The Anxiety Disorder Patient

Anxiety is a universal emotional experience precipitated by ordinary concerns and worries. Pathological anxiety is the most common clinical presentation in psychiatry either as the primary symptom or as a major accompaniment of many psychological disorders ranging from the neurotic to the psychotic. Anxiety disorders, phenomenologically united by the subjective experience of overwhelming and disabling anxiety that appears to have little basis in reality, have been classified into various discrete entities in DSM-IV-TR. However, with the exception of obsessive-compulsive disorder,1 this taxonomy may be more illusory than real because "pure" forms of these disorders are not common, and comorbidity studies have shown that one type frequently overlaps with another. Unlike illnesses in which depressive affect is dominant, the classification of the anxiety disorders seems more like the charting of unstable and shifting islands in a sea of anxiety. Some differentiate fear as an evolutionary adaptive response to conscious real dangers (the phylogenetically determined fear-flight response) from neurotic anxiety, which is seen as a reaction to unconscious dangers. Freud addressed the latter and used the term anxiety neurosis to encompass acute anxiety attacks (modern panic disorder), chronic anticipatory anxiety, and phobia. He observed that all three could lead