HealthResJ, health, medicine, nursing, research https://ejournals.epublishing.ekt.gr/index.php/HealthResJ/sitemap

A critical discussion of the development of anxiety disorders explained by biological and psychological risk factors


Vol. 10 No. 3 (2024)
Published: Jul 4, 2024
Keywords:
Anxiety disorders risk factors etiology biopsychology developmental psychology
Eva Ferhati
George Thomas
Penelope Louka
Georgios Pilafas
https://orcid.org/0000-0003-2299-8257
Abstract

The present article provides an overview of the etiology of anxiety disorders, focusing on the interplay between biological and psychological factors. Based on the global literature the prevalence of anxiety disorders affects approximately 29% of the global population. What is more, anxiety disorders can be chronic, and thus they may lead and comorbid with several mental health issues. Although genetic factors are likely to play a key role in the development of anxiety disorders, studies show that there is also an intrigued interplay between genetic and environmental factors. A specific genetic factor that has risen a great deal of attention is the serotonin-transporter-linked gene promoter region (5HTTLPR), as well as the hypothalamic-pituitary-adrenal (HPA) axis since studies discuss that the biological pathway of the stress system is also implicated in anxiety disorders. On the other hand, factors such as a stressful lifestyle and childhood maltreatment may interact negatively with genetic vulnerability to increase the risk of developing the disorders in question. For instance, parenting styles have been associated with childhood anxiety disorders in literature, including the quality of parent-child attachment, adverse and traumatic experiences. On the whole, anxiety disorders are quite complex and it is quite likely that they are influenced by a combination of biological and psychological factors. There is indeed, a clear need for further research to better understand the interplay between all factors and thus to develop effective prevention and early intervention strategies against the development of anxiety disorders.

Article Details
  • Section
  • Special Articles
Downloads
Download data is not yet available.
References
Kessler R.C., Berglund P., Demler O., Jin R., Merikangas K.R., & Walters E.E. (2005). Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 62(6), 593–602.doi:10.1001/archpsyc.62.6.593
Rosen, J. B., & Schulkin, J. (1998). From normal fear to pathological anxiety. Psychol. Rev. 105, 325–350.https://doi.org/10.1037/0033-295X.105.2.325
Barlow, D. H. (2002). Anxiety and its disorders. New York: Guilford Press.
Gray, J.A. & McNaughton, N. (2000). The neuropsychology of anxiety: An enquiry into the functions of the septo-hippocampal system. Oxford University Press, Oxford.
Rector N., Bourdeau D., Kitchen K. & Joseph-Massiah L. (2016). Anxiety disorders an information guide. Centre for Addiction & Mental Health.
Marks, I., & Lader, M. (1973). Anxiety states (anxiety neu-rosis): A review. Journal of Nervous and Mental Disease, 156(1), 3–18. https://doi.org/10.1097/00005053-197301000-00001
Evans, D. L., Foa, E. B., Gur, R. E., Hendin, H., O'Brien, C. P., Seligman, M. E. P., & Walsh, T. (Eds.). (2005). Treating and preventing adolescent mental health disorders: What we know and what we don't know: A research agenda for im-proving the mental health of our youth. Oxford University Press.https://doi.org/10.1093/9780195173642.001.0001
Bittner A., Egger H.L, Erklanli A., Costello J., Foley D.L. & Angold A. (2007). What do childhood anxiety disorders predict? Journal of Child Psychology and Psychiatry 48, 1174–1183.https://doi.org/10.1111/j.1469-7610.2007.01812.x
Kalin, N. H. (2020). The critical relationship between anxie-ty and depression. American Journal of Psychiatry, 177(5), 365-367.https://doi.org/10.1176/appi.ajp.2020.20030305
Cates, M., Wells, B. G., & Thatcher, G. W. (1996). Anxiety Disorders. In E. T. Herfindal & D. R. Gourley (Eds.). Textbook of Therapeutics: Drug and Disease Management 6, 1073-1093. Hagerstown, MD: Lippincott Williams and Wilkins.
