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The relevance of age of onset to the psychopathology of generalized anxiety disorder
Abstract
The present study sought to clarify the relevance of age of onset to the psychopathology of generalized anxiety disorder (GAD) using a large clinical sample of 154 patients with DSM-IV GAD. Most patients reported onset of GAD by early adulthood, although a smaller proportion of cases emerged in middle adulthood. Structural equation and regression models tested predictions that earlier onset GAD would be characterized by different levels of stress at disorder onset, disorder severity, lifetime comorbidity, and traits that predispose individuals to emotional disorders. Results showed that cases of GAD that emerged without any precipitating stressors were more likely to be of earlier onset. However, another sizable group of patients with earlier-onset GAD identified severely stressful early environments that they linked to the emergence of GAD symptoms. In contrast, cases of GAD that began in adulthood were most likely to emerge in the context of mild to moderate stress. Further analyses revealed that earlier-onset GAD was associated with higher levels of disorder severity, comorbidity, and temperamental vulnerability to emotional disorders. These results are discussed in regard to their clinical and conceptual implications for anxiety disorders.
... represent a subtype that is more severe. Early onset has been associated with higher symptom severity in SP (Van Ameringen, Oakman, Mancini, Pipe, & Chung, 2004), PD ( Segui et al., 2000;Tibi et al., 2013), and GAD (Le Roux, Gatz, & Wetherell, 2005), more psychiatric comorbidity in PD (Goodwin, Lipsitz, Chapman, Mannuzza, & Fyer, 2001;Goldstein, Wickramaratne, Horwath, & Weissman, 1997;Ramsawh, Weisberg, Dyck, Stout, & Keller, 2011;Segui et al., 1999;Tibi et al., 2013) and GAD (Campbell, Brown, & Grisham, 2003;Le Roux et al., 2005), and more suicidality in PD ( Iketani et al., 2004), although contradictory findings have also been reported ( Iketani et al., 2004;Le Roux et al., 2005;Segui et al., 1999Segui et al., , 2000). These inconsistencies might be attributed to variations in definitions of early onset ( Tibi et al., 2013). ...
... These inconsistencies might be attributed to variations in definitions of early onset ( Tibi et al., 2013). AOO has been approached as a continuous variable in SP (Van Ameringen et al., 2004), GAD ( Campbell et al., 2003), and PD ( Goodwin et al., 2001); but also through unsubstantiated cut-off ages, covering a wide age-range from 9 (Van Ameringen et al., 2004) and 20 (Ramsawh et al., 2011) in SP; 18 ( Segui et al., 1999), 20 ( Goldstein et al., 1997;Ramsawh et al., 2011), 25 ( Iketani et al., 2004), and 60 ( Segui et al., 2000) in PD; and 20 (Ramsawh et al., 2011) and 50 (Le Roux et al., 2005) in GAD. The use of objectively determined cut-offs to define early onset could benefit comparability of findings, as well as their trans-lation to clinical practice. ...
... In order to identify the relevance of early onset for clinical practice, this comparison was repeated in an outpatient sample. Based on previous studies (Campbell et al., 2003;Goldstein et al., 1997;Goodwin et al., 2001;Iketani et al., 2004;Le Roux et al., 2005;Ramsawh et al., 2011;Segui et al., 1999Segui et al., , 2000Tibi et al., 2013Tibi et al., , 2015Van Ameringen et al., 2004), we hypothesized that early onset would be associated with more psychiatric comorbidity and less wellbeing. ...
Early onset is regarded as an important characteristic of anxiety disorders, associated with higher severity. However, previous findings diverge, as definitions of early onset vary and are often unsubstantiated. We objectively defined early onset in social phobia, panic disorder, agoraphobia, and generalised anxiety disorder, using cluster analysis with data gathered in the general population. Resulting cut-off ages for early onset were ≤22 (social phobia), ≤31 (panic disorder), ≤21 (agoraphobia), and ≤27 (generalised anxiety disorder). Comparison of psychiatric comorbidity and general wellbeing between subjects with early and late onset in the general population and an outpatient cohort, demonstrated that among outpatients anxiety comorbidity was more common in early onset agoraphobia, but also that anxiety- as well as mood comorbidity were more common in late onset social phobia. A major limitation was the retrospective assessment of onset. Our results encourage future studies into correlates of early onset of psychiatric disorders.
... Depression onsets peak in mid-adolescence, and while some anxiety disorders onset in childhood, rates of anxiety also increase drastically during adolescence, with some anxiety disorder onsets occurring during this period-early adulthood (e.g. social anxiety, panic, agoraphobia, generalized anxiety, and obsessivecompulsive disorder; Campbell, Brown, & Grisham, 2003;de Lijster et al. 2017;Kessler et al. 2005). Adolescent depression and anxiety are associated with a host of negative outcomes, including increased risk of disorder persistence and reoccurrence, increased comorbidity, and worse psychosocial functioning later in life (Essau, Lewinsohn, Olaya, & Seeley, 2014;Fleisher & Katz, 2001;McLeod, Horwood, & Fergusson, 2016;Naicker, Galambos, Zeng, Senthilselvan, & Colman, 2013). ...
... In a statistical sense, age 12 disorder status is capturing nearly the same variance that is important for predicting age 15 disorder status, so it is difficult for prediction to improve. Further, as noted previously, most onsets of mental disorders occur during adolescence (Caspi et al., 2020), and rates of depression and many types of anxiety increase substantially during this time (Campbell et al., 2003;de Lijster et al., 2017;Kessler et al., 2005). Although the specific mechanisms producing this developmental pattern are unclear and likely manifold, it can reasonably be assumed that factors specific to the early-mid adolescence period (e.g. ...
