What is an anxiety disorder?

Abstract

Initiated as part of the ongoing deliberation about the nosological structure of DSM, this review aims to evaluate whether the anxiety disorders share features of responding that define them and make them distinct from depressive disorders, and/or that differentiate fear disorders from anxious-misery disorders. The review covers symptom self-report as well as on-line indices of behavioral, physiological, cognitive, and neural responding in the presence of aversive stimuli. The data indicate that the anxiety disorders share self-reported symptoms of anxiety and fear; heightened anxiety and fear responding to cues that signal threat, cues that signal no threat, cues that formerly signaled threat, and contexts associated with threat; elevated stress reactivity to aversive stimuli; attentional biases to threat-relevant stimuli and threat-based appraisals of ambiguous stimuli; and elevated amygdala responses to threat-relevant stimuli. Some differences exist among anxiety disorders, and between anxiety disorders and depressive disorders. However, the differences are not fully consistent with proposed subdivisions of fear disorders vs. anxious misery disorders, and comparative data in large part are lacking. Given the high rates of comorbidity, advances in our understanding of the features of responding that are shared across vs. unique to anxiety and depressive disorders will require dimensional approaches. In summary, the extant data help to define the features of responding that are shared across anxiety disorders, but are insufficient to justify revisions to the DSM nosology at this time. Depression and Anxiety

Aversive learning and generalization predict subclinical levels of anxiety: A six-month longitudinal study

“…It is also possible, however, that common processes are involved in discriminatory aversive learning and generalization. For instance, deficits in the processing of perceptual information can account for impaired discrimination learning, as well as for increased generalization to stimuli resembling the originally conditioned stimuli (Craske et al, 2009). Future research should be aimed at gaining insight in these underlying processes.…”

Anxiety Disorder Comorbidity in Bipolar Disorder, Schizophrenia and Schizoaffective Disorder

“…In addition, this finding suggests that SZA may have etiological and pathophysiological features that differ from those of BP or SZ. Anxiety disorders are characterized by abnormalities in the amygdala and prefrontal cortex [45,46,47]. To the extent that SZA patients are differentially at risk of developing anxiety disorders, this may suggest the existence of shared neural substrates for these conditions.…”

Fear Generalization in Humans: Systematic Review and Implications for Anxiety Disorder Research

“…Fear generalization is a defining feature of anxiety disorders such that the focus of fear becomes excessive and unrestricted, extending to a whole class of objects, persons, and situations (American Psychiatric Association, 2013;Craske et al, 2009, Lissek, 2012. This perceptual and nonperceptual generalization means that aversive experiences with one exemplar may lead people to infer that classes of related cues are fearful, dangerous, and need to be avoided, despite their physical differences.…”

“…This perceptual and nonperceptual generalization means that aversive experiences with one exemplar may lead people to infer that classes of related cues are fearful, dangerous, and need to be avoided, despite their physical differences. As a result, the clinically anxious individual comes to fear, and avoid, all potentially threatening objects and situations, leading to impairment in social functioning and diminished quality of life (Craske et al, 2009). This broadening of stimuli that come to elicit fear and anxiety can involve mechanisms of stimulus generalization as traditionally described in the conditioned learning literature, as detailed in this review.…”