07/03/2010 05:12 am ET Updated Nov 17, 2011

Normal Anxiety, a Disorder, or Both?

Earlier this month, The Child Study Center Foundation convened its Scientific Research Council -- a group of world-renowned researchers and clinicians who, in my view, have the unique ability to transform the field of child and adolescent mental health. We sat for two days in a large conference room in Midtown Manhattan, many of the scientists around our table having traveled to the meeting from out of state. We had among us representation from Harvard Medical School; the Yale Child Study Center; the University of Pittsburgh; the University of California, Berkeley; the Oregon National Primate Research Center; and the National Institute of Mental Health (NIMH). Our New York-based colleagues came from the NYU Langone School of Medicine and the NYU Center for Neural Science, as well as from the Nathan S. Kline Institute for Psychiatric Research. Our collective expertise and energy were an inspiration, for never in my 30-year career as a child and adolescent psychiatrist have I had the opportunity to observe the collaboration of such a remarkable team of "superstar" scientists. The group had gathered to finalize an aggressive research agenda that will culminate in new treatments for anxiety disorders in children and adolescents. Early in the meeting, however, several of my colleagues shared their concerns that the public saw neither the importance nor the urgency of studying anxiety disorders in children and adolescents.

"I anticipate the criticism that anxiety isn't important enough," said my colleague Daniel Pine, M.D., of NIMH. "Most people look at anxiety as a trivial problem."

That mind-set is what scientists often worry about when setting research priorities. Our studies need funding and, therefore, must be marketable to funders and to their constituents, the public.

As I listened to Dr. Pine, it was clear to me that the public needed this group to distinguish "normal anxiety" from an "anxiety disorder." I had, in fact, been thinking about this over the past several months. Many friends who aren't in the medical field had looked at me somewhat dumbfounded when I described my plans for collaboration with world-class scientists to develop a research program that could lead to revolutionary treatments for anxiety disorders in children and adolescents. "Why anxiety?" I'd been asked, again and again. Some friends even said, "Anxiety is great," for without it they'd never have been able to accomplish so much in their careers.

So, here I had gathered some of our nation's leading scientists -- and, more than that, secured their leadership on the Scientific Research Council of my new organization, The Child Study Center Foundation -- and their focus on anxiety wasn't really gaining traction. Over the past 15 years, psychiatry has had great success in distinguishing for the public the difference between "depression" and "sadness," but the difference between "worrying" and the kind of "anxieties" categorized in psychiatry's diagnostic manual, DSM-IV, is not well known. We had work to do.

While some anxiety is a normal reaction to stress, the anxiety that interferes with one's ability to function, to handle everyday situations, is a debilitating disorder. Approximately 13 percent of American children and adolescents suffer from an anxiety disorder in a given year. Many of them are unable to leave home or attend school because of this disorder. And consider the broader context: Childhood anxiety disorders are the greatest predictors of mood disorders, chronic depression, and alcohol abuse in adulthood. More than 40 million adults in this country (18 percent of the population) have reported disabling anxiety that negatively impacts their lives. Furthermore, anxiety disorders cost the United States more than $42 billion a year, nearly a third of our nation's mental health bill.

My colleagues and I originally became focused on anxiety disorders because we saw an opportunity to make a very large impact on the lives of millions of children. We believed, and still believe, we could do create this impact in a relatively short amount of time. Childhood anxiety disorders, if left untreated, almost always become chronic, and refractory to treatment in adulthood. This is why we must act now to address this critical issue.

Because our cause is urgent, it is crucial that both scientific and lay communities work toward dispelling the myth that anxiety disorders are somehow less important -- or worse, insignificant -- in the vast landscape of psychiatric illnesses. We're not talking about a normal response to stress here. Anxiety, when it develops into pathology, may be diagnosed as social phobia, separation anxiety, panic disorder, obsessive-compulsive disorder, generalized anxiety disorder, post-traumatic stress disorder, anorexia, and bulimia, among a host of other maladies. We should all be alarmed--very anxious, if you will--when our nation's leading scientists worry that the public's understanding of anxiety stands in the way of groundbreaking research studies.

We need strong public acknowledgment that severe anxiety is the basis for many of the most pervasive psychiatric disorders. And we need a public outcry for research into the stressors that underlie anxiety disorders. This is the only pathway to new and better treatments.

Harold S. Koplewicz, M.D.
President, The Child Study Center Foundation, Inc.
Director, Nathan S. Kline Institute for Psychiatric Research