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

Depression and Anxiety (Impact Factor: 4.29). 04/2008; 25(4):289 - 299. DOI: 10.1002/da.20493
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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 [see Watson, 2005: J Abnorm Psychol 114:522–536]. 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. Depression and Anxiety 25:289–299, 2008. © 2008 Wiley-Liss, Inc.

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    • "Although this overlap is well documented, and has been intensively reviewed (First, 2007), the relationship between GAD and mood disorders is complex. GAD has been shown to have a number of core, unique features (e.g., worry and fear of uncertainty) validating its separate diagnosis as an anxiety disorder (Mennin et al., 2008). We recruited lay people as a comparison sample to determine whether the proposed visual causal model presentation was as effective for mental health patients as for lay people. "
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    • "In line with previous observations, Brown and Barlow [30] have recently considered the problem of sensitivity and specificity of GAD and have concluded that DSM-IV criteria for GAD do not differentiate a patient with GAD from a patient with clinical depression [31] because the exclusion of the autonomic symptoms from DSM-IV criteria for GAD might obfuscate the boundary between MDD and GAD. In fact, muscle tension appeared to be uniquely related to worry, whereas difficulty concentrating appeared to have a very strong relationship with depression [2]. Moving from these concepts, the main aim of the present research was to evaluate the coherence of GAD psychopathological pattern, the robustness of its diagnostic criteria, and the clinical utility of considering this disorder as a discrete condition rather than assigning it a dimensional value. "
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    ABSTRACT: OBJECTIVE: The main aim of the present research was to evaluate the coherence of generalized anxiety disorder (GAD) psychopathological pattern, the robustness of its diagnostic criteria, and the clinical utility of considering this disorder as a discrete condition rather than assigning it a dimensional value. METHOD: The study was designed in a purely naturalistic setting and carried out using a community sample; data from the Sesto Fiorentino Study were reanalyzed. RESULTS: Of the 105 subjects who satisfied the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for the diagnosis of GAD, only 18 (17.1%) had no other comorbid DSM-IV disorder. The most frequent comorbid condition was major depressive disorder (70.4 %). Only 2 of the GAD diagnostic symptoms (excessive worry and muscle tension) showed a specific association with the diagnosis itself, whereas the others, such as feeling wound up, tense, or restless, concentration problems, and fatigue, were found to be more prevalent in major depressive disorder than in GAD. CONCLUSION: Our study demonstrates that GAD, as defined by DSM-IV criteria, shows a substantial overlap with other DSM-IV diagnoses (especially with mood disorders) in the general population. Furthermore, GAD symptoms are frequent in all other disorders included in the mood/anxiety spectrum. Finally, none of the GAD symptoms, apart from muscle tension, distinguished GAD from patients without GAD.
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    • "MDD shows higher comorbidity with GAD than with any other anxiety disorder (Kessler, Chiu, et al., 2005); Hunt, Slade, and Andrews (2004) found that 39.3% of individuals with GAD also met criteria for MDD within the same one-month period. In fact, GAD co-occurs with depression with such regularity that some argue that it should be classified with MDD as a " general distress " disorder (Watson, 2005; although others have raised important counterarguments, Mennin, et al., 2008). Thus, understanding comorbidity between depression and GAD may have especially important conceptual implications. "
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