The WPA Section on Anxiety and Obsessive-Compulsive Disorders focuses its activities on a broad range of common and burdensome psychiatric conditions encompassing anxiety and fear-related disorders, obsessive-compulsive and related disorders, and behavioural addiction disorders, including problematic Internet use. This is an exciting area of developing clinical practice, as anxiety and obsessive-compulsive symptoms are increasingly played out in the digital environment.

The Section provides a forum for clinician scientists and academics to exchange experiences and research advances. It organizes activities at WPA meetings, produces scientific publications and develops guidance on relevant topics, in collaboration with key stakeholder groups such as the World Health Organization (WHO), the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) (www.icocs.org), the Anxiety Disorders and Obsessive-Compulsive Research Networks of the European College of Neuropsychopharmacology (ECNP) (www.ecnp.eu), and the European Network for Problematic Usage of the Internet (www.internetandme.eu). Here we review some of the Section's recent initiatives and its ambitions for the next five years.

The ICD-11 has refined and expanded the classification of anxiety disorders, and created two new groupings, one for Obsessive-Compulsive and Related Disorders and another for Disorders due to Addictive Behaviours, including several new diagnoses.

The ICD-11 grouping of Anxiety or Fear-Related Disorders differentiates fear-related disorders (i.e., phobias related to discrete aversive situations) from anxiety disorders related to a sustained expectation that diffuse aversive events will occur. Separation anxiety disorder and selective mutism have been moved into this grouping.

Obsessive-compulsive and related disorders often present late for treatment, resulting in poor clinical outcomes. To improve recognition and diagnosis, some members of our Section worked with the WHO to reclassify disparate diagnoses into a single Obsessive-Compulsive and Related Disorders grouping. A seminal field study demonstrated that health care practitioners make more accurate diagnoses of these disorders using the ICD-11 vs. ICD-10¹. Moreover, this new classification has advanced research heuristics establishing compulsivity as a transdiagnostic neuropsychological domain.

Another new ICD-11 grouping was created for Disorders due to Addictive Behaviours. This includes two new disorders – gaming disorder and gambling disorder (on- or off-line) – and a residual category for possible diagnosis of other forms of problematic behaviour with addictive, impulsive and/or compulsive features, including buying or shopping, pornography use, social media use, cyberchondria, digital hoarding, and online streaming.

Evidence of overlap between compulsive and addictive mechanisms and disorders has led to the establishment of the European Network for Problematic Usage of the Internet, bringing together experts in compulsivity, impulsivity and addiction. Seminal consensus papers on diagnosis, underpinning mechanisms, and assessment were published², culminating in a festival of science and arts, a string of educational webinars, a textbook published in the WPA Global Mental Health in Practice Series³, and a popular e-book, Learning to Deal with Problematic Usage of the Internet, translated into five languages and downloaded freely hundreds of times (www.icocs.org).

Interest in anxiety and obsessive-compulsive disorders and in problematic Internet use was sharpened into focus by the COVID-19 pandemic and its aftermath. For those with the above disorders, dangers of infection inherent during the pandemic directly impacted clinical care by increasing social avoidance and preventing engagement in critical therapeutic activities. Inflexible thinking and obsessive health concerns led to public health challenges such as vaccine hesitancy and difficulties emerging from COVID-19 lockdown.

Increased use of digital communication initiated by the pandemic brought many benefits but also new challenges and risks for individuals and civil society. These included problems in balancing time spent on- and off-line, dissemination of abuse and misinformation, and societal fragmentation. Problematic Internet use, an umbrella category representing various forms of maladaptive Internet use involving loss of control or hazardous use patterns, has far-reaching harmful consequences for health and well-being in the individual and society^{2, 4}. Adolescents whose cognitive control is not yet developed and those with certain mental health issues are disproportionately affected by this condition, which can be conceptualized as a marker of disrupted self-management. Critically, during the COVID-19 pandemic, global rates of problematic Internet use increased, reaching 7.9% in a meta-analysis and over 30% in some low- and middle-income countries⁵.

In response to the above scenario, members of our Section published open-access consensus guidance for treating anxiety and obsessive-compulsive disorders and for preventing problematic Internet use during and after the pandemic^{6, 7}.

