Rethinking the duration requirement for generalized anxiety disorder: evidence from the National Comorbidity Survey Replication. Psychol Med

Harvard University, Cambridge, Massachusetts, United States
Psychological Medicine (Impact Factor: 5.94). 07/2005; 35(7):1073-82. DOI: 10.1017/S0033291705004538
Source: PubMed

ABSTRACT The proposed revisions of the ICD and DSM diagnostic systems have led to increased interest in evaluation of diagnostic criteria. This report focuses on the DSM-IV requirement that episodes of generalized anxiety disorder (GAD) must persist for at least 6 months. Community epidemiological data are used to study the implications of changing this requirement in the range 1-12 months for estimates of prevalence, onset, course, impairment, co-morbidity, associations with parental GAD, and sociodemographic correlates.
Data come from the US National Comorbidity Survey Replication (NCS-R), a US household survey carried out during 2001-2003. Version 3.0 of the WHO Composite International Diagnostic Interview (WMH-CIDI) was used to assess DSM-IV anxiety disorders, mood disorders, substance disorders, and impulse-control disorders.
Lifetime, 12-month, and 30-day prevalence estimates of DSM-IV GAD changed from 6.1%, 2.9%, and 1.8% to 4.2-12.7%, 2.2-5.5%, and 1.6-2.6% when the duration requirement was changed from 6 months to 1-12 months. Cases with episodes of 1-5 months did not differ greatly from those with episodes of > or = 6 months in onset, persistence, impairment, co-morbidity, parental GAD, or sociodemographic correlates.
A large number of people suffer from a GAD-like syndrome with episodes of < 6 months duration. Little basis for excluding these people from a diagnosis is found in the associations examined here.

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Available from: Dan J. Stein, Sep 27, 2015
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    • "It recognizes that patients with mental disorders frequently present in primary care, where they are often evaluated by nonspecialist clinicians. Indeed, compared to the ICD-11, some of the operational criteria of the DSM-5 are pseudoprecise; for example, while the exact cut-point of 6 months duration for symptoms of generalized anxiety disorder (GAD) may contribute to diagnostic reliability, it is not surprising that GAD patients with slightly shorter symptom duration do not markedly differ from those with slightly longer duration (Kessler et al., 2005). At the same time, ICD-11 has accepted many of the tenets of DSM-5; for example, like DSM-5, ICD-11 will have separate sections for anxiety disorders, obsessivecompulsive and related disorders, and trauma-and stressorrelated disorders. "
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    ABSTRACT: Despite the effort on DSM-5 and ICD-11, few appear satisfied with these classification systems. We suggest that the core reason for dissatisfaction is expecting too much from them; they do not provide discrete categories that map to specific causes of disease, they describe clinical syndromes intended to guide treatment choices. Here we review work on anxiety and anxiety disorders to argue that while clinicians draw a pragmatic distinction between normal and abnormal emotions based on considerations such as severity and duration, understanding the evolutionary origins and utility of the emotions, including the adaptive value of adverse emotions, is key for formulating comprehensive assessments of an individual patient’s symptoms and for providing a conceptual foundation for pharmacotherapy, psychotherapy, and public health.
    Emotion Review 07/2015; 7(3). DOI:10.1177/1754073915575407 · 2.90 Impact Factor
    • "GAD is one of the most common anxiety disorders (Fisher, 2007). Results from the National Comorbidity Study Lifetime prevalence estimates (NCS-R) indicate that the 12-month prevalence of GAD is 3.1% (Kessler et al., 2005b) and the lifetime prevalence is 5.7% (Kessler, et al., 2005a). However, these statistics are based on retrospective assessments , which may underestimate the prevalence of psychopathology. "
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    ABSTRACT: Generalized anxiety disorder (GAD) is a psychological disorder characterized by chronic and severe worry. The past thirty years have seen a surge in the understanding of GAD, and specific advances have been made in how the disorder is conceptualized and treated within the field of psychology. However, despite these advances, GAD remains the most treatment refractory anxiety disorder. The current chapter, therefore, provides an overview of the current conceptualization of GAD, including its key symptoms and features. In addition, this chapter highlights many of the specific theoretical and treatment advances of the past several decades. Finally, this chapter will explore future directions that the field may be able to take in an attempt to better understand and treat this disorder.
    Primer on Anxiety Disorders: Translational Perspectives on Diagnosis and Treatment, 1 edited by Daniel Pine, Barbara Olasov Rothbaum, Kerry Ressler, 03/2015: chapter 22: pages 315-328; Oxford University Press.
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    • "No systematic differences were linked to studies’ country of origin. Prevalence rates for subthreshold GAD were generally twice as high as those for threshold GAD throughout [43,46,48,51,53,56]; a picture that did not change when the single low-quality study [48] was excluded from this aspect of the analysis. "
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    ABSTRACT: Background To review the prevalence and impact of generalized anxiety disorder (GAD) below the diagnostic threshold and explore its treatment needs in times of scarce healthcare resources. Methods A systematic literature search was conducted until January 2013 using PUBMED/MEDLINE, PSYCINFO, EMBASE and reference lists to identify epidemiological studies of subthreshold GAD, i.e. GAD symptoms that do not reach the current thresholds of DSM-III-R, DSM-IV or ICD-10. Quality of all included studies was assessed and median prevalences of subthreshold GAD were calculated for different subpopulations. Results Inclusion criteria led to 15 high-quality and 3 low-quality epidemiological studies with a total of 48,214 participants being reviewed. Whilst GAD proved to be a common mental health disorder, the prevalence for subthreshold GAD was twice that for the full syndrome. Subthreshold GAD is typically persistent, causing considerably more suffering and impairment in psychosocial and work functioning, benzodiazepine and primary health care use, than in non-anxious individuals. Subthreshold GAD can also increase the risk of onset and worsen the course of a range of comorbid mental health, pain and somatic disorders; further increasing costs. Results are robust against bias due to low study quality. Conclusions Subthreshold GAD is a common, recurrent and impairing disease with verifiable morbidity that claims significant healthcare resources. As such, it should receive additional research and clinical attention.
    BMC Psychiatry 05/2014; 14(1):128. DOI:10.1186/1471-244X-14-128 · 2.21 Impact Factor
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