The status quo as a good outcome: How the DSM-5 diagnostic criteria for generalized anxiety disorder remained unchanged from the DSM-IV criteria

Generalized anxiety disorder (GAD) is purported to start in early childhood but concerns about attenuation of anxiety symptoms over time and the development of emerging cognitive and emotional processing capabilities pose multiple challenges for accurate detection. This paper presents the first known case reports of very young children with GAD to examine these developmental challenges at the item level. Three children, five-to-six years of age, were assessed with the Diagnostic Infant and Preschool Assessment twice in a test-retest reliability study. One case appeared to show attenuation of the worries during the test-retest period based on caregiver report but not when followed over two years. The other two cases showed stability of the full complement of diagnostic criteria. The cases were useful for demonstrating that the current diagnostic criteria appear adequate for this developmental period. The challenges of accurate assessment of young children that might cause missed diagnoses are discussed. Future research on the underlying dysregulation of negative emotionality and long-term follow-ups are needed to better understand the etiology, treatment, and course of GAD in this age group.

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Social Anxiety Disorder (Social Phobia)

Anxiety Disorders in Adults ◽

10.1093/oso/9780195369250.003.0008 ◽

2009 ◽

Author(s):

Vladan Starcevic, MD, PhD

Keyword(s):

Anxiety Disorder ◽

Social Anxiety ◽

Social Phobia ◽

Generalized Anxiety Disorder ◽

Social Anxiety Disorder ◽

Generalized Anxiety ◽

Making Sense ◽

The Status ◽

Bona Fide ◽

Severe Psychopathology

Social anxiety disorder (SAD) is conceptualized as an excessive and/or unreasonable fear of situations in which the person’s behavior or appearance might be scrutinized and evaluated. This fear is a consequence of the person’s expectation to be judged negatively, which might lead to embarrassment or humiliation. Typical examples of feared and usually avoided social situations are giving a talk in public, performing other tasks in front of others, and interacting with people in general. Although the existence of SAD as a psychopathological entity has been known for at least 100 years, it was only relatively recently, with the publication of DSM-III in 1980, that SAD (or social phobia) acquired the status of an ‘‘official’’ psychiatric diagnosis. The term social anxiety disorder has been increasingly used instead of social phobia, because it is felt that the use of the former term conveys more strongly the pervasiveness and impairment associated with the condition and that this term will promote better recognition of the disorder and contribute to better differentiation from specific phobia (Liebowitz et al., 2000). Like generalized anxiety disorder, social anxiety disorder is common and controversial. Unlike generalized anxiety disorder, which is described in different ways by different diagnostic criteria and different researchers and clinicians, SAD does not suffer from a ‘‘description problem.’’ It is not particularly difficult to recognize features of SAD; what may be difficult is making sense of these features. Main issues associated with SAD are listed below…. 1. Where are the boundaries of SAD? How well is SAD distinguished from ‘‘normal’’ social anxiety and shyness on one hand, and from severe psychopathology on the other? 2. Is there a danger of ‘‘pathologizing’’ intense social anxiety by labeling it a psychiatric disorder? How can the distress and suffering of people with high levels of social anxiety be acknowledged if they are not given the corresponding diagnostic label? 3. Is SAD a bona fide mental disorder? 4. Can the subtyping scheme (nongeneralized vs. generalized SAD) be supported? 5. Is there a spectrum of social anxiety disorders?

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Diagnostic efficiency of symptoms in the diagnosis of DSM-IV: generalized anxiety disorder in youth

Journal of Child Psychology and Psychiatry ◽

10.1111/1469-7610.00100 ◽

2002 ◽

Vol 43 (7) ◽

pp. 959-967 ◽

Cited By ~ 22

Author(s):

Armando A. Pina ◽

Wendy K. Silverman ◽

Candice A. Alfano ◽

Lissette M. Saavedra

Keyword(s):

Anxiety Disorder ◽

Generalized Anxiety Disorder ◽

Generalized Anxiety ◽

Diagnostic Efficiency ◽

Dsm Iv

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Prevalence and impact of generalized anxiety disorder and major depression in primary care in Belgium and Luxemburg: the GADIS study

European Psychiatry ◽

10.1016/j.eurpsy.2004.09.035 ◽

2005 ◽

Vol 20 (3) ◽

pp. 229-235 ◽

Cited By ~ 51

Author(s):

Marc Ansseau ◽

Benjamin Fischler ◽

Michel Dierick ◽

Annick Mignon ◽

Sophie Leyman

Keyword(s):

