ANXIETY DISORDERS A Developmental Vulnerability-Stress Perspective

Anxiety disorders represent the most common class of psychological disorders in the United States, affecting as many as one in four Americans over their lifetimes (Kessler et al., 1994). Moreover, anxiety disorders are the most financially costly class of mental health problems in the United States, costing an estimated $46.6 billion in 1990 alone in direct and indirect costs (DuPont et al., 1996). Anxiety disorders are associated with heightened co-occurrence of other axis I disorders (e.g., T. A. Brown, DiNardo, Lehman, & Campbell, 2001), myriad “unexplained ” physical symptoms and chronic health conditions (e.g., Roy-Byrne & Katon, 2000), and poorer quality of life (Leon, Portera, & Weissman, 1995). An even larger percentage of the population suffers from subclinical anxiety (e.g., Kessler et al., 1994), which may contribute to a range of social, occupational, and health difficulties, including high blood pressure, heart disease, ulcers, lost productivity, impaired sleep, and interpersonal problems (Schonfeld et al., 1997). Epidemiological studies suggest that although anxiety disorders occur across all age and cultural groups, they occur approximately twice as often in females (Eaton et al., 1994; Kessler et al., 1994). Moreover, studies suggest that anxiety disorders are often long-standing in the absence of effective treatment and consequently are among the most chronic of psychological disorders (e.g., Goisman et al., 1998