Background
This study leveraged machine learning to evaluate the contribution of information from multiple developmental stages to prospective prediction of depression and anxiety in mid-adolescence.
Methods
A community sample ( N = 374; 53.5% male) of children and their families completed tri-annual assessments across ages 3–15. The feature set included several important risk factors spanning psychopathology, temperament/personality, family environment, life stress, interpersonal relationships, neurocognitive, hormonal, and neural functioning, and parental psychopathology and personality. We used canonical correlation analysis (CCA) to reduce the large feature set to a lower dimensional space while preserving the longitudinal structure of the data. Ablation analysis was conducted to evaluate the relative contributions to prediction of information gathered at different developmental periods and relative to previous disorder status (i.e. age 12 depression or anxiety) and demographics (sex, race, ethnicity).
Results
CCA components from individual waves predicted age 15 disorder status better than chance across ages 3, 6, 9, and 12 for anxiety and 9 and 12 for depression. Only the components from age 12 for depression, and ages 9 and 12 for anxiety, improved prediction over prior disorder status and demographics.
Conclusions
These findings suggest that screening for risk of adolescent depression can be successful as early as age 9, while screening for risk of adolescent anxiety can be successful as early as age 3. Assessing additional risk factors at age 12 for depression, and going back to age 9 for anxiety, can improve screening for risk at age 15 beyond knowing standard demographics and disorder history.
... The present study evaluated the relevance of age of onset of social phobia by examining its relationships with anxiety and depression severity, comorbidity, impairment, emotional disorder vulnerabilities, and stress. Similar to other studies that have examined the effects of age of onset while controlling for duration of illness (i.e., in generalized anxiety disorder, see Campbell, Brown, & Grisham, 2003), a structural modeling approach was used in the present study. Latent variables representing the constructs of interest were used when multiple indicators were available. ...
... Lifetime Comorbidity-A latent variable representing total number of lifetime diagnoses was formed by summing the total number of current and past diagnoses assigned during ADIS-IV-L administration (excluding social phobia). This approach has been used in prior structural models examining the relevance of age of onset in predicting severity of comorbidity (Campbell et al., 2003). As previously mentioned, the ADIS-IV-L has been shown to reliably diagnosis the majority of the anxiety and mood disorders (see Brown Di Nardo, et al., 2001). ...
The present study aimed to examine the relevance of age of onset to the psychopathology of social phobia using a large clinical sample of 210 patients with social phobia. The two most common periods of onset were during adolescence (ages 14-17) and early childhood (prior to age 10). Structural regression modeling was used to test predictions that early onset social phobia would be associated with greater severity of the disorder, stronger current symptoms of depression and anxiety, greater functional impairment, and more pronounced levels of emotional disorder vulnerabilities (e.g., neuroticism/behavioral inhibition, extraversion, perceptions of control). Logistic regression was used to evaluate relationships between age of onset and the presence of acute and chronic stress at the time of onset. Results showed that earlier age of social phobia onset was associated with stronger current psychopathology, functional impairment, and emotional disorder vulnerabilities, and that later age of onset predicted the presence of an acutely stressful event around the time of disorder emergence. These results are discussed in regard to their clinical implications and congruence with prominent etiological models of the emotional disorders.
... In the typically developing population, ADHD and Specific Phobia generally have an early onset in childhood and depressive disorders and psychosis have a later onset in adolescence and adulthood (American Psychiatric Association, 1994; Lewinsohn, Clarke, Seeley & Rohde, 1994; Pineda et al., 1999). Onset of GAD typically occurs in later adolescence, although a subgroup of typically developing individuals develop GAD in mid-adulthood (Campbell, Brown, & Grisham, 2003). Very little research has explored age related changes in psychopathology in WS Psychopathology in Williams Syndrome 7 across the lifespan (childhood to adulthood), although questionnaire-based research has indicated increased fears in older females with WS (Blomberg, Rosander, & Andersson, 2006; Dykens, 2003), and increased levels of withdrawal and depressive symptoms in adolescence and adulthood (Gosch & Pankau, 1997). ...
... In the majority of cases mid to late adolescence was the most common period for onset of depressive disorders and GAD. These agerelated differences are in keeping with those observed in the typically-developing population (Campbell et al., 2003; Lewinsohn et al., 1994). Taken together, these results suggest that there are significant differences in psychopathology in WS depending upon age category (childhood vs adulthood) and that these differences are in keeping with those found in the typically-developing population. ...
This research aimed to comprehensively explore psychopathology in Williams syndrome (WS) across the life span and evaluate the relationship between psychopathology and age category (child or adult), gender, and cognitive ability. The parents of 50 participants with WS, ages 6–50 years, were interviewed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children. The prevalence of a wide range of Axis I Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 19942.
American Psychiatric Association . 1994 . Diagnostic and statistical manual of mental disorders , 4th , Washington, DC : Author . View all references) disorders was assessed. In addition to high rates of anxiety and attention-deficit/hyperactivity disorder (38% and 20%, respectively), 14% of our sample met criteria for a Depressive Disorder and 42% of participants were not experiencing any significant psychopathological difficulties. There was some evidence for different patterns of psychopathology between children and adults with WS and between males and females. These relationships were largely in keeping with those found in the typically developing population, thus supporting the validity of applying theory and treatment approaches for psychopathology in the typically developing population to WS.
... In addition, individuals with GAD report worrying for more minutes of the day than non-anxious controls (Dupuy, Beaudoin, Rhéaume, Ladouceur, & Dugas, 2001) and individuals with social phobia (Hoyer et al., 2001), and a greater percentage of the day than non-anxious controls (Craske et al., 1989). Campbell, Brown, and Grisham (2004) examined the relevance of age of onset to the severity of GAD and used percent of the day worried as their measure of worry excessiveness. They found that earlier age of onset of GAD was associated with greater percentage of the day spent worrying. ...