Primary Care ◽

Anxiety Disorder ◽

Major Depression ◽

Generalized Anxiety Disorder ◽

Large Scale ◽

Screening Program ◽

Generalized Anxiety ◽

French Speaking ◽

Dsm Iv ◽

Large Scale Screening

AbstractPurposeGADIS aims at determining the prevalence of generalized anxiety disorder (GAD) and major depression (MD) in primary care and their impact on the patient’s functioning in Belgium and Luxemburg.MethodsA large scale screening program was conducted at the consultation of general practitioners to detect patients with GAD and MD according to DSM-IV criteria. We collected additional data regarding the use of hypnotic, tranquilizer, antidepressant and analgesic medications. Impact on the patient was assessed with the Sheehan disability scale.ResultsThree hundred GP’s in Belgium and Luxemburg were asked to screen 50 consecutive patients. Of the 13,677 analyzed patients, 8.3% were diagnosed to have GAD and 6.3% MD. Comorbidity was observed in 4.2% of patients. The prevalence was much higher in the French-speaking part of Belgium. GAD and MD were associated with impairment in social, familial and professional functioning. Only a minority of patients with GAD and/or MD was treated with an antidepressant and almost half of subjects with GAD and/or MD were treated with a tranquilizer.ConclusionsPrevalence rates of GAD and MD in primary care in Belgium are comparable to other countries. GAD and MD are disabling conditions. Antidepressants are still used only in a minority of subjects with GAD and/or MD in primary care in Belgium and Luxemburg. The prevalence of GAD and MD appears to be much higher in French-speaking parts of Belgium.

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The 1-Month Prevalence of Generalized Anxiety Disorder According to DSM-IV, DSM-V, and ICD-10 Among Nondemented 75-Year-Olds in Gothenburg, Sweden

American Journal of Geriatric Psychiatry ◽

10.1097/jgp.0b013e318252e749 ◽

2012 ◽

Vol 20 (11) ◽

pp. 963-972 ◽

Cited By ~ 12

Author(s):

Johan Nilsson ◽

Svante Östling ◽

Margda Waern ◽

Björn Karlsson ◽

Robert Sigström ◽

...

Keyword(s):

Anxiety Disorder ◽

Generalized Anxiety Disorder ◽

Generalized Anxiety ◽

Dsm V ◽

Icd 10 ◽

Dsm Iv

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Generalized anxiety disorder, obsessive-compulsive disorder and social phobia: sources of dissonance between ICD-10 and DSM-IV

International Journal of Methods in Psychiatric Research ◽

10.1002/mpr.39 ◽

1998 ◽

Vol 7 (2) ◽

pp. 110-115 ◽

Cited By ~ 11

Author(s):

Gavin Andrews ◽

Tim Slade ◽

Lorna Peters ◽

John Beard

Keyword(s):

Anxiety Disorder ◽

Social Phobia ◽

Obsessive Compulsive Disorder ◽

Generalized Anxiety Disorder ◽

Generalized Anxiety ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Icd 10 ◽

Dsm Iv

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Generalized anxiety disorder and clinical worry episodes in young women

Psychological Medicine ◽

10.1017/s0033291702006360 ◽

2002 ◽

Vol 32 (7) ◽

pp. 1227-1237 ◽

Cited By ~ 30

Author(s):

J. HOYER ◽

E. S. BECKER ◽

J. MARGRAF

Keyword(s):

Anxiety Disorder ◽

Generalized Anxiety Disorder ◽

Young Women ◽

Psychosocial Functioning ◽

Predictive Accuracy ◽

Community Sample ◽

Epidemiological Data ◽

Generalized Anxiety ◽

Co Morbidity ◽

Dsm Iv

Background. This article presents epidemiological data on the prevalence of DSM-IV generalized anxiety disorder (GAD) and sub-threshold GAD (fulfilling three out of four GAD criteria) in young women together with data on co-morbidity and psychosocial functioning. The prevalence of clinically relevant worry and its predictive validity for the diagnosis of GAD were also examined.Method. Young women (N = 2064), aged between 18 and 25, from a representative German community sample were diagnosed with a structured clinical interview (ADIS-L, German research version). An additional interview questioned all the participants about the frequency/intensity and uncontrollability of diverse worry topics.Results. Thirty-seven participants (1.8%) fulfilled the criteria of current GAD (1 week point prevalence) and 56 received a lifetime diagnosis (2.7%); a further 50 participants (2.3%) were diagnosed with sub-threshold GAD. Co-morbidity between GAD and other disorders was high for current (68%) and lifetime GAD (91%). GAD, as well as sub-threshold GAD, showed clearly reduced levels of psychosocial functioning. Whereas worries of low intensity and high controllability were ubiquitous in all subsamples, clinically defined worrying was rarely present in healthy subjects (0.89%) and of adequate predictive accuracy for GAD.Conclusions. Full GAD and sub-threshold GAD were moderately frequent in young women. Although DSM-IV worry criteria proved to be highly useful, the strictness of the complete GAD-criteria should not lead to absence of attention from subclinical generalized anxiety states in research and practice.

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