Anxiety and Stress Disorder

The chapters in this section reflect the advances that have been made in our understanding of the molecular neurobiology and neural circuits underlying fear and anxiety states and the potential for badly needed advances in the diagnosis, pathophysiology, and treatment of anxiety disorders. Many readers will be surprised by the data cited in the Kessler and Greenberg chapter on the economic burden of anxiety and stress disorders. Recent surveys demonstrate that anxiety and stress disorders are the most commonly occurring of all mental disorders. Anxiety disorders are temporally the primary disorders in many people with a lifetime history of any mental disorder. Indeed the combined occurrence of high lifetime prevalence with an early age at onset and high chronicity makes anxiety disorders unique. The chapter by Stein and Lang reviews in detail the course of anxiety and stress disorders over the lifetime. One point they make that is especially important to emphasize is the critical need for further research in childhood anxiety disorders. The presence of an anxiety disorder in childhood or adolescence is a predictor of the persistence into adulthood of not only anxiety disorders but other psychiatric disorders as well, particularly depression. It is not known if early effective treatment of childhood and adolescent anxiety disorders will prevent the development of psychiatric disorders later in life. Important insights into the pathogenesis of anxiety disorders come from preclinical investigations reviewed by Davis in his chapter. The identification of the brain structures and neural circuits involved in the generation of fear and anxiety-related behaviors are most noteworthy. The delineation of specific neural pathways mediating conditioned and unconditioned fear can logically guide the design and conduct of clinical studies investigating the neurobiological mechanisms of anxiety disorders such as generalized anxiety disor-