Generalized anxiety disorder pathophysiology

Generalized anxiety disorder has been linked to the disrupted functional connectivity of the amygdala and its processing of fear and anxiety. Sensory information enters the amygdala through the nuclei of the basolateral complex (consisting of lateral, basal and accessory basal nuclei).

• Generalized anxiety disorder has been linked to the disrupted functional connectivity of the amygdala and its processing of fear and anxiety.^[1]
• Sensory information enters the amygdala through the nuclei of the basolateral complex (consisting of lateral, basal and accessory basal nuclei). The basolateral complex processes the sensory-related fear memories and communicates their threat importance to elsewhere in the brain, such as the medial prefrontal cortex and sensory cortices, along with:^[2]
  • Memory processing
  • Sensory processing
• Another area, the adjacent central nucleus of the amygdala, controls species-specific fear responses in its connections to the brainstem, hypothalamus and cerebellum areas.
• In those with generalized anxiety disorder, these connections seem less functionally distinct, and there is greater gray matter in the central nucleus.
• Another difference is that the amygdala areas have decreased connectivity with the insula and cingulate areas that control general stimulus salience while having greater connectivity with the parietal cortex and prefrontal cortex circuits that underlie executive functions.^[3]
  • The latter suggests a compensation strategy for dysfunctional amygdala processing of anxiety.
  • This is consistent with cognitive theories that suggest the use in this disorder of attempts to reduce the involvement of emotions with compensatory cognitive strategies.^[4]