... Age of onset, number of comorbid disorders, and the Penn state worry questionnaire have been linked to disorder severity or used to differentiate individuals with GAD from those with other anxiety disorders. Earlier age of onset is associated with greater GAD severity, comorbidity and negative affect (Campbell et al., 2004 ). People with comorbid diagnoses report more symptom interference (Wittchen, Zhao, Kessler, & Eaton, 1994) and greater severity of symptoms (Newman et al., 2002). ...
... [9] Clinical studies conducted with young and middle-aged outpatients with current GAD indicated that early onset was associated with higher interpersonal sensitivity, more depressive symptoms, higher trait anxiety, and higher neuroticism, [9] as well as increased severity and higher likelihood of psychiatric comorbidity. [10] Additionally, those with early onset GAD were more likely to report stressful childhood environments, but less likely to identify a specific precipitating factor. [9,10] There are only a few extant studies on age at onset of GAD in older cohorts. ...
... [10] Additionally, those with early onset GAD were more likely to report stressful childhood environments, but less likely to identify a specific precipitating factor. [9,10] There are only a few extant studies on age at onset of GAD in older cohorts. Beck et al. [11] used a clinical convenience sample of older adults with current GAD, split into early (o15 years) and late (439 years) onset. ...
Generalized anxiety disorder (GAD) is a common disorder in older adults, with widespread and long-lasting consequences. In this study, we assessed the characteristics associated with lifetime GAD in community-dwelling adults according to their age at onset of the disorder.
Study sample was extracted from the 2007 National Survey of Mental Health and Well Being, a nationally representative cross-sectional survey that interviewed 8,841 Australians aged between 16 and 85 years using the Composite International Diagnostic Interview. Of the 3,178 participants aged 55-85 years, there were 227 (M = 63.7 years; 65% female) with a lifetime diagnosis of GAD who were the focus of our analyses.
Age at onset was defined as early (<26 years) or late (≥ 26 years), based on the median age at onset for the entire sample. The weighted prevalence estimates for 12-month and lifetime GAD were 2.8% (95% CI: 2.0, 3.7) and 7.0% (95% CI: 5.7, 8.3), respectively, with less than one-tenth of the participants being diagnosed after the age of 60 years. Having the first GAD episode earlier in life was significantly associated with physical abuse during childhood (OR = 0.34, 95% CI: 0.16, 0.75), lifetime diagnosis of dysthymia (OR = 0.34, 95% CI: 0.18, 0.67), and number of GAD episodes (OR = 0.29, 95% CI: 0.14, 0.58), after adjusting for current age and 12-month GAD.
In older adults, an earlier age at onset of GAD was associated with childhood physical abuse and worse clinical outcomes, thus appearing to be a marker for increased vulnerability to GAD.
... "Early onset" was defined as age of onset < 20; "late onset" was defined as ≥ 20. This operational definition is in accordance with other investigators who have defined adult onset or late onset per a cutoff of age 18, 20, or 25 (Campbell et al 2003;Goldstein et al. 1997;Iketani et al. 2004;Segui et al. 1999;Venturello et al. 2002). To examine the association between age of onset and longitudinal course, Cox regression analyses were conducted to examine course over the first 15 years of the study-time to recurrence and time to recovery, respectively-for each diagnostic group. ...
... Individuals with early-onset PDA were less likely to be married, and more likely to have comorbid GAD and SP at baseline. These findings are in accordance with previous research suggesting increased comorbidity associated with early-onset anxiety disorders (Campbell et al., 2003;Goodwin and Hamilton, 2002;Iketani et al., 2004). ...
Age of onset is rarely studied in the anxiety disorders literature. The current study examined age of onset as it relates to clinical characteristics and course of anxiety disorders using a prospective, longitudinal, observational design.
Fifteen-year follow-up data were examined for participants with panic disorder with (PDA) or without (PD) agoraphobia, social phobia (SP), and/or generalized anxiety disorder (GAD) at baseline. Logistic regression analyses were conducted to determine whether age of onset was associated with demographic or clinical variables at baseline. Cox regression analyses were conducted to examine longitudinal course (time to recurrence and recovery, respectively) for each diagnostic group.
At baseline, PD participants with early onset (i.e., < age 20) were more likely to have comorbid MDD, GAD, and SP relative to late-onset participants (≥ age 20). For PDA, early-onset participants were less likely to be married, and more likely to have both GAD and SP at baseline. With respect to longitudinal course, earlier onset was associated with an increased likelihood of recurrence in participants with PDA. No other models reached significance.
The sample sizes for some disorders were comparatively small in relation to PDA, and all participants were treatment-seeking, which may limit generalizability.
For some anxiety disorders, earlier age of onset appears to be associated with greater severity and worse course, as evidenced by increased risk of recurrence over 15years of follow-up. Early interventions focused on children and adolescents may alleviate some of the public health burden associated with anxiety disorders.
... One in five adolescents that previously had not used alcohol, initiated drinking in the early pandemic, while one in ten adolescents reduced their consumption. Our findings of increases in both anxiety and depression symptoms over the three years, are consistent with past research suggesting a consistent increase in substance use and internalizing symptoms during adolescence (Campbell et al., 2003;Colder et al., 2002;Lewinsohn et al., 1993). Although in our study, the levels of changes in depression and anxiety varied among different groups of alcohol use change. ...
