Anxiety Disorders

by

Jeannette M. Reid, Dean McKay

• LAST REVIEWED: 22 April 2013
• LAST MODIFIED: 22 April 2013
• DOI: 10.1093/obo/9780199828340-0006

Introduction

Recent epidemiological research has shown that anxiety disorders, collectively, are the most common set of psychiatric disorders. Lifetime prevalence estimates suggest that nearly 30 percent of the population will experience an anxiety disorder at some point in their life (Kessler, et al. 2005, cited under Phobias). Bolstering the concern, anxiety disorders (as a group) tend to be associated with a host of cognitive impairments (e.g., perseveration, visual memory deficits), diminished quality of life (e.g., in areas of work and social functioning), and both psychiatric and medical comorbidities. Anxiety disorders may be roughly classed into two groups: (1) those characterized primarily by acute fear (e.g., phobias) and (2) those associated with lower level, but chronic, anxiety and apprehension (with the clearest example being generalized anxiety disorder). Cognitive and behavioral explanations of anxiety predominate, with related treatments showing most consistent research support among psychosocial interventions. (While standard pharmacological practices are mentioned wherever relevant, a more in-depth discussion of pharmacological interventions for anxiety disorders is outside the scope of this chapter.) In general, the etiology of anxiety disorders is likely best understood through the lens of the diathesis-stress model—such that individuals have a genetic predisposition/vulnerability and situational factors mediate symptomatology. (Certainly, a sudden expression of symptoms following brain damage would be an exception. However, as these presentations—albeit fascinating—are in the minority, a related discussion will be beyond the scope of this bibliography.) Within this article, the following anxiety disorders will be discussed in detail: phobias, panic with and without agoraphobia, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder. Factors of current interest in the field will be attended to specifically—for instance, comorbidity in obsessive-compulsive disorder and differential risk in posttraumatic stress disorder. Throughout the discussion, pertinent works will be delineated and summarized.

Introductory Works

The following works have been selected for both their breadth and the authors’ prominence in the field. Barlow 2002 provides an in-depth review of classification, presentation, etiology, assessment, and treatment of all anxiety disorders that appear in the Diagnostic and statistical manual of mental disorders (DSM-IV-TR). Theories of fear acquisition (e.g., evolutionary) are assessed by Ollendick and King 1991 and by Ohman 2009. Borkovec’s is the most frequently cited name in GAD (generalized anxiety disorder) for his research in developing a comprehensive model of the condition and the underlying primary mechanism: worry. This has led to considerable research on worry; accordingly, two of Borkovec’s most frequently cited works have been selected—Borkovec 1994 and Borkovec, et al. 1991. Finally, we recommend the comprehensive work by Antony and Stein 2008 for information on biological bases of various anxiety disorders.

• Antony, M. M., and M. B. Stein. 2008. Oxford handbook of anxiety disorders. New York: Oxford Univ. Press.

  DOI: 10.1093/oxfordhb/9780195307030.001.0001

  This book offers comprehensive coverage of the full range of anxiety disorders. Of note, the book includes a chapter on the underlying biological bases of specific anxiety disorders and includes a chapter on the neuroscience of anxiety (i.e., proposed fear circuitry).

• Barlow, D. H. 2002. The nature of anxious apprehension. In Anxiety and its disorders: The nature and treatment of anxiety and panic. 2d ed. Edited by D. H. Barlow, 64–104. New York: Guilford.

  Barlow reviews his fundamental conceptualization of anxiety as a “sense of uncontrollability focused largely on possible future, threat, danger, or other potentially negative events” (p. 64)—a state that appears to require both cognitive and physical hypervigilance. This chapter, as well as the book as a whole, is one of the most frequently cited sources on anxiety disorders and covers the full range of theory and phenomenology of anxiety experiences.

• Borkovec, T. D. 1994. The nature, functions, and origins of worry. In Worrying: Perspectives on theory, assessment, and treatment. Edited by G. Davey and F. Tallis, 5–33. New York: Wiley.

  Borkovec reviews theoretical perspectives on worry’s origins as well as physiological correlates to the common experience of worry. Given the central role worry occupies in many anxiety disorders, this chapter is important in the foundations of understanding this specific cognitive feature.

• Borkovec, T. D., R. Shadick, and M. Hopkins. 1991. The nature of normal and pathological worry. In Chronic anxiety: Generalized anxiety disorder, and mixed anxiety depression. Edited by R. M. Rapee and D. H. Barlow, 29–51. New York: Guilford.

  Borkovec is the leading name in research on generalized anxiety disorder. In this chapter, he and colleagues offer distinctions between typical and pathological (i.e., functional and dysfunctional) worry. This chapter sets the stage for establishing the distinct nature of worry in psychopathology as compared to everyday worry. In light of the ubiquity of worry, setting out the boundaries for how to distinguish normal from abnormal worry is an important conceptualization.

• Ohman, A. 2009. Of snakes and faces: An evolutionary perspective on the psychology of fear. Scandinavian Journal of Psychology 50:543–552.

  DOI: 10.1111/j.1467-9450.2009.00784.x

  Ohman reviews an evolutionary perspective of fear via literature on differential fear conditioning, quicker nonconscious processing, and enhanced attention toward both snakes and threatening faces when compared to neutral stimuli. There has been considerable interest in the basic evolved nature of fear. Of particular interest has been the way in which this information is processed, and Ohman provides an extensive analysis of cognitive processing of fear.

• Ollendick, T. H., and N. J. King. 1991. Origins of childhood fears: An evaluation of Rachman’s theory of fear acquisition. Behaviour Research and Therapy 29:117–123.

  Ollendick and King examine the extent to which childhood fear onset can be attributed to indirect sources of learning (i.e., vicarious and instructional factors) versus direct conditioning. Childhood anxiety is of generalized importance since the developmental features of anxiety set the stage for treatment across all ages. The etiological theory of anxiety is described and evaluated in the context of Rachman’s theory, an important model of anxiety acquisition.