Generalized anxiety disorder (ICD‐10) in primary care from a cross‐cultural perspective: a valid diagnostic entity?

Maier, Wolfgang; Gänsicke, Michael; Freyberger, Harald J.; Linz, M.; Heun, Reinhard; Lecrubier, Y.

doi:10.1034/j.1600-0447.2000.101001029.x

Cited by 137 publications

(95 citation statements)

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“…This is supported by indications that some cases falling below the GAD threshold are sufficiently similar to diagnosed cases that their inclusion may improve the validity of the diagnosis. Important similarities have previously been observed in functional impairment, socio-demographic features, family history of GAD, and other key correlates between the full GAD syndrome and GAD lasting as little as one month (Bienvenu et al, 1998;Carter et al, 2001;Hunt et al, 2002;Kendler et al, 1992;Kessler et al, 2005b;Maier et al, 2000;Wittchen et al, 2002) or involving non-excessive worry (Bienvenu et al, 1998;Ruscio et al, 2005).…”

Section: Discussionmentioning

confidence: 80%

Broadening the definition of generalized anxiety disorder: Effects on prevalence and associations with other disorders in the National Comorbidity Survey Replication

Ruscio

Chiu

Roy‐Byrne

et al. 2007

Journal of Anxiety Disorders

127

119

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Concerns have been raised that the DSM-IV requirements of six-month duration, excessive worry, and three associated symptoms exclude a substantial number of people with clinically significant anxiety from a diagnosis of generalized anxiety disorder (GAD). We examined the implications of relaxing these three criteria for the estimated prevalence and predictive validity of GAD using nationally representative data from the US National Comorbidity Survey Replication. Relaxing all three criteria more than doubles the estimated prevalence of GAD. Broadly-defined GAD significantly predicts the subsequent first onset of a wide range of temporally secondary disorders. The odds of secondary disorders are somewhat smaller for broadly-defined than DSM-IV GAD, though few of these differences are statistically significant. Results suggest that subthreshold manifestations of GAD are significantly related to elevated risk of subsequent psychopathology. Further research is needed to determine whether broadening the current diagnostic criteria results in a more valid characterization of GAD. Keywordsgeneralized anxiety disorder; prevalence; epidemiology; comorbidity; classification The diagnostic definition of generalized anxiety disorder (GAD) has been a source of debate since the disorder was first introduced in the third edition of the Diagnostic and Statistical Manual of Mental disorders (DSM-III) (American Psychiatric Association, 1980). Given the challenges of distinguishing generalized anxiety from normal stress reactions and from other anxiety and mood disorders (Barlow et al., 1986;Breslau & Davis, 1985; Correspondence concerning this article should be addressed to Ayelet Meron Ruscio, who is now at the Department of Psychology, University of Pennsylvania, 3720 Walnut Street, Philadelphia, PA, USA 19104. Voice: 215-573-4113; Fax: 215-898-7301; E-mail: ruscio@psych.upenn.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. 1994), it is perhaps not surprising that the definition of GAD has changed substantially with each subsequent DSM revision. DSM-III defined GAD as one month of persistent anxiety accompanied by associated symptoms from three of four categories. DSM-III-R changed the requirements to six months of worry along with six of 18 associated symptoms to improve the validity of separation from normal anxiety and from anxiety that occurs secondary to other mental disorders (American Psychiatric Association, 1987). DSM-IV made further changes aimed at sharpening the characterization of GAD by requiring that worry be excessive and uncontrollable (American Psychia...

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Section: Discussionmentioning

confidence: 80%

Broadening the definition of generalized anxiety disorder: Effects on prevalence and associations with other disorders in the National Comorbidity Survey Replication

Ruscio

Chiu

Roy‐Byrne

et al. 2007

Journal of Anxiety Disorders

127

119

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“…In the Australian National Survey of Mental Health and Well-Being sample, Slade and Watson [2006] found similarly high tetrachoric correlations for GAD and panic disorder (.62), agoraphobia (.61), and social anxiety disorder (.58), which were not well distinguished from the associations between social anxiety disorder and panic disorder (.59). Consistent with these reported rates, Maier et al [2000] examined the role of the autonomic symptoms that comprise the diagnosis of GAD in ICD-10 (but were removed from DSM-IV) and found that there were strong relationships between these symptoms and persistent worry and anxiety. These relationships suggest that, at least for a subgroup of individuals with GAD, fear processes may be an important component of their anxious presentation.…”

