From normal fear to pathological anxiety

Author(s): Schulkin, J.

Journal/Book: Psychol Rev. 1998; 105: 750 First St NE, Washington, DC 20002-4242. Amer Psychological Assoc. 325-350.

Abstract: In this article the authors address how pathological anxiety may develop from adaptive fear states. Fear responses (e.g., freezing, startle, heart rate and blood pressure changes, and increased vigilance) are functionally adaptive behavioral and perceptual responses elicited during danger to facilitate appropriate defensive responses that can reduce danger or injury (e.g., escape and avoidance). Fear is a central motive state of action tendencies subserved by fear circuits, with the amygdala playing a central role. Pathological anxiety is conceptualized as an exaggerated fear state in which hyperexcitability of fear circuits that include the amygdala and extended amygdala (i.e., bed nucleus of the stria terminalis) is expressed as hypervigilance and increased behavioral responsivity to fearful stimuli. Reduced thresholds for activation and hyperexcitability in fear circuits develop through sensitization-or kindling-like processes that involve neuropeptides, hormones, and other proteins. Hyperexcitability in fear circuits is expressed as pathological anxiety that is manifested in the various anxiety disorders.

Note: Review Rosen JB, Univ Delaware, Dept Psychol, 220 Wolf Hall, Newark,DE 19716 USA

Keyword(s): CORTICOTROPIN-RELEASING FACTOR; POSTTRAUMATIC-STRESS-DISORDER; FOS MESSENGER-RNA; POTENTIATED STARTLE PARADIGM; AMYGDALA-KINDLED SEIZURES; OBSESSIVE-COMPULSIVE DISORDER; MIDBRAIN PERIAQUEDUCTAL GRAY; VISUAL CONDITIONED-STIMULI; CENTRAL NUCLEUS LESIONS; LONG-TERM POTENTIATION

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