Issues in diagnosing anxiety disorders

Abstract

Research progress in the anxiety disorders is predicated on a useful classification system. In this paper, we review the reliability and validity data for the Diagnostic and Statistical Manual of Mental Disorders, anxiety disorders and discuss the salient issues associated with both the conceptualization of anxiety disorders and the diagnostic criteria offered in the DSM-III. It is concluded that the diagnostic reliability for these disorders is, overall, satisfactory. A dearth of validity data, however, hinders progress in both the diagnosis and the treatment of the anxiety disorders.Nevertheless, the DSM-11I work group has proposed several changes in the diagnostic criteria for the anxiety disorders. We find some of these proposed changes helpful in that they clarify current diagnostic criteria; changes in diagnostic criteria that alter the basic classification schema, however, seem to be premature.

Psychopathology of social phobia and comparison to avoidant personality disorder.

“…It was also reported in an earlier study by Turner, McCann, Beidel, & Mezzich (1986) that socially phobic subjects experience considerably more general anxiety and depression than do those individuals with simple phobia, but somewhat less than the anxiety states. Similar findings were reported by Cerny et al (1984).…”

“…Although we have witnessed an explosion in the quantity and type of research in the anxiety disorders over the past few years, one anxiety disorder, social phobia, remains relatively unstudied. Socially phobic behavior can be seen in a number of clinical syndromes (Cerny, Himadi, & Barlow, 1984), but socially phobic individuals meeting DSM-III criteria are specifically characterized by fear of negative evaluation and scrutiny by others.…”

“…Although we have witnessed an explosion in the quantity and type of research in the anxiety disorders over the past few years, one anxiety disorder, social phobia, remains relatively unstudied. Socially phobic behavior can be seen in a number of clinical syndromes (Cerny, Himadi, & Barlow, 1984), but socially phobic individuals meeting DSM-III criteria are specifically characterized by fear of negative evaluation and scrutiny by others. Little empirical data exist on the clinical syndrome of social phobia, but newly emerging data suggest that the clinical manifestations are much more severe than previously thought (e.g., Amies et al., 1983; Pilkonis, Feldman, & Himmelhoch, 1981; Smail, Stockwell, Canter, & Hodgson, 1984).…”

Conceptual, methodological, and clinical issues in the assessment of anxiety disorders

“…(DSM-III;American Psychiatric Association, 1980)] has clearly improved the precision in the classification of psychiatric disturbances including the anxiety disorders. This system is far from perfect, which is attested to by the current work being undertaken on a revision (DSM-III-R) in which some changes will be made in at least one anxiety category-generalized anxiety disorder (see Cerny, Himadi, & Barlow, 1984). Thus, the architects of the DSM-III, as well as its many critics, recognize that there are limitations to the current system.…”

Assessing the clinical utility of agoraphobia in the context of panic disorder

“…The classification of agoraphobia within the Diagnostic and Statistical Manual (DSM) for Mental Disorders has undergone significant changes over time and continues to be a controversial issue [Cerny et al, 1984]. Marks and Bebbington [1976] originally suggested that agoraphobia was a phobic disorder arising from fears of public places that may or may not occur with panic attacks.…”