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Unspecified Anxiety Disorder: Expert Treatment Recommendations in Japan (2023)

Anxiety disorders, a widespread mental health concern, encompass a range of conditions, each with specific characteristics and treatment protocols.

However, the realm of “unspecified anxiety disorder” remains a grey area, often challenging healthcare professionals due to its lack of clear-cut guidelines.

A recent study aimed to fill this gap by developing a consensus among experts on managing this elusive disorder.


  • Unspecified anxiety disorder lacks specific criteria, making its treatment challenging.
  • Experts recommend nonpharmacological strategies as first-line treatments.
  • Benzodiazepine anxiolytics, while effective for some anxiety disorders, are not advised as a primary treatment for unspecified anxiety disorder.
  • The study emphasizes the need for more research and clinical trials to establish solid guidelines.

Source: Neuropsychopharmacology Reports (2023)

What is Unspecified Anxiety Disorder? (Causes & Symptoms)

Unspecified Anxiety Disorder is a diagnosis used when a person exhibits significant anxiety or phobic symptoms that don’t fully align with the specific criteria of known anxiety disorders like Generalized Anxiety Disorder, Panic Disorder, or Social Anxiety Disorder.

This ambiguity often poses challenges in diagnosis and treatment.


The exact causes of unspecified anxiety disorder are not well-defined due to its broad and non-specific nature.

However, like other anxiety disorders, a combination of genetic, environmental, psychological, and developmental factors may contribute to its onset.


Symptoms can vary widely but generally include:

  • Persistent and excessive worry
  • Restlessness or feeling on edge
  • Difficulty concentrating
  • Irritability
  • Muscle tension
  • Sleep disturbances

These symptoms are similar to other anxiety disorders but do not meet the complete criteria for any one specific disorder.


Diagnosing unspecified anxiety disorder typically involves:

  • A detailed medical and psychological history
  • Assessing symptoms and their impact on daily life
  • Ruling out other mental health disorders
  • Evaluating if the symptoms match specific anxiety disorders or if they remain unclassified

Treatment of Unspecified Anxiety (2023 Expert Opinion)

Sakurai et al. sought to establish a consensus among experts on the management of unspecified anxiety disorder, given the lack of specific treatment guidelines.

How was the expert consensus established?

The study engaged 119 mental health experts who evaluated treatment options using a nine-point Likert scale.

These options spanned pharmacological and nonpharmacological treatments, based on eight clinical questions related to unspecified anxiety disorder.

What were the findings?

Nonpharmacological strategies (like coping strategies, psychoeducation, lifestyle changes, and relaxation techniques) were highly recommended as first-line treatments.

Benzodiazepine anxiolytics, typically used for anxiety disorders, were not recommended as a primary treatment option.

Limitations to consider…

The study’s limitations are noteworthy:

  • It reflects expert opinions, which are considered lower evidence in evidence-based medicine.
  • The heterogeneity of the disorder and lack of specific clinical trials on the subject limit the generalizability of the findings.

What are the takeaways for clinical practice?

The study’s results have several implications for treating unspecified anxiety disorder:

Emphasis on Nonpharmacological Treatments

  • Patient Empowerment: These treatments empower patients to actively manage their anxiety through lifestyle changes and coping strategies.
  • Reduced Dependency on Medication: There is a clear shift away from the reliance on benzodiazepines, potentially reducing issues related to drug dependency and side effects.

Need for Holistic Treatment Approaches

  • Comprehensive Care: The findings encourage healthcare providers to adopt a more holistic and patient-centered approach.
  • Individualized Treatment Plans: Given the variability in the efficacy of treatments, personalized care plans are essential.

Conflicts of Interest in the Expert Consensus Recommendations for Unspecified Anxiety Disorder?

It is crucial to highlight the potential conflicts of interest among the contributors to the study on unspecified anxiety disorder, as they could influence the study’s recommendations and outcomes.