Given the well-established relationship between alcohol and internalizing symptoms, potential increases in depression and anxiety during the COVID-19 pandemic may lead to increases in alcohol consumption and binge drinking. This study examines this association from before to during two phases of the pandemic in a cohort of Canadian youth. We used linked data from a sub-sample of 1901 secondary school students who participated in three consecutive school years of the Cannabis use, Obesity, Mental health, Physical activity, Alcohol use, Smoking, and Sedentary behaviour (COMPASS) study between 2018/19 and 2020/21. Separate multilevel logistic regression models examined the association between depression and anxiety symptoms with odds of escalation and reduction (vs. maintenance) and initiation (vs. abstinence) of alcohol consumption. Results show that depression and anxiety symptoms significantly increased over the three years, and these changes were moderated by changes in alcohol consumption and binge drinking. Students with increased depression symptoms were less likely to reduce their alcohol consumption in the early pandemic (Adjust odds ratio [AOR] 0.94, 95% CI:0.90-0.98), more likely to initiate alcohol consumption in the ongoing pandemic period (AOR 1.03, 95% CI: 1.01-1.05), and more likely to initiate binge drinking in both periods. The depression-alcohol use association was stronger among females than males. This study demonstrates a modest association between internalizing symptoms and alcohol use, particularly for depression symptoms and in females. The identified depression-alcohol use association suggests that preventing or treating depression might be beneficial for adolescent alcohol use and vice versa.
... I NTERNALIZING PROBLEMS (DEPRESSION and anxiety) and alcohol misuse often co-occur, particularly during adolescence (Marmorstein, 2009). Indeed, levels of depression (Lewinsohn et al., 1993), anxiety (Campbell et al., 2003), and alcohol use (Colder et al., 2002;Jackson et al., 2002) consistently increase starting between 13 and 15 years of age, and the internalizing problem-alcohol use association may be stronger during adolescence than during other developmental periods (Marmorstein, 2009). However, evidence is conflicting regarding the temporal ordering of this association. ...
Background
Depression, anxiety, and alcohol misuse predict adverse social, academic, and emotional outcomes, and their relations to one another increase during adolescence—particularly in girls. However, evidence on the directions of these relations is mixed. Longitudinal models of internalizing problem–alcohol use links may identify promising prevention targets. Accordingly, we examined reciprocal associations between anxiety severity and alcohol use, as well as between depression severity and alcohol use, in adolescent girls.
Methods
Data were drawn from a population‐based longitudinal study of female adolescents. The current sample comprised 2,100 participants (57.1% Black, 42.9% White) assessed annually between ages 13 and 17. Girls self‐reported depression severity, anxiety severity, and frequency of alcohol use (consumption of ≥1 full drink) in the past year. Primary caregivers reported on socioeconomic and neighborhood factors; these were included with race, early puberty, and conduct problems (youth‐report) as covariates. Anxiety and depression severity were included within a single cross‐lagged panel model, along with alcohol use, to isolate their independent and reciprocal links to drinking behavior.
Results
Higher depression severity modestly predicted increased likelihood of subsequent alcohol use from ages 13 to 17. However, inconsistent relations emerged for the reverse pathway: Alcohol use modestly predicted decreased depression severity at ages 14 and 16; associations were nonsignificant in other lagged associations. Anxiety severity and alcohol use were not consistently associated.
Conclusions
Results highlight the key role of depression, relative to anxiety, in predicting later alcohol use. Future studies may examine whether depression prevention programs yield secondary reductions in alcohol use in adolescent girls.
... Taken together, these findings provide mixed support for conventional views of GAD as a chronic condition present since early life. [54][55][56][57] Instead, we found that the GAD syndrome usually first emerges in adulthood and that its course, although often unremitting, differs substantially by country. ...
Importance: Generalized anxiety disorder (GAD) is poorly understood compared with other anxiety disorders, and debates persist about the seriousness of this disorder. Few data exist on GAD outside a small number of affluent, industrialized nations. No population-based data exist on GAD as it is currently defined in DSM-5.
Objective: To provide the first epidemiologic data on DSM-5 GAD and explore cross-national differences in its prevalence, course, correlates, and impact.
Design, Setting, and Participants: Data come from the World Health Organization World Mental Health Survey Initiative. Cross-sectional general population surveys were carried out in 26 countries using a consistent research protocol and assessment instrument. A total of 147 261 adults from representative household samples were interviewed face-to-face in the community. The surveys were conducted between 2001 and 2012. Data analysis was performed from July 22, 2015, to December 12, 2016.
Main Outcomes and Measures: The Composite International Diagnostic Interview was used to assess GAD along with comorbid disorders, role impairment, and help seeking.
Results: Respondents were 147 261 adults aged 18 to 99 years. The surveys had a weighted mean response rate of 69.5%. Across surveys, DSM-5 GAD had a combined lifetime prevalence (SE) of 3.7% (0.1%), 12-month prevalence of 1.8% (0.1%), and 30-day prevalence of 0.8% (0). Prevalence estimates varied widely across countries, with lifetime prevalence highest in high-income countries (5.0% [0.1%]), lower in middle-income countries (2.8% [0.1%]), and lowest in low-income countries (1.6% [0.1%]). Generalized anxiety disorder typically begins in adulthood and persists over time, although onset is later and clinical course is more persistent in lower-income countries. Lifetime comorbidity is high (81.9% [0.7%]), particularly with mood (63.0% [0.9%]) and other anxiety (51.7% [0.9%]) disorders. Severe role impairment is common across life domains (50.6% [1.2%]), particularly in high-income countries. Treatment is sought by approximately half of affected individuals (49.2% [1.2%]), especially those with severe role impairment (59.4% [1.8%]) or comorbid disorders (55.8% [1.4%]) and those living in high-income countries (59.0% [1.3%]).
