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  • Cited by 40
Cambridge University Press
Online publication date:
November 2010
Print publication year:
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Book description

Anxiety disorders are amongst the most common of all mental health problems. Research in this field has exploded over recent years, yielding a wealth of new information in domains ranging from neurobiology to cultural anthropology to evidence-based treatment of specific disorders. This book offers a variety of perspectives on new developments and important controversies relevant to the theory, research, and clinical treatment of this class of disorders. Clinicians will find reviews of state-of-the-art treatments for panic disorder, social anxiety disorder, phobias, obsessive-compulsive disorder, generalized anxiety disorder, and post-traumatic stress disorder, as well as controversies over diagnostic and treatment issues. Researchers will find in-depth consideration of important selected topics, including genetics, neuroimaging, animal models, contemporary psychoanalytic theory, and the impact of stressors. This book illustrates the enormous advances that have occurred in anxiety research and describes the evolving multi-disciplinary efforts that will shape the future of the field.


‘It is uncommon to read a good book on anxiety disorders. This one, however, is unusually fine. Anxiety Disorders: Theory, Research and Clinical Perspectives is highly descriptive and clinically useful. It is well researched and a pleasure to read … It is written in a compelling style, which is a benefit to the student, clinician, or educated layman. The references are excellent and the index is helpful. This is a good book for any clinician interested in anxiety. It covers theory, diagnoses, treatment, and future directions … I highly recommend it.’