Narmandakh, A., Roest, A. M., de Jonge, P., & Oldehinkel, A. J. (2021). Psychosocial and biological risk factors of anxiety disorders in adolescents: a TRAILS report. European child & adolescent psychiatry, 30(12), 1969-1982.DOI:10.1007/s00787-020-01669-3
Murray, L., Creswell, C. and Cooper, P. J. (2009). The devel-opment of anxiety disorders in childhood: an integrative review. Psychological Medicine, 39(9),1413-1423.https://doi.org/10.1017/S0033291709005157
Hettema, J.M., Neale, M.C. & Kendler, K.S. (2001). A review and meta-analysis of the genetic epidemiology of anxiety disorders. Am. J. Psychiatry 158,1568–1578.https://doi.org/10.1176/appi.ajp.158.10.1568
Cooper P.J, Fearn V, Willetts L, Seabrook H, Parkinson M (2006). Affective disorder in the parents of a clinic sample of children with anxiety disorders. Journal of Affective Disorders 93, 205–212.https://doi.org/10.1016/j.jad.2006.03.017
Schreier, A., Wittchen, H., Höfler, M., & Lieb, R. (2008). Anxiety disorders in mothers and their children: Prospec-tive longitudinal community study. British Journal of Psychiatry, 192(4), 308-309.https://doi.org/10.1192/bjp.bp.106.033589
Ehringer, M. A., Rhee, S. H., Young, S. E., Corley, R. P., and Hewitt, J. K. (2006). Genetic and environmental contribu-tions to common psychopathologies of childhood and ad-olescence: a study of twins and their siblings. J. Abnorm. Child Psychol. https://doi.org/10.1007/s10802-005-9000-0
Gregory, A.M., & Eley, T. C. (2007). Genetic influences on anxiety in children: what we’ve learned and where we’re heading. Clin. Child Fam. Psychol. Rev. 10, 199–212.https://doi.org/10.1007/s10567-007-0022-8
Kendler K.S., Karkowski L.M., & Prescott C.A. (1999) Fears and phobias: reliability and heritability. PsycholMed 29, 539-553. https://doi.org/10.1017/s0033291799008429
Waszczuk, M. A., Zavos, H. M., & Eley, T. C. (2013). Genetic and environmental influences on relationship between anxiety sensitivity and anxiety subscales in chil-dren. Journal of anxiety disorders, 27(5), 475–484. https://doi.org/10.1016/j.janxdis.2013.05.008
Petersen, I. T., Bates, J. E., Goodnight, J. A., Dodge, K. A., Lansford, J. E., Pettit, G. S., ... & Dick, D. M. (2012). Interac-tion between serotonin transporter polymorphism (5-HTTLPR) and stressful life events in adolescents' trajectories of anxious/depressed symptoms. Developmental psychol-ogy, 48(5), 1463. https://doi.org/10.1037/a0027471
Ming, Q., Zhang, Y., Yi, J., Wang, X., Zhu, X., & Yao, S. (2015). Serotonin transporter gene polymorphism (5-HTTLPR) L allele interacts with stress to increase anxiety symptoms in Chinese adolescents: a multiwave longitudinal study. BMC psychiatry, 15(1), 1-8.https://doi.org/10.1186/s12888-015-0639-y
Karg K., Burmeister M., Shedden K., Sen S. (2011). The sero-tonin transporter promoter variant (5-HTTLPR), stress, and depression meta-analysis revisited: evidence of genetic moderation. Arch Gen Psychiatry 68, 444–54.https://doi.org/10.1001/archgenpsychiatry.2010.189
Munafo M.R, Clark T.G, Moore L.R, Payne E., Wlaton R., Flint J. (2003). Genetic polymorphisms and personality in healthy adults: a systematic review and meta-analysis. Molecular Psychiatry 8, 471–484.https://doi.org/10.1038/sj.mp.4001326
Schmidt L.A, Fox N.A, Rubin K.H, Hu S. & Hamer D.H (2002). Molecular genetics of shyness and aggression in preschoolers. Personality and Individual Differences 33, 227–238.
Arbelle S., Benjamin J., Golin J., Kremer I., Belmaker R.H. & Ebstein R.P. (2003). Relation of shyness in grade school children to the genotype for the long form of the serotonin transporter promoter region polymorphisms. American Journal of Psychiatry 160, 671–676.https://doi.org/10.1176/appi.ajp.160.4.671
Battaglia M., Ogliari A., Zanoni A., Citterio A., Pozzoli U., Giorda R., Maffei C. & Marino C. (2005). Influence of the serotonin supporter gene and shyness on cerebral respons-es to facial expressions. Archives of General Psychiatry 62, 85–94.https://doi.org/10.1001/archpsyc.62.1.85
Rapee R.M. (2018). Anxiety disorders in children and ado-lescents: Nature, development, treatment, and prevention. In Rey JM (ed), IACAPAP e-Textbook of Child and Adoles-cent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions.
