Origins of Phobias and Anxiety Disorders: Why More Women Than Men?
Dobson, Deborah, Journal of Cognitive Psychotherapy
Origins of Phobias and Anxiety Disorders: Why More Women than Men? Michelle G. Craske. Kidlington, Oxon, UK: Elsevier (www.elsevier.com). 2003, 312 pp., $85.00 (hardcover).
Michelle Craske writes succinctly and clearly in Origins of Phobias and Anxiety Disorders: Why More Women than Men? This book covers a broad array of studies and related topics and is deceptively slim. Deceptive because it is packed with information, statistics, research reviews, and theory development related to the topic. The author states her goals and then systematically and comprehensively proceeds to review the relevant literature in accomplishing them. The approach is matter-of-fact, with minimal interpretation or embellishment. Her goals were to provide an overarching review of factors contributing to high levels of fear and anxiety disorders and to explore the factors responsible for why more women experience these disorders than men. Throughout the text, Craske confidently and methodically builds her arguments, showing a thorough grasp not only of the extensive literature on fear and anxiety disorders, but also of child development, covariation between anxiety and mood disorders, gender differences, and so on. Ultimately, she reaches a convincing conclusion by a reasoned theoretical approach to explain the gender disparity.
In the first chapter, which covers features of fear and anxiety, Craske engages the topic immediately and without ceremony. She has a great deal to say. The chapter is replete with statistics on sex differences in "normal" fear as well as anxiety disorders, associated forms of distress, and avoidance behavior across the lifespan. There are many interesting findings reviewed-for example, in youths, anxiety precedes not only depression, but also anorexia nervosa, bulimia nervosa, and substance abuse in the majority of cases. Once anxiety develops, males and females have been shown to be equally likely to develop a depressive disorder. She argues that covariation between anxiety and mood disorders may have a common vulnerability factor, of which anxiety may occur earlier in the developmental process. Furthermore, it may not be anxiety per se that leads to gender differences, but the reaction to it, most notably avoidance. At the end of this chapter, she describes the Origins Model and the structure of the book.
Chapter 2 teases apart the nature and function of fear and anxiety. As others have argued, she takes the position that fear and anxiety are different states, with fear being a consequence of a detected threat leading to increased autonomie reactivity and inhibition of some cognitive processes and anxiety being a consequence of undetected threats leading to worry. Increased verbal processes tend to result in anxious worry whereas increased imagery tends to lead to fear. Chapters 3 and 4 provide a review of broad-based vulnerabilities to anxiety-notably negative affectivity and its consequences. She reviewed the available empirical support for links between underlying temperament as a vulnerability factor for anxiety, including negative affectivity, behavioral inhibition, and genetic influences. She moves to a detailed analysis of the developmental literature on infants and children, particularly of the interactions among different factors, such as parenting style, temperament, self-regulation, and the risk of anxiety disorders. One of the conclusions is that the parents of anxious children reinforce avoidant coping as a solution, leading to development of more anxiety. Chapter 5 provides a review of the experimental literature on anxious processing of information. Anxious processing is generally characterized by biases towards detection of potential threat for attention, judgments, and memory. …