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

Abstract

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.

Gradients of Fear Potentiated Startle During Generalization, Extinction, and Extinction Recall—and Their Relations With Worry

“…Also, individuals with GAD have greater intolerance of uncertainty (Mennin, Heimberg, Fresco, & Ritter, 2008), and a tendency to interpret ambiguous or neutral stimuli as threatening (Butler & Mathews, 1983;Hazlett-Stevens & Borkovec, 2004;Mathews, Richards, & Eysenck, 1989).…”

Introduction to the Special Issue: Emotion Regulation as a Transdiagnostic Process

“…One specific form that this question has taken pertains to establishing meaningful boundaries between different ''types'' of abnormal behavior. In this respect, two opposing views have been popular over the years: (1) the ''splitter'' approach, which posits that the best way to understand dysfunction is by identifying an increasingly larger number of diagnoses, and (2) the ''lumper'' approach, which emphasizes functional similarities across pathologies and proposes dimensional models of psychopathology (e.g., Barlow et al 2014;Cuthbert 2005;Mennin et al 2008).…”

Early life course determinants of psychopathology

“…While the depressive and anxiety disorders described in table 1 are considered to be distinct and separate disorders, the high comorbidity among the depressive and anxiety disorders has led many to question what these comorbid relationships represent (62). In particular, the strong relationship between Major Depressive Disorder (MDD) and Generalised Anxiety Disorder (GAD) has prompted calls for the reclassification of both disorders under the same diagnostic category (63). Such arguments gain additional support due to GAD's historically poor nosological integrity (63).…”

“…In particular, the strong relationship between Major Depressive Disorder (MDD) and Generalised Anxiety Disorder (GAD) has prompted calls for the reclassification of both disorders under the same diagnostic category (63). Such arguments gain additional support due to GAD's historically poor nosological integrity (63). However, over recent revisions of the DSM, GAD has developed relatively rapidly, from a residual diagnosis in DSM-III to a reliable diagnosis characterized by worry, (apprehensive expectation of future events), in DSM-IV (64).…”

“…Some evidence also suggests that both disorders represent different manifestations of a single underlying construct (63). MDD and GAD exhibit higher comorbidity than do other anxiety disorders with MDD (62), with a temporal sequence suggesting that GAD symptoms represent a prodrome of MDD (65).…”