Stein, M. B., Schork, N. J., & Gelernter, J. (2008). Gene-by-environment (serotonin transporter and childhood mal-treatment) interaction for anxiety sensitivity, an intermedi-ate phenotype for anxiety disorders. Neuropsychopharmacology 33,312–319.https://doi.org/10.1038/sj.npp.1301422
Fox N.A, Henderson H.A, Marshall P.J, Nichols K.E, Ghera M.M. (2005). Behavioral inhibition: linking biology and behavior within a developmental framework. Annual Review of Psychology 56, 235–262.https://doi.org/10.1146/annurev.psych.55.090902.141532
Belsky J., Jonassaint C., Pluess M., Stanton M., Brummett B. & Williams R. (2009). Vulnerability genes or plasticity genes? Molecular Psychiatry, 14, 746-754.https://doi.org/10.1038/mp.2009.44
Norrholm, S. D., & Ressler, K. J. (2009). Genetics of anxiety and trauma-related disorders. Neuroscience, 164(1), 272–287. https://doi.org/10.1016/j.neuroscience.2009.06.036
Bortoluzzi, A., Blaya, C., da Rosa, E. D., Paim, M., Rosa, V., Leistner-Segal, S., & Manfro, G. G. (2015). What can HPA axis-linked genes tell us about anxiety disorders in adoles-cents? Trendsin psychiatry and psychotherapy, 37(4), 232–237.
Erhardt A., Ising M., Unschuld P.G., Kern N., Lucae S., Pütz B., Uhr M., Binder E.B., Holsboer F. & Keck M.E. (2006). Regulation of the hypothalamic-pituitary-adrenocortical system in patients with panic disorder. Neuropsychophar-macology31, 2515–2522.https://doi.org/10.1038/sj.npp.1301168
Kallen V.L., Tulen J.H., Utens E.M., Treffers P.D., De Jong F.H., Ferdinand R.F. (2008). Associations between HPA axis functioning and level of anxiety in children and adoles-cents with an anxiety disorder. Depress Anxiety 25, 131–141.https://doi.org/10.1002/da.20287
Adwas, A.A., Jbireal, J.M. & Azab, E.A. (2019). Anxiety: Insights into Signs, Symptoms, Etiology, Pathophysiology, and Treatment. The South African journal of medical sci-ences 2(10), 80-91.
Martini J., Knappe S., Beesdo-Baum K., Lieb R., Wittchen H.U. (2010). Anxiety disorders before birth and self-perceived distress during pregnancy: associations with ma-ternal depression and obstetric, neonatal and early child-hood outcomes. Early Hum. Dev. 86, 305–310.https://doi.org/10.1016/j.earlhumdev.2010.04.004
Essex M.J., Klein M.H., Cho E., & Kalin N.H. (2002). Ma-ternal stress beginning in infancy may sensitize children to later stress exposure: effects on cortisol and behavior. Biol Psychiat, 52, 776-778.https://doi.org/10.1016/s0006-3223(02)01553-6
Rothenberger S.E., Moehler E., Reck C. & Resch F. (2011). Prenatal stress: course and interrelation of emotional and physiological stress measures. Psychopathology44, 60–67.https://doi.org/10.1159/000319309
Shea A.K., Streiner D.L., Fleming A., Kamath M.V., Broad K., & Steiner M. (2007). The effect of depression, anxiety and early life trauma on the cortisol awakening response during pregnancy: preliminary results. Psychoneuroendocrinolo-gy32(8–10), 1013–1020.https://doi.org/10.1016/j.psyneuen.2007.07.006
Obel C., Hedegaard M., Henriksen T.B., Secher N.J., Olsen J. & Levine S. (2005). Stress and salivary cortisol during pregnancy. Psychoneuroendocrinology30(7), 647–656.https://doi.org/10.1016/j.psyneuen.2004.11.006
Pluess M., Bolten M., Pirke K.M. & Hellhammer D.H. (2010). Maternal trait anxiety, emotional distress, and sali-vary cortisol in pregnancy. Biol. Psychol. 83, 169–175.https://doi.org/10.1016/j.biopsycho.2009.12.005
