in adolescence: I: The incidence and course of PTSD. Journal of Child Psychology and Psychiatry, 41(4), 503-511.