Vol 5 n° 3 - Anxiety II
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he anxiety disorders, including panic disorder (PD), generalized anxiety disorder (GAD), social anxi- ety disorder (SAD), and posttraumatic stress disorder (PTSD), are among the disabling medical disorders.They frequently  begin  early  in  life,  are  characterized  by repeated episodes and chronicity, and can have serious medical and psychological consequences leading to func- tional disability in many patients. These disorders are currently diagnosed using standard- ized diagnostic criteria (Diagnostic and Statistical Manual of  Mental  Disorders,  Fourth  Edition  [DSM-IV]  and International Classification of Diseases [ICD-10]), which are almost exclusively based upon phenomenology, and not genetics, etiology, or pathophysiology.1 This has ham- pered progress in some spheres, since these disorders, as currently diagnosed, are often comorbid with each other, and advances in preclinical and clinical neuroscience sug- gest that there may be overlapping circuit and neuro- chemical modulation of behaviors that characterize one or more of these disorders.2 Clinical neurobiological research pertaining to these anx- iety  disorders  has  been  dominated  by  investigations directed toward identifying dysfunctional neural circuits and neurochemical systems, vulnerability genes, and psy- chopharmacology.While this makes obvious sense, there has been far too little clinical research on neurobiological factors that may convey protection from anxiety disorders and promote psychobiological resilience in the face of stress that commonly increases psychopathology.This type of research may facilitate the discovery of preventative approaches  to  anxiety  disorders. Further, by  reducing reliance on the standardized diagnostic classification sys- tems noted above, while increasing our knowledge of the neural circuits that mediate behavioral and psychological responses to threat, fear conditioning, reward behavior, and social attachment—circuits relevant to essentially all of the anxiety disorders—the opportunity exists to estab- S t a t e   o f   t h e   a r t 2 0 7 Copyright © 2003 LLS SAS.  All rights reserved www.dialogues-cns.org The psychobiology of resilience and vulnerability to anxiety disorders: implications for prevention and treatment Dennis S. Charney, MD Keywords: resilience; anxiety disorder; fear; neurochemistry; psychobiology Author  affiliations:  Chief,  Mood  and  Anxiety  Disorders  Program,  National Institute of Mental Health, Bethesda, Md, USA Address   for   correspondence:   Mood   and   Anxiety   Disorders   Program, National   Institute   of   Mental   Health,   15K   North   Drive,   Room   101, Bethesda, MD 20892-2670, USA
(e-mail: charneyd@nih.gov) T Much of the research on the neurobiology of human anxiety disorders has focused on psychopathological abnormalities in patients with anxiety disorders. While this line of research is obviously important, more inves- tigation is needed to elucidate the psychobiology of resilience to extreme stress. Study of the psychobiology of resilience has the potential to identify neurochemi- cal, neuropeptide, and hormonal mediators of vulnera- bility and resilience to severe stress. In addition, the rel- evance of neural mechanisms of reward and motivation, fear responsiveness, and social behavior to character traits associated with risk and resistance to anxiety dis- orders may be clarified. These areas of investigation should lead to improved methods of diagnosis, novel approaches to prevention, and new targets for antianx- iety drug discovery. © 2003, LLS SAS Dialogues Clin Neurosci. 2003;5:207-221.