Seng J.S., Low L.K., Ben-Ami D. & Liberzon I. (2005). Corti-sol level and perinatal outcome in pregnant women with post-traumatic stress disorder: a pilot study. J. Midwifery Womens Health 50(5), 392–398.https://doi.org/10.1016/j.jmwh.2005.04.024
Faravelli, C., Lo Sauro, C., Lelli, L., Pietrini, F., Lazzeretti, L., Godini, L., Benni, L., Fioravanti, G., Talamba, G. A., Castelli-ni, G., & Ricca, V. (2012). The role of life events and HPA axis in anxiety disorders: a review. Current pharmaceuticaldesign, 18(35), 5663–5674.https://doi.org/10.2174/138161212803530907
Duthie L., Reynolds R.Μ. (2013). Changes in the Maternal Hypothalamic-Pituitary-Adrenal Axis in Pregnancy and Postpartum: Influences on Maternal and Fetal Outcomes. Neuroendocrinology98, 106-115.https://doi.org/10.1159/000354702
Fassaie, S., & McAloon, J. (2020). Maternal distress, HPA activity, and antenatal interventions. Asystematic re-view. Psychoneuroendocrinology,112.https://doi.org/10.1016/j.psyneuen.2019.104477
Fontein-Kuipers, Y. J., Nieuwenhuijze, M. J., Ausems, M., Budé, L., & de Vries, R. (2014). Antenatal interventions to reduce maternal distress: a systematic review and meta-analysis of randomised trials. An international journal of obstetrics and gynaecology, 121(4), 389–397.https://doi.org/10.1111/1471-0528.12500
Evans, K., Morrell, C. J., & Spiby, H. (2018). Systematic re-view and meta-analysis of non-pharmacological interven-tions to reduce the symptoms of mild to moderate anxiety in pregnant women. Journal of advanced nursing, 74(2), 289–309.https://doi.org/10.1111/jan.13456
McLaughlin, K.A., Kubzansky, L.D., Dunn, E.C., Waldinger, R., Vaillant, G., & Koenen, K.C. (2010). Childhood social en-vironment, emotional reactivity to stress, and mood and anxiety disorders across the life course. Depression and anxiety, 27(12), 1087–1094.https://doi.org/10.1002/da.20762
Nolte, T., Guiney, J., Fonagy, P., Mayes, L. C., & Luyten, P. (2011). Interpersonal stress regulation and the develop-ment of anxiety disorders: An attachment-based develop-mental framework. Frontiers in Behavioral Neuroscience, 5(55).https://doi.org/10.3389/fnbeh.2011.00055
Bögels, S. M., & Tarrier, N. (2004). Unexplored issues and future directions in social phobia research. Clin. Psychol. Rev.24, 731–736.https://doi.org/10.1016/j.cpr.2004.07.003
Hudson, J., & Rapee, R. (2000). The origins of social pho-bia. Behavior Modification24, 102–129.https://doi.org/10.1177/0145445500241006
DiBartolo, P. M., & Helt, M. (2007). Theoretical models of affectionate versus affectionless control in anxious families: a critical examination based on observations of parent child interactions. Clin. Child Fam. Psychol. Rev. 10, 253–274.https://doi.org/10.1007/s10567-007-0017-5
Manassis, K., & Bradley, S. J. (1994). The development of childhood anxiety disorders: Toward an integrated model. Journal of Applied Developmental Psychology,15, 345- 366.https://doi.org/10.1016/0193-3973(94)90037-X
Hudson, J. L., & Rapee, R. M. (2004). From anxious tem-perament to disorder: An etiological model of generalized anxiety disorder. In R. G. Heimberg, C. L. Turk & D. S. Men-nin (Eds.), Generalized anxiety disorder: Advances in re-search and practice (pp. 51-76). New York: Guilford Publications Inc.
Brook, C. A., & Schmidt, L. A. (2008). Social anxiety disor-der: a review of environmental risk factors. Neuropsychiatric disease and treatment, 4(1), 123–143. https://doi.org/10.2147/ndt.s1799
Wasif, S., Noor, A.M., Aqeel, M., & Rohail, I. (2015). Rela-tionship between Perceived Parental Rejection and Depres-sion among Adolescents. Academic Research International6(2).
