Generalized worry disorder: A review of DSM-IV Generalized Anxiety Disorder and options for DSM-V

Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales, Sydney, Australia.
Depression and Anxiety (Impact Factor: 4.41). 02/2010; 27(2):134-47. DOI: 10.1002/da.20658
Source: PubMed


Generalized anxiety disorder (GAD) has undergone a series of substantial classificatory changes since its first inclusion in DSM-III. The majority of these revisions have been in response to its poor inter-rater reliability and concerns that it may lack diagnostic validity. This article provides options for the revision of the DSM-IV GAD criteria for DSM-V.
First, searches were conducted to identify the evidence that previous DSM Work Groups relied upon when revising the DSM-III-R GAD and the overanxious disorder classifications. Second, the literature pertaining to the DSM-IV criteria for GAD was examined.
The review presents a number of options to be considered for DSM-V. One option is for GAD to be re-labeled in DSM-V as generalized worry disorder. This would reflect its hallmark feature. Proposed revisions would result in a disorder that is characterized by excessive anxiety and worry generalized to a number of events or activities for 3 months or more. Worry acts as a cognitive coping strategy that manifests in avoidant behaviors. The reliability and validity of the proposed changes could be investigated in DSM-V validity tests and field trials.

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    • "Whereas the self-reported ability to control worry was smaller in likely GAD sufferers, individuals with high PSWQ scores who did not fulfill all GAD criteria still reported less control over worry. In consequence, they and others (e. g. Andrews, et al., 2010) argue that the experienced loss of control over worry varies with the intensity or excessiveness of worrying and does not mark a clear distinction between ''normal worriers'' and persons with GAD. However, in our opinion this argument is flawed because high worriers were selected with the PSWQ. "
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    ABSTRACT: Five types of intervention may be of special relevance and in consequence have been included in treatments targeting generalized anxiety disorder (GAD) symptomology: metacognitive therapy targeting both negative and positive metacognitions concerning worrying; fear imagery exposure, based on the avoidance theory of worrying; interventions developed to increase tolerance of uncertainty; relaxation exercises; and finally, treatment modules focusing on negative problem orientation. This chapter first describes the diagnostic procedures most helpful for the preparation of treatment and then the treatment modules. All these modules have been included in manualized treatments, which have been evaluated with regard to their efficacy in a number of RCTs. The chapter presents an overview of the evidence for the efficacy of variations of this cognitive-behavioral treatment (CBT). Applied relaxation is one of the most regularly used components within standard CBTs for GAD. Besides cognitive-behavioral therapy and psychodynamic psychotherapy, pharmacotherapy offers another evidence-based treatment option for GAD.
    The Wiley Handbook of Anxiety Disorders, 04/2014: pages 1003-1037; , ISBN: 9781118775356
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    • "These subscales had 3M-P α reliability estimates of 0.85 and 0.88. The latent construct representing MDD symptoms was indicated by MDD CSRs, and two subscales that were created by dividing six EPDS items into two three-item subscales.2 These subscales had 3M-P alpha reliability estimates of 0.80 and 0.82. "
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