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This chapter describes the underlying mechanisms and causes of anxiety in people with PWS. Underlying medical conditions such as hypothyroidism may cause anxiety. Response perseveration as a possible explanatory mechanism behind anxiety, obsessive-compulsive symptoms, and poor frustration tolerance is discussed. Co-occurring anxiety disorders are described through case examples. Anxiety can be a sign of an underlying disorder: panic disorder, GAD, etc. COVID-19 pandemic related worsening of anxiety is discussed.Patients with PWS of all ages are especially vulnerable to behavioral outbursts and psychological distress in the face of rapid and drastic changes to routine and lifestyle. Awareness of the wide variety of ways anxiety presents in PWS is needed for its early recognition and appropriate management.
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