Conclusions and Relevance: The findings of this study show that DSM-5 GAD is more prevalent than DSM-IV GAD and is associated with substantial role impairment. The disorder is especially common and impairing in high-income countries despite a negative association between GAD and socioeconomic status within countries. These results underscore the public health significance of GAD across the globe while uncovering cross-national differences in prevalence, course, and impairment that require further investigation.
... In addition, age at onset has important correlates in many different disorders such as major depressive disorder [8][9][10], bipolar disorder [11][12], schizophrenia [13][14][15], panic disorder [16][17][18][19], social phobia [20,21] and obsessive-compulsive disorder (OCD; [22][23][24][25][26][27][28][29][30][31]). In general, early age at onset has been associated with greater severity of illness (eg, [8,32]), although there are exceptions, particularly for panic disorder, for which some studies have found no differences in symptom severity between early-onset and late-onset patients [16,19]. Furthermore, in many studies early age at onset is associated with increased comorbidity on both Axis I (eg, [8,17]) and Axis II (eg, [9,10,18]), although not all studies have found this (eg [19]). ...
Objective:
Age at onset is an important clinical feature of all disorders. However, no prior studies have focused on this important construct in body dysmorphic disorder (BDD). In addition, across a number of psychiatric disorders, early age at disorder onset is associated with greater illness severity and greater comorbidity with other disorders. However, clinical correlates of age at onset have not been previously studied in BDD.
Methods:
Age at onset and other variables of interest were assessed in two samples of adults with DSM-IV BDD; sample 1 consisted of 184 adult participants in a study of the course of BDD, and sample 2 consisted of 244 adults seeking consultation or treatment for BDD. Reliable and valid measures were used. Subjects with early-onset BDD (age 17 or younger) were compared to those with late-onset BDD.
Results:
BDD had a mean age at onset of 16.7 (SD=7.3) in sample 1 and 16.7 (SD=7.2) in sample 2. 66.3% of subjects in sample 1 and 67.2% in sample 2 had BDD onset before age 18. A higher proportion of females had early-onset BDD in sample 1 but not in sample 2. On one of three measures in sample 1, those with early-onset BDD currently had more severe BDD symptoms. Individuals with early-onset BDD were more likely to have attempted suicide in both samples and to have attempted suicide due to BDD in sample 2. Early age at BDD onset was associated with a history of physical violence due to BDD and psychiatric hospitalization in sample 2. Those with early-onset BDD were more likely to report a gradual onset of BDD than those with late-onset in both samples. Participants with early-onset BDD had a greater number of lifetime comorbid disorders on both Axis I and Axis II in sample 1 but not in sample 2. More specifically, those with early-onset BDD were more likely to have a lifetime eating disorder (anorexia nervosa or bulimia nervosa) in both samples, a lifetime substance use disorder (both alcohol and non-alcohol) and borderline personality disorder in sample 1, and a lifetime anxiety disorder and social phobia in sample 2.
Conclusions:
BDD usually began during childhood or adolescence. Early onset was associated with gradual onset, a lifetime history of attempted suicide, and greater comorbidity in both samples. Other clinical features reflecting greater morbidity were also more common in the early-onset group, although these findings were not consistent across the two samples.
... In addition, the cross-sectional nature of the study limits the ability to determine directionality of relations. For instance, GAD is a chronic disorder in which nearly 50% of cases have an age of onset prior to adulthood (Campbell, Brown, & Grisham, 2003). Rather than adult attachment influencing GAD symptoms, it is possible that the presence of GAD contributes to adult attachment style. ...
Differences in attachment style have been linked to both emotion regulation and psychological functioning, but the emotion regulatory mechanism through which attachment style might impact symptoms of depression and anxiety is unclear. The present study examined the explanatory role of emotion dysregulation in the relation between adult attachment style and symptoms of depression and generalized anxiety disorder (GAD) in a sample of 284 adults. Secure attachment was associated with lower depression and GAD symptoms and lower emotion dysregulation, whereas insecure attachment styles were generally associated with higher depression and GAD scores and higher emotion dysregulation. Perceived inability to generate effective emotion regulation strategies mediated the relation between insecure attachment and both depression and GAD symptoms. Nonacceptance of negative emotions and inability to control impulsive behaviors emerged as additional mediators of the relation between insecure attachment styles and GAD symptoms. The differential contribution of attachment style and emotion regulation to the prediction of depression and GAD symptoms may reflect differences in vulnerability to depression and GAD.
... Adult cases with shorter duration may also reflect short-lived adaptation processes to life stressors. Another possibility is that the young age group had a higher proportion of individuals with an early onset of GAD, which is a predictor for severity (Campbell et al., 2003; Hoehn-Saric et al., 1993) and therefore for the duration of the disorder. A similar explanation may be that young individuals that meet all other GAD criteria present a clinically severe subgroup that is more likely to be affected by the condition for longer periods of time. ...
... It is possible that the diagnostic criteria for GAD (excessive worry or anxiety across a number of situations and events, which is difficult to control) [8] encompass the stressors directly associated with raising a child with WS, such as health, school, and behavior as well as stressors likely due to having a child with WS, but involving other family members, including spousal relations and parental relations with TD children. This finding is consistent with previous findings on the onset of GAD, demonstrating that later-onset GAD is associated with the emergence of life stressors [e.g., [81][82][83]. A potential limitation of this finding is that the onset of maternal GAD is based on a retrospective report by the mothers, and it is possible that the report is inaccurate and the mothers of children with WS have a higher prevalence of GAD than the women in the general population even prior to having the child with WS. ...
To determine the prevalence of anxiety disorders in children with Williams syndrome (WS), their sibling closest in age, and their mothers and to examine the predictors of anxiety in these groups.