Chorpita, B. F., & Barlow, D. H. (1998). The development of anxiety: the role of control in the early environment. Psy-chol. Bull 124, 3–21.https://doi.org/10.1037/0033-2909.124.1.3
Festa, C., & Ginsburg, G. (2011). Parental and peer predic-tors of social anxiety in youth. Child Psychiatry and Human Development, 42, 291–306.https://doi.org/10.1007/s10578-011-0215-8
Gulley, L., Oppenheimer, C., & Hankin, B. (2014). Associa-tions among negative parenting, attention bias to anger, and social anxiety among youth. Developmental Psychology, 50, 577–585.https://doi.org/10.1037/a0033624
Knappe, S., Beesdo, K., Fehm, L., Hofler, M., Leib, R., & Wittchen, H. (2009). Do parental psychopathology and un-favorable family environment predict the persistence of so-cial phobia? Journal of Anxiety Disorders23, 986–994.https://doi.org/10.1016/j.janxdis.2009.06.010
Rudoph, J., & Zimmer-Gembeck, M. (2014). Parent rela-tionships and adolescents’ depression and social anxiety: Indirect associations via emotional sensitivity to rejection threat. Australian Journal of Psychology 66, 110–121. DOI: 10.1111/ajpy.12042
McLeod, B. D., Wood, J. J., & Weisz, J. R. (2007). Examining the association between parenting and childhood anxiety: a meta-analysis. Clin. Psychol. Rev. 27, 155–172.https://doi.org/10.1016/j.cpr.2006.09.002
Lieb, R., Wittchen, H.U., Hoefler, M., Fuetsch, M., Stein, M.B., & Merikangas, K.R. (2000). Parental psychopatholo-gy, parenting styles, and the risk of social phobia in off-spring: A prospectivelongitudinal community study. Archives of General Psychiatry, 57, 859.
Bayer, J. K., Sanson, A. V., & Hemphill, S. A. (2006). Parent influences on early childhood internalizing difficulties. Journal of Applied Developmental Psychology27, 542-559.
Hirshfeld, D. R., Biederman, J., Brody, L., Faraone, S. V., & Rosenbaum, J. F. (1997). Expressed emotion toward chil-dren with behavioral inhibition: Associations with maternal anxiety disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 36(7), 910–917.https://doi.org/10.1097/00004583-199707000-00012
Sroufe, L. A., Fox, N., & Pancake, V. (1983). Attachment and dependency in developmental perspective. Child Dev. 54, 1615–1627.
Moss, E., Smolla, N., Cyr, C., Dubois-Comtois, K., Maz-zarello, T., & Berthiaume, C. (2006). Attachment and be-havior problems in middle childhood as reported by adult and child informants. Development and Psychopathology, 18, 425-444.https://doi.org/10.1017/S0954579406060238
van Ijzendoorn, M. H., & Bakermans-Kranenburg, M. J. (2003). Attachment disorders and disorganized attach-ment: similar and different. Attachment & human devel-opment, 5(3), 313–320.https://doi.org/10.1080/14616730310001593938
Brumariu, L. E., & Kerns, K. A. (2010). Parent-child attach-ment and internalizing symptoms in childhood and adoles-cence: A review of empirical findings and future directions. Development and Psychopathology, 22, 177-203.https://doi.org/10.1017/S0954579409990344
Borelli, J., David, D., Crowley, M., & Mayes, L. (2010). Links Between disorganized attachment classification and clinical symptoms in school-aged children. Journal of Child and Family Studies19, 243–256.
Norton, A.R., & Abbott, M.J. (2017). The Role of Environ-mental Factors in the Aetiology of Social Anxiety Disorder: A Review of the Theoretical and Empirical Literature. Behaviour Change, 34, 76-97.DOI:10.1017/bec.2017.7
Kerns, K., & Brumariu, L. (2014) Is insecure parent–child attachment a risk factor for the development of anxiety in childhood or adolescence? Child Development Perspec-tives8, 12–17.https://doi.org/10.1111/cdep.12054
Urban, Julianne R. (2020) "Attachment Theory and Its Rela-tionship with Anxiety" The Kabod6(2).
