@article{ba0029af87694a83abba96d7018cb1d8,
title = "Normal and Abnormal Anxiety in the Age of DSM-5 and ICD-11",
abstract = "Despite the effort on DSM-5 and ICD-11, few appear satisfied with these classification systems. We suggest that the core reason for dissatisfaction is expecting too much from them; they do not provide discrete categories that map to specific causes of disease, they describe clinical syndromes intended to guide treatment choices. Here we review work on anxiety and anxiety disorders to argue that while clinicians draw a pragmatic distinction between normal and abnormal emotions based on considerations such as severity and duration, understanding the evolutionary origins and utility of the emotions, including the adaptive value of adverse emotions, is key for formulating comprehensive assessments of an individual patients symptoms and for providing a conceptual foundation for pharmacotherapy, psychotherapy, and public health.",
keywords = "anxiety, anxiety disorders, emotion, evolutionary theory, psychiatric classification",
author = "Stein, {Dan J.} and Randolph Nesse",
note = "Funding Information: Dissatisfaction with psychiatric diagnostic systems arises mainly, we believe, from unrealistic expectations. The failure to find biomarkers for DSM diagnoses should not be blamed on the DSM categories. The conviction that other categories will prove superior may be based on the false assumption most mental disorders arise from specific brain abnormities. Diagnostic categories are not diseases with specific causes, they are descriptions of clinically observed syndromes that are useful for research and treatment despite their limitations. Clinicians understandably draw a pragmatic distinction between normal and abnormal emotions based on multiple considerations including severity and duration. At the same time, we argue that psychiatric classifications must increasingly address issues of diagnostic validity, and for emotional disorders, this must be based on a theoretical framework that includes an understanding not only of proximal molecular and psychosocial mechanisms, but also of the evolutionary forces that shaped brain mechanisms that regulate the expression of emotions. Author note: Dr Stein is supported by the Medical Research Council of South Africa. Declaration of Conflicting Interests None declared. Publisher Copyright: {\textcopyright} ISRE and SAGE.",
year = "2015",
month = jul,
day = "11",
doi = "10.1177/1754073915575407",
language = "English (US)",
volume = "7",
pages = "223--229",
journal = "Emotion Review",
issn = "1754-0739",
publisher = "SAGE Publications Ltd",
number = "3",
}