Anxiety disorders in the elderly: DSM-IV and other barriers to diagnosis and treatment.

Traditional lore suggests that anxiety disorders are less prevalent in elderly than in younger adults, and late-onset anxiety disorders are especially rare. We question these assumptions, and suggest that these conditions are underdiagnosed in late life. A common problem in the literature is the application of DSM-IV-like criteria developed from studies of younger adults to geriatric samples without regard for atypical symptom presentations, high occurrence of depressive and medical co-morbidity, and influence of aging-related psychosocial changes on the clinical picture. Diagnostic problems are further compounded by therapeutic ones. Clinicians are often forced to make treatment decisions for their elderly patients based on uncontrolled clinical observations or questionable extrapolation of treatment data in younger adults. An open-minded approach unhinged by 'conventional wisdom' is warranted.