The prevalence of anxiety disorders was assessed and compared to that in the general population.
Children with WS had a significantly higher prevalence of specific phobia, generalized anxiety disorder (GAD), and separation anxiety in comparison to children in the general population. While mothers had a higher prevalence of GAD than population controls, the excess was accounted for by mothers who had onset after the birth of their WS child. The siblings had rates similar to the general population.
This pattern of findings suggests the presence of a gene in the WS region whose deletion predisposes to anxiety disorders. It is also worthwhile to investigate relations between genes deleted in WS and genes previously implicated in anxiety disorders.
... More recently, Gray's BIS/BAS constructs have been further validated by converging biological and psychological evidence that abnormal approach and withdrawal predispositions underlie several forms of psychopathology . Such work includes data on major depression (Kasch et al. 2002) bipolar disorder (Meyer et al. 2001), generalised anxiety disorder (Campbell et al. 2003), schizophrenia (Scholten et al. 2006) and personality disorders (Arnett et al. 1997). In some of these cases BIS/BAS scores were predictive of disease course and severity (Kasch et al. 2002). ...
Gray's behavioural inhibition and behavioural activation (BIS/BAS) neural systems model has led to research on approach and withdrawal as the two most fundamental dimensions of affective behaviour, and their role in psychopathology. Although Gray proposed the BIS as the neurological basis of anxiety, there are no reports examining approach and withdrawal predispositions in social anxiety disorder. Here we report approach and withdrawal predispositions in a group of 23 non-medicated individuals with social anxiety disorder (SAD) without co-morbid depression and in 48 normal controls. Results show increased BIS and decreased BAS fun-seeking in SAD subjects thereby underscoring Gray's dimensional model.
... Despite the increasing interest and use of the BIS/BAS in psychopathological research (e.g., Campbell, Brown, & Grisham, 2003;Kasch et al., 2002), no studies have examined the psychometric properties of this measure in clinical samples. Although frequently overlooked in applied clinical research, classical test theory underscores the importance of evaluating the generalizability of a scale's measurement properties for use in novel populations (Lord & Novick, 1968;McDonald, 1999). ...
The latent structure, reliability, and validity of the Behavioral Inhibition/Behavioral Activation Scales (BIS/BAS; C. L. Carver and T. L. White, 1994) were examined in a large sample of outpatients (N = 1,825) with anxiety and mood disorders. Four subsamples were used for exploratory and confirmatory factor analyses. In addition to generally upholding a latent structure found previously in nonclinical samples, results indicated measurement invariance of the BIS/BAS between genders and a higher order structure of the BAS scales. Convergent and discriminant validity of the BIS/BAS were supported by findings that the subscales correlated most strongly with measures of neighboring personality constructs (e.g., BIS with neuroticism, BAS with positive affect) than with measures of current anxiety and depression symptoms. Overall, the results support the psychometric properties of the BIS/BAS in this clinical sample.
... First, might excessive GAD, with its earlier onset and more chronic, comorbid course, represent a different form of the disorder than non-excessive GAD? It has been suggested that earlier-onset GAD represents a more severe disorder stemming from temperament factors or from extreme early stressors that predispose the individual to a range of emotional disorders, whereas late-onset GAD represents a more circumscribed, less characterological condition precipitated by moderate life stress (Brown et al., 1994;Campbell et al., 2003). It is possible that the concepts of excessive GAD and early-onset GAD converge on an overlapping set of individuals who are especially vulnerable to developing severe, chronic emotional disturbance (see Hudson & Rapee, 2004). ...
Excessive worry is required by DSM-IV, but not ICD-10, for a diagnosis of generalized anxiety disorder (GAD). No large-scale epidemiological study has ever examined the implications of this requirement for estimates of prevalence, severity, or correlates of GAD.
Data were analyzed from the US National Comorbidity Survey Replication, a nationally representative, face-to-face survey of adults in the USA household population that was fielded in 2001-2003. DSM-IV GAD was assessed with Version 3.0 of the WHO Composite International Diagnostic Interview. Non-excessive worriers meeting all other DSM-IV criteria for GAD were compared with respondents who met full GAD criteria as well as with other survey respondents to consider the implications of removing the excessiveness requirement.
The estimated lifetime prevalence of GAD increases by approximately 40% when the excessiveness requirement is removed. Excessive GAD begins earlier in life, has a more chronic course, and is associated with greater symptom severity and psychiatric co-morbidity than non-excessive GAD. However, non-excessive cases nonetheless evidence substantial persistence and impairment of GAD, high rates of treatment-seeking, and significantly elevated co-morbidity compared with respondents without GAD. Non-excessive cases also have sociodemographic characteristics and familial aggregation of GAD comparable to excessive cases.
Individuals who meet all criteria for GAD other than excessiveness have a somewhat milder presentation than those with excessive worry, yet resemble excessive worriers in a number of important ways. These findings challenge the validity of the excessiveness requirement and highlight the need for further research into the optimal definition of GAD.
The current study sought to test whether higher quality mother–daughter communication would buffer associations between maternal depressive symptoms and girls’ internalizing and externalizing psychopathology symptoms among urban African American girls across a 12-month period. One hundred ninety-four treatment-seeking urban African American adolescent girls, ages 12–16, and their mothers participated in the study. Every 6 months (for up to 3 assessments), daughters reported on their internalizing and externalizing symptoms, mothers reported on their depressive symptoms, and both mothers and daughters reported on the quality of their dyadic communication. Daughters additionally reported on the extent to which they felt accepted by their mothers at each assessment. Results of multilevel modeling revealed that quality of communication significantly interacted with maternal depressive symptoms to predict externalizing and internalizing symptoms in daughters, such that the risk associated with maternal depressive symptoms was fully buffered for daughters in high-quality communication dyads. Secondary analyses demonstrated that these patterns of results were not accounted for by higher levels of social status or maternal acceptance. Drawing on a vulnerable and understudied population of urban African American adolescent girls, this work suggests that family communication may contribute to important intergenerational psychopathology transmission processes, above and beyond more general features of the family environment.
