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Key Words risk factors, etiology, maintenance, anxiety disorders
Abstract This chapter provides a review of recent empirical developments, current controversies, and areas in need of further research in relation to factors that are common as well as specific to the etiology and maintenance of panic disorder, phobias, and generalized anxiety disorder. The relative contribution of broad risk factors to these disorders is discussed, including temperament, genetics, biological influences, cognition, and familial variables. In addition, the role that specific learning experiences play in relation to each disorder is reviewed. In an overarching hierarchical model, it is proposed that generalized anxiety disorder, and to some extent panic disorder, loads most heavily on broad underlying factors, whereas specific life history contributes most strongly to circumscribed phobias.
INTRODUCTION
The purpose of this chapter is to review recent empirical developments, controversies in the literature, and areas in need of future research in relation to panic disorder (PD), phobias, and generalized anxiety disorder (GAD). The factors in common as well as the factors that are unique to the etiology and maintenance of these anxiety disorders are presented.
FEATURES OF PANIC DISORDER, PHOBIAS, AND GENERALIZED ANXIETY DISORDER
As with all the anxiety disorders, PD, phobias, and GAD share features of threatrelevant responding (i.e., anxious apprehension, fear, and avoidance), but differ in the object and breadth of threat. The broadest threat-responding occurs in GAD, which is defined as excessive and uncontrollable worry about a number of different life events and accompanying symptoms of motor tension and vigilance (American Psychiatric Association 1994). The onset of GAD tends to be insidious, with many patients reporting having been generally anxious since childhood (Anderson et al. 1984).
Panic disorder is characterized by recurrent unexpected panic attacks accompanied by persistent apprehension over their recurrence or consequences, which may occur with or without agoraphobia (American Psychiatric Association 1994). Relative to GAD, the object of threat is narrower and pertains to bodily sensations and their associated contexts (internal and external), and onset is usually defined by an initial unexpected panic attack (Barlow 1988), most typically in the mid 20s (Brown et al. 2001).
Social phobia [or social anxiety disorder (SAD)], the most prevalent anxiety disorder (13.3% lifetime; Kessler et al. 1994), represents excessive fear of social or performance...