James Allen Wilcox Source: Annals of Clinical Psychiatry

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  • 9 - Co-occurring anxiety and depression: concepts, significance, and treatment implications
    pp 90-102
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    This introductory chapter presents an overview of concepts covered in the following chapters of the book. It represents a selective review of the work undertaken over the last three decades to advance our understanding of anxiety and anxiety disorders. Research has transformed how we treat anxiety disorders: evidence-based practices have been developed and are being disseminated not only to mental health settings but also to primary care practices. Cognitive-behavioral approaches reign among psychotherapies, and the FDA has approved several classes of medication for the treatment of anxiety disorders. The focus has shifted away from identifying a treatment that can beat a placebo or usual care to developing better and novel treatments for those who do not fully respond to first-line treatments. Increasingly, these novel treatments are based on sophisticated theories of the mechanisms underlying the symptoms.
  • 10 - Understanding health anxiety
    pp 103-115
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    Epidemiologic surveys consistently document that anxiety disorders are the most prevalent class of mental disorders. This chapter reviews the prevalence and distribution of DSM-IV anxiety disorders across the life span, drawing predominantly on large-scale epidemiologic surveys conducted in developed regions of the world, where the most rigorous work has been conducted. Sex differences in the prevalence of anxiety disorders are consistent across cultures and survey methods. Across cultures, epidemiologic work typically finds women to be at greater risk for social anxiety disorder (SAD) than men. Across several DSM iterations, generalized anxiety disorder (GAD) has evolved from a non-specific residual anxiety category to its current status as a primary anxiety disorder. Across cultures, lifetime panic disorder (PD) rates range roughly from 2% to 4%, and 1-3% reports the presence of PD within the past year. Increased efforts are needed to document population- based prevalence estimates of childhood anxiety disorders.
  • 12 - “Idioms of distress” (culturally salient indicators of distress) and anxiety disorders
    pp 127-138
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    This chapter follows the evolution of the nosology of the anxiety disorders through various editions of the APA's Diagnostic and Statistical Manuals (DSM) and culminates with a summary of some of the possible changes that might occur in the classification of anxiety disorders in DSM-5. Present-day anxiety disorders were also covered in some of the other DSM-I groupings. Given increased attention to disorders specifically related to children and adolescents, a new grouping, behavior disorders of childhood and adolescence, was added in DSM-II. The DSM-III diagnostic criteria for panic disorder were based on the Feighner criteria for anxiety neurosis. DSM-III-R field trials were conducted for agoraphobia without history of panic disorder (AWOPD) and generalized anxiety disorder (GAD). One new anxiety disorder was added to DSM-IV, acute stress disorder. The grouping of related disorders into spectra is a novel organizational approach proposed for DSM-5.
  • Section 3 - Understanding the causes of anxiety
    pp 139-248
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    Social phobia turned out to be a severe clinical problem for patients whose fear of evaluation and scrutiny by others interfered with social functioning as well as performance. The study comparing phenelzine, atenolol, and placebo in social anxiety disorder became a model to be followed by subsequent trials. Social anxiety disorder appears to be a highly prevalent condition. While the most recent epidemiologic survey, the NESARC, has found a lifetime prevalence of 5% as opposed to the 13% found in the original National Comorbidity Survey (NCS) study, it would still appear that social anxiety disorder is one of the more common psychiatric conditions. Future studies should go a long way toward clarifying the pathophysiology of social anxiety disorder, which in turn should facilitate diagnosis as well as treatment. Positron emission tomography (PET) scans of patients giving speeches are beginning to delineate the brain circuits relevant to social phobic symptomatology.
  • 14 - Animal models of anxiety disorders: behavioral and genetic approaches
    pp 156-167
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    Anxiety is both an innate and a constructed response to perceived and anticipated threat. This chapter explores anxiety as signal, symptom and syndrome, and describes the evolution of the major psychodynamic models of signal anxiety. The major psychodynamic models of signal anxiety posit anxiety as a signal of unconscious, intrapsychic danger. Neurobiological factors also contribute to the development and expression of anxiety symptoms and syndromes. Imaging techniques have been used to illustrate the presence of unconscious processes that to date have only been hypothesized; specifically that unconscious affects are a crucial determinant of behavior. Many symptomatic patients were forced to make adaptations to internal and external threats in early childhood. Ironically, the treatment of symptomatic anxiety may create an anxiety of its own, the anxiety about change. Many patients present with the acute onset of anxiety symptoms but do not meet the criteria for an Axis I anxiety disorder.
  • 15 - Role of the cortex in the regulation of anxiety states
    pp 168-179
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    This chapter views anxiety as an organized group of adaptive functions by which an organism senses, evaluates, and responds to cues of danger in its external (or internal) environment. The mechanism of evolution, natural selection, is primarily supported by evidence provided in the remarkable variation in domesticated species. One of the major difficulties that psychiatrists have with evolutionary accounts of the origin of major mental illnesses is the apparently incapacitating effects of these conditions and effects that should have led to their disappearance from the gene pool in the more hostile environments of our prehistoric past. The evolution of social relationships based on mutual attachment in mammals provides a new set of behaviors, motivational systems, and dangers within which a new variant of anxiety can evolve. Social and other environmental interactions can either intensify anxiety and/or preserve the life and comfort of the patient with anxiety disorder.
  • 16 - Learned fear and innate anxiety in rodents and their relevance to human anxiety disorders
    pp 180-191
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    This chapter identifies clinically meaningful subtypes of obsessive-compulsive disorder (OCD) including discrete categories based on age of onset and comorbidity with related disorders, and then describes efforts to understand obsessive-compulsive (OC) symptoms as dimensions. Both categorical and dimensional approaches have been applied in research on refining the phenotype of OCD. A strategy that has been successfully applied to other heterogeneous and complex psychiatric disorders is to identify intermediate phenotypes that are more closely related to neurobiological mechanisms than phenotypes. Modern neuroimaging techniques have allowed abnormalities in white-matter brain tissue to be investigated as potential OCD endophenotypes. Subtypes of OCD have been proposed, based on early age of onset, tic comorbidity, and obsessive-compulsive personality disorder (OCPD) comorbidity. Another approach to deconstructing the heterogeneity of OCD is the identification of vulnerability markers or endophenotypes. Integrating phenotypical and endophenotypical approaches may be fruitful in advancing the field.
  • 18 - Cognitive–behavioral treatment of anxiety disorders: model and current issues
    pp 204-215
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    This chapter assesses the relationship of social anxiety disorder (SAD) to trait phenomena of shyness, behavioral inhibition, and avoidant personality. It explores the concept that these constructs lie on a spectrum of socially anxious temperaments, and that these temperaments are essential and adaptive for group-living species. Finally, it considers evidence that the same temperamental features influence, to a variable extent, a much broader spectrum of psychopathology. Several key features of SAD are also considered defining features of personality traits and disorders, including early age of onset, chronic course, pervasive quality, and tendency to be experienced as ego-syntonic. The spectrum of social anxiety temperament also appears to be related to a much broader spectrum of associated psychopathology. SAD has been reported to be a pre-morbid risk factor for schizophrenia and a comorbid disorder in as many as 36% of outpatients with schizophrenia.
  • 19 - The stressor criterion A in posttraumatic stress disorder: issues, evidence, and implications
    pp 216-226
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    This chapter reviews the phenomenology and neurobiology of co-occurring anxious and depressive symptoms and disorders, and describes their clinical relevance, including prognostic and treatment implications. Several demographic factors were also associated with anxious depression, including African-American or Hispanic race, and lower educational attainment or income. It examines the extent to which genetic factors contributing to anxiety and depression are shared by reviewing family, twin, and molecular association studies. A unique series of twin studies has examined the genetic contribution to the comorbidity of major depressive disorder (MDD) and generalized anxiety disorder (GAD). The evidence from multiple lines of inquiry suggests that there is a biologic relationship between anxiety and depression, including a shared genetic diathesis that may manifest in either a depression or an anxiety phenotype. Brain imaging studies suggest that comorbid anxiety and depression may exhibit some additive effects of the pathophysiology of individual depression and anxiety disorders.

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