Chapter 15. Anxiety Disorders 15.6 Anxiety Disorders: Clinical Features

The last 30 years have seen a dramatic increase in clinical research on a group of mental conditions labeled “anxiety disorders” in the Diagnostic and Statistical Manual of Mental Disorders (DSM) nomenclature. While the term “anxiety” has been applied to diverse phenomena in the psychoanalytic, learning-based, and neurobiological literature, the term “anxiety” in the clinical psychopathological literature refers to the presence of fear or apprehension that is out of proportion to the context of the life situation. Hence, extreme fear or apprehension can be considered “clinical anxiety” if it is developmentally inappropriate (e.g., fear of separation in a 10-year-old child) or if it is inappropriate to an individual's life circumstances (e.g., worries about unemployment in a successful business executive). The last 30 years of clinical research has led to progressive refinement of the nosology for clinical anxiety disorders. While these disorders were broadly conceptualized in the early twentieth century, narrower definitions have arisen, partially stimulated by Donald Klein's observations on pharmacological distinctions between panic and nonpanic anxiety.