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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Available from: Thomas D Borkovec, Sep 29, 2015
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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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    ABSTRACT: Background The objective was to examine the course and longitudinal associations of generalized anxiety disorder (GAD) and major depressive disorder (MDD) in mothers over the postpartum 2 years. Method Using a prospective naturalistic design, 296 mothers recruited from a large community pool were assessed for GAD and MDD at 3, 6, 10, 14, and 24 months postpartum. Structured clinical interviews were used for diagnoses, and symptoms were assessed using self-report questionnaires. Logistic regression analyses were used to examine diagnostic stability and longitudinal relations, and latent variable modeling was employed to examine change in symptoms. Results MDD without co-occurring GAD, GAD without co-occurring MDD, and co-occurring GAD and MDD, displayed significant stability during the postpartum period. Whereas MDD did not predict subsequent GAD, GAD predicted subsequent MDD (in the form of GAD + MDD). Those with GAD + MDD at 3 months postpartum were significantly less likely to be diagnosis free during the follow-up period than those in other diagnostic categories. At the symptom level, symptoms of GAD were more trait-like than those of depression. Conclusions Postpartum GAD and MDD are relatively stable conditions, and GAD is a risk factor for MDD but not vice versa. Given the tendency of MDD and GAD to be persistent, especially when comorbid, and the increased risk for MDD in mothers with GAD, as well as the potential negative effects of cumulative exposure to maternal depression and anxiety on child development, the present findings clearly highlight the need for screening and treatment of GAD in addition to MDD during the postpartum period.
    Depression and Anxiety 06/2013; 30(6). DOI:10.1002/da.22040 · 4.41 Impact Factor
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    • "Two questions on the Radimer/Cornell scale pertain specifically to feelings of anxiety regarding food access: “I worry whether my food will run out before I get money to buy more” and “I worry about whether the food that I can afford to buy for my household will be enough.” Obsessive or chronic worrying is recognized as a symptom of generalized anxiety disorder within the DSM-V [57]. Mental health disorders, including anxiety and depression, are commonly reported among HIV-positive populations, and believed to increase risk of mortality through both behavioral and biologic mechanisms. "
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    ABSTRACT: Little is known about the potential impact of food insecurity on mortality among people living with HIV/AIDS. We examined the potential relationship between food insecurity and all-cause mortality among HIV-positive injection drug users (IDU) initiating antiretroviral therapy (ART) across British Columbia (BC). Cross-sectional measurement of food security status was taken at participant ART initiation. Participants were prospectively followed from June 1998 to September 2011 within the fully subsidized ART program. Cox proportional hazard models were used to ascertain the association between food insecurity and mortality, controlling for potential confounders. Among 254 IDU, 181 (71.3%) were food insecure and 108 (42.5%) were hungry. After 13.3 years of median follow-up, 105 (41.3%) participants died. In multivariate analyses, food insecurity remained significantly associated with mortality (adjusted hazard ratio [AHR] = 1.95, 95% CI: 1.07-3.53), after adjusting for potential confounders. HIV-positive IDU reporting food insecurity were almost twice as likely to die, compared to food secure IDU. Further research is required to understand how and why food insecurity is associated with excess mortality in this population. Public health organizations should evaluate the possible role of food supplementation and socio-structural supports for IDU within harm reduction and HIV treatment programs.
    PLoS ONE 05/2013; 8(5):e61277. DOI:10.1371/journal.pone.0061277 · 3.23 Impact Factor
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