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Anxiety: its role in the history of psychiatric epidemiology

Published online by Cambridge University Press:  22 October 2008

J. M. Murphy  and
A. H. Leighton
J. M. Murphy*
Affiliation:
Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
A. H. Leighton
Affiliation:
Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
*
*Address for correspondence: Dr J. M. Murphy, Department of Psychiatry, Massachusetts General Hospital, 5 Longfellow Place, Room 215, Boston, MA 02114, USA. (Email: [email protected])
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Abstract

Background

The role played by anxiety in the history of psychiatric epidemiology has not been well recognized. Such lack of understanding retarded the incremental growth of psychiatric research in general populations. It seems useful to look back on this history while deliberations are being carried out about how anxiety will be presented in DSM-V.

Method

Drawing on the literature and our own research, we examined work that was carried out during and after the Second World War by a Research Branch of the United States War Department, by the Stirling County Study, and by the Midtown Manhattan Study. The differential influences of Meyerian psychobiology and Freudian psychoanalysis are noted.

Results

The instruments developed in the early epidemiologic endeavors used questions about nervousness, palpitations, sweating, trembling, shortness of breath, upset stomach, etc. These symptoms are important features of what the clinical literature called ‘manifest’, ‘free-floating’ or ‘chronic anxiety’. A useful descriptive name is ‘autonomic anxiety’.

Conclusions

Although not focusing on specific circumstances as in Panic and Phobic disorders, a non-specific form of autonomic anxiety is a common, disabling and usually chronic disorder that received empirical verification in studies of several community populations. It is suggested that two types of general anxiety may need to be recognized, one dominated by excessive worry and feelings of stress, as in the current DSM-IV definition of Generalized Anxiety Disorder (GAD), and another emphasizing frequent unexplainable autonomic fearfulness, as in the early epidemiologic studies.

Keywords

Autonomic hyperactivitydepressionDSM-V
Type
Review Article
Information
Psychological Medicine , Volume 39 , Issue 7 , July 2009 , pp. 1055 - 1064
Copyright
Copyright © 2008 Cambridge University Press

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