Vladan Starcevic, MD, PhD
- Published in print:
- 2009
- Published Online:
- November 2020
- ISBN:
- 9780195369250
- eISBN:
- 9780197562642
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/oso/9780195369250.003.0005
- Subject:
- Clinical Medicine and Allied Health, Psychiatry
Anxiety disorders can be defined as conditions characterized by pathological anxiety that has not been caused by physical illness, is not associated with substance use, and is not part of a ...
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Anxiety disorders can be defined as conditions characterized by pathological anxiety that has not been caused by physical illness, is not associated with substance use, and is not part of a psychotic illness. Therefore, the concept of anxiety disorders is largely based on exclusion of several causes of pathological anxiety–hardly a scientifically defensible position. Since pathological anxiety has been postulated as the sine qua non of anxiety disorders, it is important to first make a distinction between pathological and ‘‘normal’’ anxiety. For the sake of clarifying this matter, the terms anxiety and fear are used here interchangeably (as they both denote a response to a perceived threat), although there is also a prominent view that conceptual differences do exist between them (see also Table 2—21 and Barlow’s account of panic attacks in Chapter 2 for further discussion of this issue). There is broad agreement that pathological and normal anxiety can be distinguished on the basis of the criteria listed in Table 1—1. These criteria cut across all the components of anxiety: subjective, physiological (somatic), cognitive, and behavioral. Although the criteria may seem clear-cut, in practice it may be difficult to draw a precise boundary between pathological and normal anxiety. It is often assumed that normal anxiety has an adaptive role, because it serves as a signal that there is some danger and that measures need to be taken (e.g., a fight or flight response) to protect oneself against that danger; both the danger perceived and the measures taken are considered appropriate (i.e., not exaggerated) in normal anxiety. For example, a student who is anxious about failing the exam correctly judges herself to be well below the sufficient level of knowledge and doubles the effort to catch up with her studies and minimize the risk of failing. In contrast, pathological anxiety pertains to an inaccurate or excessive appraisal of danger; protective measures taken against this danger are way out of proportion to the real threat. Anxiety disorders were introduced in 1980 as a distinct nosological group in the Third Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric Association, 1980).
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Anxiety disorders can be defined as conditions characterized by pathological anxiety that has not been caused by physical illness, is not associated with substance use, and is not part of a psychotic illness. Therefore, the concept of anxiety disorders is largely based on exclusion of several causes of pathological anxiety–hardly a scientifically defensible position. Since pathological anxiety has been postulated as the sine qua non of anxiety disorders, it is important to first make a distinction between pathological and ‘‘normal’’ anxiety. For the sake of clarifying this matter, the terms anxiety and fear are used here interchangeably (as they both denote a response to a perceived threat), although there is also a prominent view that conceptual differences do exist between them (see also Table 2—21 and Barlow’s account of panic attacks in Chapter 2 for further discussion of this issue). There is broad agreement that pathological and normal anxiety can be distinguished on the basis of the criteria listed in Table 1—1. These criteria cut across all the components of anxiety: subjective, physiological (somatic), cognitive, and behavioral. Although the criteria may seem clear-cut, in practice it may be difficult to draw a precise boundary between pathological and normal anxiety. It is often assumed that normal anxiety has an adaptive role, because it serves as a signal that there is some danger and that measures need to be taken (e.g., a fight or flight response) to protect oneself against that danger; both the danger perceived and the measures taken are considered appropriate (i.e., not exaggerated) in normal anxiety. For example, a student who is anxious about failing the exam correctly judges herself to be well below the sufficient level of knowledge and doubles the effort to catch up with her studies and minimize the risk of failing. In contrast, pathological anxiety pertains to an inaccurate or excessive appraisal of danger; protective measures taken against this danger are way out of proportion to the real threat. Anxiety disorders were introduced in 1980 as a distinct nosological group in the Third Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric Association, 1980).