Anxiety is linked to deficits in structural and functional connectivity between limbic structures and pre-frontal cortices. We employed a monozygotic (MZ) twin difference design to examine the relationship between structural characteristics of the uncinate fasciculus (UF) measured by Diffusion Tensor Imaging (DTI) and anxiety symptoms in a sample of N = 100 monozygotic (genetically identical), adolescent twins. The MZ difference design allowed us focus on environmental factors that vary within twin pairs while controlling for genetic and environmental factors shared by twin pairs. Twins aged 13–18 years reported on symptoms of generalized anxiety and social phobia prior to participating in a neuroimaging visit. Regions of interest from the JHU ICBM atlas, including uncinate fasciculus and sagittal stratum as a control tract, were registered to the study template. We incorporated multiple diffusion tensor measures to characterize the white matter differences. Within twin pairs, the more anxious twin exhibited decreased fractional anisotropy (t = −2.22, p = 0.032) and axial diffusivity (t = −2.38, p = 0.022) in the left UF compared to the less anxious twin, controlling for age and gender. This study demonstrated the feasibility and advantages of adopting the MZ twin design for DTI measures in neuroimaging research.
Background and objectives: Anxiety disorders are the most common mental health problems during childhood and adolescence. This study examined the course of anxiety symptoms in early adolescents from the general population over three phases.
Design: Prospective cohort study.
Methods: Two hundred and forty-two participants (mean-age of 13.52) from a baseline sample of 1514 (mean-age of 10.23) were followed up three times. Of the 1514 children, those with emotional risk and controls without risk constituted the second-phase sample (n = 562; mean-age of 11.25). The Screen for Child Anxiety Related Emotional Disorders-SCARED was administered in all three phases.
Results: Fifty-six percent and 32% of respondents showed total scores above the SCARED cutoff point at one and three years follow-up, respectively. Eight percent showed fluctuating symptoms. Fifty-five percent of respondents showed high scores for any subtype of anxiety over three years. Social phobia and generalized anxiety symptoms were the most prevalent and persistent. Participants with persistent separation anxiety showed the highest co-occurrence with symptoms of other psychopathological disorders. Participants with persistent anxiety showed lower academic performance. Being male was a protective factor against persistence.
Conclusions: The data support anxiety maintenance during early adolescence. Early adolescence is a critical period which may involve other serious academic, social, and family problems.
Introduced as a residual category, generalized anxiety disorder (GAD) was diagnosed only if a patient failed to meet criteria for any other Axis I disorder. To warrant a diagnosis of GAD, an individual's worry and associated symptoms must result in clinically significant impairment or distress. Prevalence estimates of GAD vary widely, depending on the diagnostic criteria used and the population examined. Large-scale studies have indicated that most individuals diagnosed with GAD have additional symptoms that meet criteria for at least one additional diagnosis. Many patients with GAD present to their primary-care physicians (PCPs) for treatment of somatic problems, which may include headache, muscle tension, gastrointestinal problems, and fatigue. Effective treatment of GAD requires that patients understand that their worry, although it may feel functional, is not an effective problem-solving strategy.
This chapter examines generalized anxiety disorder (GAD), a condition characterized by chronic worry and associated symptoms of negative affect and tension. Historical changes to the diagnostic criteria are reviewed, as are patterns of comorbidity and evidence for the disorder's discriminant validity. Epidemiological patterns are discussed, including cross-cultural differences in presentation and prevalence. The chapter provides an overview of methods of assessment and guidelines for differential diagnosis, as well as genetic, neurobiological, and psychological factors related to the etiology of GAD are discussed. Empirically supported treatments, including cognitive-behavioral therapy and pharmacotherapy, are presented, and case vignettes illustrate the clinical features of GAD.
Adolescence is a period of heightened vulnerability for the onset of internalizing psychopathology. Characterizing developmental patterns of symptom stability, progression, and co-occurrence is important in order to identify adolescents most at risk for persistent problems. We use latent growth curve modeling to characterize developmental trajectories of depressive symptoms and four classes of anxiety symptoms (GAD, physical symptoms, separation anxiety, and social anxiety) across early adolescence, prospective associations of depression and anxiety trajectories with one another, and variation in trajectories by gender. A diverse sample of early adolescents (N = 1 065) was assessed at three time points across a one-year period. All classes of anxiety symptoms declined across the study period and depressive symptoms remained stable. In between-individual analysis, adolescents with high levels of depressive symptoms experienced less decline over time in symptoms of physical, social, and separation anxiety. Consistent associations were observed between depression and anxiety symptom trajectories within-individuals over time, such that adolescents who experienced a higher level of a specific symptom type than would be expected given their overall symptom trajectory were more likely to experience a later deflection from their average trajectory in other symptoms. Within-individual deflections in GAD, physical, and social symptoms predicted later deflections in depressive symptoms, and deflections in depressive symptoms predicted later deflections in GAD and separation anxiety symptoms. Females had higher levels of symptoms than males, but no evidence was found for variation in symptom trajectories or their associations with one another by gender or by age.
