Anxiety, fever, and pain are the three main symptoms seen in medicine, and anxiety represents one of the central (both normal and pathological) manifestations of the human psyche. This issue of Dialogues in Clinical Neuroscience is devoted to anxiety and includes basic, clinical, historical and therapeutic aspects of current research in this field.
As described in the Guest editorial by David J. Kupfer (p 245), the classification of anxiety disorders has been significantly reorganized in DSM-5, in order to reflect the progress of knowledge in neurocircuitry, brain imaging, and genetics. Accordingly, the anxiety disorders of DSM-IV have been separated into three distinct and more homogeneous chapters (obsessive-compulsive, and trauma- and stressor-related disorders). It is expected that ICD-11, the future classification from the WHO, will be largely compatible with DSM-5.
Guy M. Goodwin (p 249) has written a State of the art article on the overlap between anxiety, depression, and obsessive-compulsive disorders. All three of these disorders seem to share a general dimension of distress and negative affectivity. In addition, these disorders may respond to the same treatments (eg, serotonergic drugs). In the end, there is evidence for both “lumping” and “splitting” these disorders. The two approaches are not necessarily contradictory, since common as well as specific features characterize the various anxiety disorders.
The next part of this issue is devoted to four Translational research articles.
Samantha J. Brooks and Dan J. Stein (p 261) discuss the neural bases of psychotherapy for anxiety and related disorders. The authors review 19 fMRI studies examining the neural bases of CBT in 509 patients with anxiety. They conclude that, although each of the anxiety disorders is mediated by different neural circuitry, cognitive-behavioral therapy acts in a similar way to increase prefrontal control of subcortical structures.
In an intellectually stimulating article, Marco Battaglia (p 277) incorporates knowledge from different disciplines to describe how adaptive separation anxiety is intimately connected with the evolutionary emergence of the human brain. The author delineates some of the mechanisms that link childhood-adolescence separation anxiety to health problems later in life.
Jack van Honk, Peter A. Bos, David Terburg, Sarah Heany, and Dan J. Stein (p 287) discuss how steroid hormones such as testosterone and peptide hormones such as oxytocin play a key role in mediating social anxiety. Such work may ultimately lead to new approaches to the treatment of social anxiety disorder. Finally, clinicians will derive much benefit from the article by Michel Bourin (p 295) who offers a precise and didactic description of animal models of anxiety.
Eduard Maron and David Nutt (p 305) address the Pharmacological aspects of anxiety disorders. These authors review the biological predictors of treatment response. It is crucially important to understand why some anxious patients respond well, but others not, to the same classes of medication.
This issue contains three Clinical research papers.
An article by Marc-Antoine Crocq (p 319) retraces the history of anxiety, from Hippocrates to DSM. Greek and Latin physicians and philosophers distinguished anxiety from other types of negative affect, identified it as a medical disorder, and suggested techniques to reach an anxiety-free state of mind that are reminiscent of modern cognitive psychology. Is the prevalence of anxiety increased by our modern lifestyle?
Probably not, according to Borwin Bandelow and Sophie Michaelis (p 327) who analyze whether the epidemiology of anxiety disorders has changed in the 21st century. Anxiety disorders (panic disorder with or without agoraphobia, generalized anxiety disorder, social anxiety disorder, specific phobias, separation anxiety disorder) may reach a lifetime prevalence of up to one third of the population. These disorders are under-recognized and undertreated. It is likely that their prevalence remains constant across cultures and epochs.
The next two articles address cognitive-behavioral therapy (CBT). Antonia N. Kaczkurkin and Edna B. Foa (p 337) provide an overview of two of the most commonly used CBT methods to treat anxiety disorders (exposure and cognitive therapy).
Finally, in a Brief report, Laure Wolgensinger (p 347) focuses on the developments that have occurred in recent years in group cognitive-behavorial interventions designed to treat anxiety disorders, particularly in children and adolescents.
Marc-Antoine Crocq, MD; César Carvajal, MD