Such reactions reach clinical levels, however, when adolescents are unable to recover from the anxiety (as manifested by recurrent doubts or ruminations about how they behave), or when adolescents avoid such encounters on a consistent basis. For example, it is not necessarily deviant for adolescents to respond with acute discomfort or anxiety when meeting a peer that they find attractive. A useful rule of thumb for determining the diagnostic threshold is the person's ability to recover from anxiety and to remain anxiety-free when the provoking situation is absent. Similarly, in adolescence, particular questions arise concerning anxiety about social situations, given changes in the social milieu that are experienced as stressful by many adolescents. For example, anxiety about separation represents a normal aspect of development that is experienced by many young children. However, anxiety about particular circumstances may develop at one or another developmental stage, based on the typical age-related experiences that occur during this stage. By analogy, the fact that anxiety falls on a continuum of severity does not preclude the presence of qualitatively distinct disorders at any point in the distribution (Klein & Pine, 2001).Īnxiety may become symptomatic at any age when it prevents or limits developmentally appropriate adaptive behavior (Klein & Pine, 2001). For example, some cases of mental retardation, as caused by neurological injury, represent a quantal departure from factors influencing normal variations in intelligence. Distributions may consist of distinct entities, however. Because anxiety can be rated on a continuum, some inves-tigators suggest that extreme anxiety represents only a severe expression of the trait, rather than a distinct or pathological state. In the case of anxiety, however, it is especially problematic to establish the limits between normal behavior and pathology because when mild, anxiety plays an adaptive role in human development, signaling that self-protective action is required to ensure safety. This applies to symptoms such as delusional beliefs or hallucinations. A few symptoms escape this definitional conundrum by virtue of their being deviant, regardless of their severity. Milder forms, by contrast, present problems when one attempts to define the point at which “caseness” begins. For some very extreme conditions, such as Downs syndrome, diagnostic decisions are straightforward. This knowledge should lead to a more fruitful set of psychiatric classifications.ĭefining the boundaries between extremes of normal behavior and psychopathology is a dilemma that pervades all psychiatry. The results of this work will permit the parsing of individuals who have a particular diagnosis into subgroups with more homogeneous biological and psychological features. Major advances will occur when investigators and clinicians add these procedures to their interview data. Finally, clinicians and investigators now have an initial set of cognitive and biological procedures that promise to aid differential diagnosis of individuals who report anxiety. Second, epidemiological and genetic data imply distinct biological profiles for the varied anxiety disorders, many of which implicate neurochemical processes. First, the state we call anxiety in humans is not unitary in origin or consequence and can be the result of living with realistic threat, past history, conditioning, or a temperamental bias for unexpected somatic sensations that are interpreted as meaning one is anxious. A comparison of contemporary reports with those of the last half century provides reason for optimism, for we have learned several important facts. The research of the past few decades has expanded our understanding of the phenomena linked to the concepts of anxiety and anxiety disorder.
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