Sex Differences in Anxiety Disorders: A Review

Women have consistently shown to be more likely than men to meet criteria for the diagnosis of an anxiety disorder during their lifetime. 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. 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. There is also evidence of differences in brain structures responsible for anxiety and panic related circuitry. 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. 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). 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 epide- miology, phenomenology, course, and treatment response of these anxiety disorders. 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 dif- ferences in the pharmacologic management of women with anxiety disorders.