Section: Symptomatic Overlap Between Gad and Other Anxiety Disorders:mentioning

confidence: 76%

Is generalized anxiety disorder an anxiety or mood disorder? Considering multiple factors as we ponder the fate of GAD

et al. 2008

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Generalized anxiety disorder (GAD) and major depressive disorder (MDD) demonstrate a strong relationship to each other at both genotypic and phenotypic levels, and both demonstrate substantial loadings on a higher-order negative affectivity factor. On the basis of these findings, there have been a number of calls to reclassify GAD in the same category as MDD (the "distress disorders"). However, any consideration of the reclassification of GAD should also take into account a number of other factors not only related to GAD and MDD but also to the overlap of these disorders with other anxiety and mood disorders. First, GAD has established reliability and validity in its own right, and specific features (e.g., worry) may become obscured by attempts at reclassification. Second, examination of the nature of the overlap of GAD and MDD with each other and with other disorders suggests a more complex pattern of differences between these conditions than has been suggested (e.g., MDD has strong relationships with other anxiety disorders, and GAD may be more strongly related to fear than it may first appear). Third, although findings suggest that GAD and MDD may have overlapping heritable characteristics, other evidence suggests that the two disorders may be distinguished by both environmental factors and temporal presentations. Finally, although overlap between GAD and MDD is reflected in their relationships to negative affectivity, temporal relationships between these disorders may be demonstrated by functional changes in emotional responsivity.

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“…[81] A number of studies have shown that a lower duration threshold (e.g., 1 month, 3 months) would identify respondents with similar symptom severity and clinical impairment to the current 6-month threshold (WHO Psychological Problems in Primary Care; NCS-R; Zurich Cohort Study). [79,82,83] Requiring a longer duration requirement (e.g., 12 months), however, would identify respondents with more severe and impairing symptoms than are found in DSM-IV GAD (WMHS). [78] Moreover, variations in the duration threshold would not substantially influence the type of person identified in DSM-V in terms of demographics (ECA; NCS-R; Zurich Cohort Study); [79,83,84] age of onset (WMHS); [78] familial risk of GAD (Virginia Twin Registry; NCS-R; EDSP); [77,85,86] or comorbidity profiles (ECA; Zurich Cohort Study; WMHS; EDSP).…”

Section: Dsm-v Options For ''A Number Of Events or Activities''mentioning

confidence: 99%

Generalized worry disorder: a review of DSM-IV generalized anxiety disorder and options for DSM-V

Andrews¹,

Hobbs²,

Borkovec³

et al. 2010

Depress. Anxiety

226

187

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Background: Generalized anxiety disorder (GAD) has undergone a series of substantial classificatory changes since its first inclusion in DSM-III. The majority of these revisions have been in response to its poor inter-rater reliability and concerns that it may lack diagnostic validity. This article provides options for the revision of the DSM-IV GAD criteria for DSM-V. Method: First, searches were conducted to identify the evidence that previous DSM Work Groups relied upon when revising the DSM-III-R GAD and the overanxious disorder classifications. Second, the literature pertaining to the DSM-IV criteria for GAD was examined. Conclusions: The review presents a number of options to be considered for DSM-V. One option is for GAD to be re-labeled in DSM-V as generalized worry disorder. This would reflect its hallmark feature. Proposed revisions would result in a disorder that is characterized by excessive anxiety and worry generalized to a number of events or activities for 3 months or more. Worry acts as a cognitive coping strategy that manifests in avoidant behaviors. The reliability and validity of the proposed changes could be investigated in DSM-V validity tests and field trials. Depression and Anxiety 27:134-147, 2010.

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Generalized anxiety disorder (ICD‐10) in primary care from a cross‐cultural perspective: a valid diagnostic entity?

Cited by 137 publications

References 0 publications

Broadening the definition of generalized anxiety disorder: Effects on prevalence and associations with other disorders in the National Comorbidity Survey Replication

Broadening the definition of generalized anxiety disorder: Effects on prevalence and associations with other disorders in the National Comorbidity Survey Replication

Is generalized anxiety disorder an anxiety or mood disorder? Considering multiple factors as we ponder the fate of GAD

Generalized worry disorder: a review of DSM-IV generalized anxiety disorder and options for DSM-V

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