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Chapter 4
Vulnerability to Anxiety
We walk in circles so limited by our own anxieties that we can no longer distinguish
between true and false, between the gangster’s whim and the purest ideal.
—in g r i d Be r gM a n (Swedish-born actress, 1915–1982)People who have suffered years from an anxiety disorder are often perplexed about the
origins of their disorder. Clients will frequently ask “Why me?,” “How come I devel-
oped this problem with anxiety?”, “Did I inherit this condition, do I have some kind of
imbalance in my brain chemistry?,” “Did I do something to bring this on myself?” “Is
there a flaw in my personality or some weakness in my psychological makeup?” Unfor-
tunately, clinicians facing questions about the etiology of anxiety have great difficulty
providing satisfactory answers given that our knowledge of vulnerability to anxiety is
relatively limited (McNally, 2001).
Even though research on vulnerability has lagged behind our knowledge of the psy-
chopathology and treatment of anxiety, most would agree that susceptibility to devel-
oping an anxiety disorder varies greatly within the general population. This is well
illustrated in the following case examples. Cynthia, a 29-year-old factory worker, who
described herself as being highly anxious, worrisome, and lacking self- confidence since
early childhood, developed moderately severe doubt and checking compulsions after
leaving high school and assuming the increased responsibilities of work and living inde-
pendently. Andy, a 41-year-old accountant, presented with a first onset of severe panic
disorder and agoraphobic avoidance after promotion to a highly stressful, performance-
driven managerial position that led to the onset of various physical symptoms, such as
chest pressure and pain, heart palpitations, numbness, sweating, lightheadedness, and
stomach tightness. He had a comorbid health anxiety that intensified after receiving
treatment for hiatus hernia, high cholesterol, and acid reflux. Ann Marie, a 35-year-
old government office worker, suffered from long- standing social phobia that remained
untreated until she experienced her first full-blown panic attack after a promotion that
caused a significant increase in her work stress. Ann Marie stated that she had always
been a generally anxious and worrisome person since high school, but currently found
social interactions the most threatening for her.