Improving recognition of late life anxiety disorders in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition: observations and recommendations of the Advisory Committee to the Lifespan Disorders Work Group

Abstract

Background Recognition of the significance of anxiety disorders in older adults is growing. The revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) provides a timely opportunity to consider potential improvements to diagnostic criteria for psychiatric disorders for use with older people. The authors of this paper comprise the Advisory Committee to the DSM5 Lifespan Disorders Work Group, the purpose of which was to generate informative responses from individuals with clinical and research expertise in the field of late-life anxiety disorders. Methods This paper reviews the unique features of anxiety in later life and synthesizes the work of the Advisory Committee. Results Suggestions are offered for refining our understanding of the effects of aging on anxiety and other disorders (e.g., mood disorders) and changes to the DSM5 criteria and text that could facilitate more accurate recognition and diagnosis of anxiety disorders in older adults. Several of the recommendations are not limited to the study of anxiety but rather are applicable across the broader field of geriatric mental health. Conclusions DSM5 should provide guidelines for the thorough assessment of avoidance, excessiveness, and comorbid conditions (e.g., depression, medical illness, cognitive impairment) in anxious older adults.

A prospective study of the impact of floods on the mental and physical health of older adults

“…A recent review suggested that although most older adults do not develop PTSD in face of adversity, those who did, might suffer far-reaching and long-lasting impairments (Thorp & Blazer, 2012). It has also been suggested that older adults may under-report symptoms of anxiety (Mohlman et al, 2012), including PTSD (Cook & O'Donnell, 2005). This is of particular concern in older adults, as it is known that even sub-threshold symptom levels can cause significant functional impairment in this age group (Jeste, Blazer, & First, 2005).…”

Initial evaluation of the Older Adult Social-Evaluative Situations Questionnaire: a measure of social anxiety in older adults

“…This decision was influenced by lifespan theories of emotion (e.g. SST; Carstensen, 1995) and evidence that older adults' maladaptive avoidance of situations may not be captured by existing anxiety measures or by the DSM-IV-TR diagnostic criteria for most anxiety disorders (Mohlman et al, 2012). Of the final 37 items, only ten items were thematically similar, though not identical, to items found on the SPAI.…”

“…Furthermore, the combined group of older adults with SAD and those with subsyndromal SAD had lower social and mental functioning compared to older adults without social anxiety. Thus, older adults may be less likely to report their fears as being excessive or unreasonable, which calls into question the utility of the DSM-IV-TR criteria for older adults (Bryant, 2010;Mohlman et al, 2012).…”

“…These interviews are time and resource-intensive, and may not be feasible for use with older adults in many research and clinical settings. Additionally, there may be problems with using the current diagnostic criteria to identify social anxiety symptoms in late life (see Mohlman et al, 2012). Mohlman and colleagues make several recommendations including: (1) eliminating the criteria specifying that fears are perceived as excessive and (2) including assessment of functional domains that are salient for older adults, such as visiting grandchildren and volunteering.…”

“…Thus, older adults may use avoidance to experience negative emotions such as anxiety or anger less frequently. Others have suggested that older adults' maladaptive avoidance of situations may not be captured by existing anxiety measures or by the DSM-IV-TR diagnostic criteria for most anxiety disorders (Mohlman et al, 2012). Specific avoidance behaviors, such as keeping busy to avoid anxiety and worries, may not be adequately assessed by existing measures.…”