Responding to the “hidden pandemic” of problematic Internet use, Section members expanded the relevant European Network into a 5-year research programme, Boosting Societal Adaptation and Mental Health in a Rapidly Digitalizing, Post-Pandemic Europe (BootStRaP). This includes partners in >20 countries and a global advisory panel. It aims to reduce the harmful effects of digitalization on mental health by creating an evidence-based suite of digital behavioural health interventions addressing vulnerability to problematic Internet use in young people, whose effectiveness will be tested in a series of randomized controlled trials. The project will also develop a health and social policy toolkit, and standards to promote digital human rights and safeguard vulnerable groups from exploitation.

Advances in the neurobiology and treatment of the Anxiety or Fear-Related Disorders and Obsessive-Compulsive and Related Disorders has resulted in an expanding armamentarium of interventions, reaching beyond traditional models to include techniques such as neuromodulation, immunotherapy and neurosurgery. Section members contributed to a revision of the World Federation of Societies of Biological Psychiatry treatment guidelines^{8, 9}. Another collaboration with the Canadian Network for Mood and Anxiety Treatments and the ICOCS is developing a user-friendly set of international guidelines for obsessive-compulsive disorder for release in 2024.

Addressing a critical knowledge gap, Section members were among a group of experts applying a Delphi method-based consensus approach to produce internationally agreed, consistent and clinically useful criteria for treatment-resistant anxiety disorders, to support future trial design and advance evidence-based stepped-care treatment algorithms¹⁰. Following this initiative, Section members, in collaboration with the ECNP Obsessive-Compulsive Research Network and the ICOCS, will use a similar approach to develop clinically useful criteria for treatment-resistant obsessive-compulsive and related disorders.

Given the global burden of problematic Internet use, its impact on youth, and the need for large-scale public health approaches to address it, Section members have embarked on a Lancet Psychiatry Commission with broad international representation that will focus on particularly vulnerable populations to provide globally relevant recommendations for health and social policy changes.

Contemporary challenges in mental health demand cutting-edge solutions. Theoretical frameworks that take an integrative and transdiagnostic approach, and practical initiatives that are inclusive and have transcultural impact, are needed.

The WPA Section on Anxiety and Obsessive-Compulsive Disorders has embraced the responsibility of contributing to such frameworks and initiatives, focusing on disorders that collectively impact a large proportion of the population. Given the high prevalences and limited resources, there is a pressing need for novel technologies in prevention, diagnosis and treatment.

Our Section has considerable potential to empower clinicians, mental health providers and researchers to advance the field. Colleagues who share our vision and interest are warmly invited to join us and contribute to our shared goals.

WPA 焦虑和强迫症科的活动重点是广泛的常见和繁重的精神疾病，包括焦虑和恐惧相关障碍、强迫症和相关障碍以及行为成瘾障碍，包括有问题的互联网使用。这是临床实践发展中一个令人兴奋的领域，因为焦虑和强迫症状越来越多地在数字环境中表现出来。

该科为临床科学家和学者提供了一个交流经验和研究进展的论坛。它与世界卫生组织 (WHO)、国际强迫症谱系障碍学院 (ICOCS) (www.icocs. org）、欧洲神经精神药理学学院（ECNP）焦虑症和强迫症研究网络（www.ecnp.eu）以及欧洲互联网使用问题网络（www.internetandme.eu）。在这里，我们回顾了该科最近的一些举措及其未来五年的目标。

ICD-11 完善并扩展了焦虑症的分类，并创建了两个新的分组，一个用于强迫及相关疾病，另一个用于成瘾行为引起的疾病，其中包括一些新的诊断。

ICD-11 对焦虑或恐惧相关障碍的分类将恐惧相关障碍（即与离散厌恶情境相关的恐惧症）与与持续预期会发生弥漫性厌恶事件相关的焦虑障碍区分开来。分离焦虑症和选择性沉默症已被归入这一组。

强迫症及相关疾病往往治疗较晚，导致临床结果不佳。为了提高认识和诊断，我们科的一些成员与世界卫生组织合作，将不同的诊断重新分类为一个强迫症及相关疾病组。一项开创性的现场研究表明，医疗保健从业者使用 ICD-11 与 ICD-10 ¹相比，可以更准确地诊断这些疾病。此外，这种新的分类具有先进的研究启发法，将强迫症确立为跨诊断的神经心理学领域。

另一个新的 ICD-11 分组是针对成瘾行为引起的疾病而创建的。这包括两种新的疾病——游戏障碍和赌博障碍（在线或离线）——以及一个剩余类别，用于可能诊断其他形式的具有成瘾、冲动和/或强迫特征的问题行为，包括购买或购物、色情内容的使用、社交媒体使用、网络疑病症、数字囤积和在线流媒体。