Kessler, R.C., Davis, C.G., & Kendler, K.S. (1997). Childhood adversity and adult psychiatric disorder in the U.S. National Comorbidity Survey. Psychological Medicine27, 1101–1119.https://doi.org/10.1017/s0033291797005588
Tiet, Q. Q., Bird, H. R., Hoven, C. W., Moore, R., Wu, P., Wicks, J., Jensen, P. S., Goodman, S., & Cohen, P. (2001). Relationship between specific adverse life events and psy-chiatric disorders. Journal of abnormal child psycholo-gy, 29(2), 153–164.https://doi.org/10.1023/a:1005288130494
Goodyer, I. M., Wright, C., & Altham, P. M. E. (1988). Ma-ternal adversity and recent stressful life events in anxious and depressed children. J. Child Psychol. Psychiatry29, 651–667.https://doi.org/10.1111/j.1469-7610.1988.tb01886.x
Phillips, N. K., Hammen, C. L., Brennan, P. A., Najman, J. M., & Bor, W. (2005). Early adversity and the prospective pre-diction of depressive and anxiety disorders in adolescents.J. Abnorm. Child Psychiatry33, 13–24.https://doi.org/10.1007/s10802-005-0930-3
Swearingen, E.M.C., & Cohen, L.H. (1985). Life events and psychological distress: a prospective study of young ado-lescents. Dev. Psychol. 21, 1045–1054.https://doi.org/10.1007/BF00923260
Kim, K.J., Conger, R.D., Elder, G.H.J., & Lorenz, F.O. (2003). Reciprocal influences between stressful life events and adolescent internalizing and externalizing problems. Child Dev. 74, 127–143.https://doi.org/10.1111/1467-8624.00525
Juvonen J., & Graham S. (2014). Bullying in schools: The power of bullies and the plight of victims. Annual Review of Psychology65,159-185.https://doi.org/10.1146/annurev-psych-010213-115030
Briere, J. N., & Elliot, D. M. (1994). Immediate and longterm impacts of child sexual abuse. The Future of Children, 4, 54–69.
Maniglio R. (2013). Child sexual abuse in the etiology of anxiety disorders: a systematic review of reviews. Trauma, violence & abuse, 14(2), 96–112. https://doi.org/10.1177/1524838012470032
Holmes, W. C., & Slap, G. B. (1998). Sexual abuse of boys: Definition, prevalence, correlates, sequelae, and manage-ment. Journal of the American Medical Association, 280, 1855–1862.https://doi.org/10.1001/jama.280.21.1855
Levitan, R. D., Rector, N. A., Sheldon, T., & Goering, P. (2003). Childhood adversities associated with major de-pression and/or anxiety disorders in a community sample of Ontario: Issues of comorbidity and specificity. Depression and Anxiety, 17, 34-42.https://doi.org/10.1002/da.10077
Silverman, A. B., Reinherz, H. Z., & Giaconia, R. M. (1996). The long-term sequelae of child and adolescent abuse: A longitudinal community study. Child Abuse & Neglect, 20(8), 709-723.https://doi.org/10.1016/0145-2134(96)00059-2
Fuller-Thomson, E., Sohn, H. R., Brennenstuhl, S., & Baker, T. M. (2012). Is childhood physical abuse associated with anxiety disorders among adults?. Psychology, health & medicine, 17(6), 735-746.
Rapee, R. M. (2012). Family factors in the development and management of anxiety disorders. Clinical child and family psychology review15(1), 69-80.https://doi.org/10.1007/s10567-011-0106-3
Kendler K.S., Myers J., & Prescott C.A. (2000). Parenting and adult mood, anxiety and substance disorders in female twins: an epidemiological, multi-informant, retrospective study. Psychological Medicine 30, 281–294.https://doi.org/10.1017/s0033291799001889
Rachman S. (1990). The determinants and treatment of simple phobias. Advances in Behavior Research and Therapy12, 1–30.
Morris-Rosendahl D. J. (2002). Are there anxious genes? Dialogues in clinical neuroscience, 4(3), 251–260. https://doi.org/10.31887/DCNS.2002.4.3/dmrosendahl
Elzinga, B. M., Spinhoven, P., Berretty, E., de Jong, P., & Roelofs, K. (2010). The role of childhood abuse in HPA-axis reactivity in Social Anxiety Disorder: a pilot study. Biological psychology, 83(1), 1–6.https://doi.org/10.1016/j.biopsycho.2009.09.006
Barlow D.H. (1988). Anxiety and its Disorders: The Nature and Treatment of Anxiety and Panic. Guilford Press: New York.
Rapee R.M. (2001). The development of generalized anxie-ty disorder. In The Developmental Psychopathology of Anxiety (ed. M. W. Vasey and M. R. Dadds), 481–504. Ox-ford University Press: New York.
Most read articles by the same author(s)