Genetic and Other Vulnerability Factors for Anxiety and Stress Disorders

Despite dramatic advances in our understanding of genetics and neurobiology, the etiology of the anxiety disorders is still relatively unknown. To date, there remain no pathognomonic markers with which a presumptive diagnosis of an anxiety disorder may be made. This highlights the importance of the empirical epidemiologic approach to investigating the definitions and risk factors for the expression of anxiety across the life course. Anxiety disorders are developmental conditions that often emerge during childhood and follow varied developmental trajectories (1,2). Research on early-life vulnerability factors that predict the trajectory of anxiety symptoms across development holds promise for elucidating mechanistic pathways in anxiety. In evaluating the risk factors for the development of anxiety disorders, there are several issues requiring consideration. First, there is substantial overlap between the anxiety disorders and other psychiatric disorders both concomitantly and longitudinally. Second, manifestations of anxiety change substantially across the life course, particularly during childhood and adolescence. Therefore, a developmental perspective is essential in evaluating links between risk factors and anxiety disorders. Third, the assessment of anxiety requires evaluation of the context in which the individual experiences anxiety as well as the subjective response to anxiety-inducing situations. As such, anxiety becomes a disorder when there is a mismatch between inherent threat posed by a particular stimulus or situation and the cognitive or somatic response. Research on vulnerability factors has undergone a relatively marked transformation in recent years, due to conceptual changes in causal theories of mental disorders. Such conceptual changes are reflected in three major themes that organize current research on vulnerability factors in anxiety.