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The Role of the Hypothalamic–Pituitary–Adrenal Axis in Anxiety Disorders 

The Role of the Hypothalamic–Pituitary–Adrenal Axis in Anxiety Disorders
The Role of the Hypothalamic–Pituitary–Adrenal Axis in Anxiety Disorders

Luminita Luca

and Charles B. Nemeroff

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date: 25 October 2020

The current understanding of the neurobiological underpinnings of all severe psychiatric disorders, including anxiety disorders, is evolving as advances in neuroscience are realized. Of particular importance is a growing body of evidence suggesting that early life trauma induces vulnerability to stress later in life, manifested by increased risk for mood and anxiety disorders The hypothalamic–pituitary–adrenal (HPA) axis is the major neuroendocrine mediator of the response to stress. This review summarizes the role of the HPA axis in stress regulation and in the pathophysiology of anxiety disorders by describing the combination of genetic factors, early life stressors, and ongoing trauma that regulate an individual’s vulnerability to syndromal anxiety disorders. Disturbances in the HPA axis across specific anxiety disorders are reviewed, including panic disorder (PD), generalized anxiety disorder (GAD), social anxiety disorder (SAD), and posttraumatic stress disorder (PTSD).

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