强迫性和成瘾机制与疾病之间存在重叠的证据导致了欧洲互联网使用问题网络的建立，汇集了强迫性、冲动性和成瘾方面的专家。发表了关于诊断、基础机制和评估的开创性共识论文² ，最终形成了科学和艺术节、一系列教育网络研讨会、WPA 全球心理健康实践系列³中出版的教科书以及一本流行的电子书，学习处理有问题的互联网使用，翻译成五种语言并免费下载数百次（www.icocs.org）。

COVID-19 大流行及其后果加剧了人们对焦虑症、强迫症以及有问题的互联网使用的兴趣。对于患有上述疾病的人来说，大流行期间固有的感染危险增加了社交回避并阻止参与关键的治疗活动，从而直接影响了临床护理。僵化的思维和过分的健康担忧导致了公共卫生挑战，例如对疫苗的犹豫以及因 COVID-19 封锁而出现的困难。

大流行引发的数字通信使用增加带来了许多好处，但也给个人和民间社会带来了新的挑战和风险。其中包括平衡线上和线下时间、滥用行为和错误信息的传播以及社会分裂等问题。有问题的互联网使用是一个总括类别，代表各种形式的不适应互联网使用，涉及失控或危险使用模式，对个人和社会的健康和福祉产生深远的有害后果^{2, 4} 。认知控制尚未发展的青少年和患有某些心理健康问题的青少年尤其容易受到这种情况的影响，这可以被概念化为自我管理紊乱的标志。至关重要的是，在 COVID-19 大流行期间，全球互联网使用问题率有所上升，荟萃分析显示达到 7.9%，在一些低收入和中等收入国家超过 30% ⁵ 。

针对上述情况，我们部门的成员发布了开放获取共识指南，用于治疗焦虑症和强迫症以及预防大流行期间和之后的互联网使用问题^{6, 7} 。

为了应对互联网使用问题这一“隐性流行病”，该部门成员将相关欧洲网络扩展为一项为期 5 年的研究计划，即在疫情后快速数字化的欧洲促进社会适应和心理健康 (BootStRaP)。这包括 >20 国家的合作伙伴和全球顾问小组。它旨在通过创建一套基于证据的数字行为健康干预措施来减少数字化对心理健康的有害影响，解决年轻人对互联网使用问题的脆弱性，其有效性将在一系列随机对照试验中进行测试。该项目还将开发健康和社会政策工具包以及标准，以促进数字人权并保护弱势群体免受剥削。

神经生物学以及焦虑或恐惧相关疾病和强迫及相关疾病治疗方面的进步导致干预措施不断扩大，超越了传统模式，包括神经调节、免疫治疗和神经外科等技术。该部门成员为世界生物精神病学协会联合会治疗指南的修订做出了贡献^{8, 9} 。与加拿大情绪和焦虑治疗网络以及 ICOCS 的另一项合作是制定一套用户友好的强迫症国际指南，将于 2024 年发布。

为了解决关键的知识差距，该部门成员与一组专家一起应用基于德尔菲法的共识方法，为难治性焦虑症制定国际商定的、一致的和临床有用的标准，以支持未来的试验设计并推进基于证据的步骤-护理治疗算法¹⁰ ．在这一举措之后，该部门的成员将与 ECNP 强迫症研究网络和 ICOCS 合作，使用类似的方法来制定临床上有用的治疗难治性强迫症及相关疾病的标准。

鉴于有问题的互联网使用给全球带来的负担、其对青少年的影响以及采取大规模公共卫生方法来解决这一问题的必要性，该部门成员已着手成立一个具有广泛国际代表性的柳叶刀精神病学委员会，该委员会将重点关注特别脆弱的人群，以提供关于卫生和社会政策变化的全球相关建议。

当代心理健康挑战需要尖端的解决方案。需要采用综合和跨诊断方法的理论框架，以及具有包容性和跨文化影响的实际举措。

WPA 焦虑和强迫症科承担了为此类框架和举措做出贡献的责任，重点关注共同影响大部分人口的疾病。鉴于患病率高和资源有限，迫切需要预防、诊断和治疗方面的新​​技术。

我们的部门具有巨大的潜力，可以帮助临床医生、心理健康服务提供者和研究人员推动该领域的发展。热烈邀请与我们有共同愿景和兴趣的同事加入我们，为我们的共同目标做出贡献。