Here are the specific conflicts of interest disclosed:

  1. Dr. Hitoshi Sakurai: Reported receiving grants from Takeda Science Foundation, and manuscript and speaker fees from multiple pharmaceutical companies including Eisai, Takeda Pharmaceutical, Otsuka Pharmaceutical, Meiji Seika Pharma, Shionogi Pharma, Yoshitomiyakuhin, Sumitomo Pharma, Kyowa Pharmaceutical, and Lundbeck Japan.
  2. Dr. Ken Inada: Disclosed receiving personal fees and grant support from various companies such as Eisai, Eli Lilly, Janssen, Meiji Seika Pharma, Mitsubishi Tanabe Pharma, Mochida, MSD, Novartis, Otsuka, Shionogi, Sumitomo Pharma, and Yoshitomiyakuhin in the last three years.
  3. Other Authors: Several other authors involved in the study also declared receiving speaker’s honoraria, personal fees, and research grants from various pharmaceutical companies. These affiliations encompass a range of companies involved in the production and marketing of psychiatric medications, including those for the treatment of anxiety disorders.

The conflicts of interest disclosed by the authors of the study on unspecified anxiety disorder could have influenced the paper in several ways.

It’s important to note that while the presence of conflicts of interest does not necessarily imply bias, it does raise questions about the potential for such bias.

Here are some ways in which these conflicts might have influenced the study:

  • Pharmaceutical Company Ties: Many of the authors disclosed receiving funding or fees from pharmaceutical companies. These companies often have vested interests in promoting their medications as treatment options.
  • Recommendations for Specific Treatments: Authors with financial ties to pharmaceutical companies might be more inclined to recommend specific medications, particularly those produced by companies they have relationships with. This could influence the study’s treatment recommendations, particularly concerning the use of SSRIs.
  • Interpretation of Data: Authors’ ties to pharmaceutical companies might affect how they interpret study data, potentially leading to a bias in presenting the effectiveness or safety of certain treatments.
  • Selection of Study Parameters: The design of the study, including the choice of which treatments to evaluate and how to evaluate them, could be influenced by the authors’ conflicts of interest. There might be a tendency to include or emphasize treatments that align with the interests of pharmaceutical companies.
  • Reporting of Results: There could be a bias in how results are reported, with a possible emphasis on findings that favor pharmacological treatments. This might also influence the discussion of the study’s implications and the framing of its conclusions.
  • Underrepresentation of Nonpharmacological Approaches: Although the study emphasized nonpharmacological treatments, there could be a tendency to underrepresent these approaches or not explore them in as much detail due to the authors’ connections with drug companies.

Future Research of Unspecified Anxiety

Validation of Nonpharmacological Interventions

  • Effectiveness Studies: Rigorous clinical trials are needed to confirm the effectiveness of the recommended nonpharmacological strategies.

Pharmacological Treatments

  • Role of SSRIs and Other Drugs: Further research should explore the role and effectiveness of SSRIs and other antidepressants in treating unspecified anxiety disorder.

Long-Term Outcomes

  • Sustainability of Treatment: Studies should focus on the long-term outcomes and sustainability of both pharmacological and nonpharmacological treatments.

Broader Patient Demographics

  • Diverse Populations: Future research needs to include more diverse patient groups to enhance the generalizability of the findings.

Takeaway: Nonpharmacological Treatments Recommended for Unspecified Anxiety

This report represents a crucial advancement in the understanding and management of unspecified anxiety disorder.

By highlighting the effectiveness of nonpharmacological interventions and questioning the conventional reliance on benzodiazepines, it paves the way for a more nuanced and patient-focused approach to treatment.

However, the need for further research is evident, particularly in conducting randomized controlled trials and exploring the long-term effectiveness and applicability of these recommendations across diverse patient populations.

As the field evolves, these insights will undoubtedly contribute to more effective and personalized treatment strategies for those suffering from unspecified anxiety disorder.


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