This study explored whether intolerance of uncertainty and/or meta-worry discriminate between non-clinical individuals and those diagnosed with generalised anxiety disorder (GAD group). The participants were 107 GAD clients and 91 university students. The students were divided into two groups (high and low GAD symptom groups). A multivariate analysis of covariance (MANCOVA) adjusting for age indicated that intolerance of uncertainty distinguished between the low GAD symptom group and the high GAD symptom group, and between the low GAD symptom group and the GAD group. Meta-worry distinguished all three groups. A discriminant function including intolerance of uncertainty and meta-worry classified 94.4% of the GAD group and 97.9% of the low GAD symptom group. Only 6.8% of the high GAD symptom group was classified correctly, 77.3% of the high GAD symptom group was classified as GAD. Findings indicated that intolerance of uncertainty and meta-worry may assist with the diagnosis and treatment of GAD.
Merkmale der heute so genannten »generalisierten Angststörung « wurden schon von Freud als »Angstneurose« beschrieben. Das
klinische Bild der Angstneurose beinhaltete als Kernsymptom die ängstliche Erwartung (»frei flottierende Angst«) und zusätzlich
u. a. allgemeine Reizbarkeit, Angstanfälle, Schwindel und sekundär phobisches Vermeidungsverhalten. Als eigenständiges und
von der Panikstörung getrenntes Störungsbild, bei dem übermäßige Sorgen im Vordergrund stehen, wurde die generalisierte Angststörung
aber erst im DSM-III betrachtet. Seither wurden die diagnostischen Kriterien der generalisierten Angststörung in den Revisionen
des DSM immer wieder verändert. Hervorzuheben ist, dass im DSM-IV (APA, 1994) die Sorgen nicht mehr als »übertrieben und unrealistisch« definiert wurden, sondern als »übermäßig und unkontrollierbar« (◘ Abb. 42.1).
Generalized anxiety disorder (GAD) is a commonly occurring anxiety disorder that many times is characterized by an onset in adolescence and symptoms that increase in severity into adulthood. Due to the persistent nature of the disorder's primary symptom of worry, which appears more related to a personality trait than an anxiety state, the current DSM-IV nosology of GAD has been debated. Recently, evidence is accumulating that suggests that the GAD symptom of worry is strongly related to the personality trait of neuroticism. This study investigates whether the GAD symptom of worry and neuroticism are best explained as 1 general factor or as 2 distinct entities in adolescents. Additionally, the interrelation over time between the GAD symptom of worry and neuroticism in adolescents is examined.
Dutch secondary school adolescents from the general community were prospectively studied annually for 5 years. The adolescent population consisted of 923 early adolescents (49% girls) and 390 middle adolescents (57% girls), with mean ages of 12 and 16 years, respectively, on the first measurement wave. At all 5 waves, the adolescents completed self-rated measures of GAD and neurotic symptoms.
Confirmatory factor analyses established that the GAD symptom of worry and neuroticism are 2 distinct entities, and structural equation modeling demonstrated very strong interrelated properties between these 2 entities. These findings did not differ between the adolescent sex and age groups.
The findings suggest that the GAD symptom of worry is more akin to a personality trait than an anxiety state in adolescents, which may hold implications for the current nosology and treatment of GAD.
To investigate the distribution of age at onset of generalized anxiety disorder (GAD) as well as the possible differences in demographic and psychosocial risk factors, the comorbidities of other psychiatric disorders, health status, and healthcare utilization in respondents suffering from early onset GAD (<50 years) and late-onset GAD (> or =50 years) in adults aged 55 or above.
Cross-sectional observational study.
The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (2001-2002), a national representative survey of the noninstitutionalized U.S. household population.
The 439 respondents aged 55 or above who participated in the NESARC and were found to have lifetime GAD.
The Alcohol Use Disorder and Associated Disabilities Interview Schedule--DSM-IV version was used to assess psychiatric disorders, and the Medical Outcomes study 12-item Short Form questionnaire was included.
The distribution of age at onset appeared normally distributed for respondents with current or lifetime GAD. Among respondents with lifetime GAD, early-onset cases tended to be younger with a higher education level and to have a significantly higher prevalence of panic disorder (current and lifetime), lifetime social phobia, current bipolar I disorder, lifetime alcohol abuse or dependence, or lifetime nicotine dependence than late-onset cases. In addition, respondents presenting with late-onset GAD were more likely to report hypertension and poor health-related quality of life than those with early-onset GAD.
About half of the older adult respondents with GAD reported a late onset and, among those with lifetime GAD, late-onset GAD was distinguished from early-onset GAD by a more frequent association with the presence of hypertension and a poorer health-related quality of life.
The prevalence of most adult psychiatric disorders varies across racial/ethnic groups and has important implications for prevention and intervention efforts. Research on racial/ethnic differences in the prevalence of internalizing and externalizing symptoms and disorders in adolescents has been less consistent or generally lacking. The current study examined the prevalence of these symptom groups in a large sample of sixth, seventh, and eighth graders in which the three major racial/ethnic groups in the U.S. (White, Black, and Hispanic/Latino) were well-represented. Hispanic females reported experiencing higher levels of depression, anxiety, and reputational aggression than other groups. Black males reported the highest levels of overtly aggressive behavior and also reported higher levels of physiologic anxiety and disordered eating than males from other racial/ethnic groups. Hispanic females also exhibited higher levels of comorbidity than other racial/ethnic groups.
Using outpatients with anxiety and mood disorders (N = 350), the authors tested several models of the structural relationships of dimensions of key features of selected emotional disorders and dimensions of the tripartite model of anxiety and depression. Results supported the discriminant validity of the 5 symptom domains examined (mood disorders; generalized anxiety disorder, GAD; panic disorder; obsessive-compulsive disorder; social phobia). Of various structural models evaluated, the best fitting involved a structure consistent with the tripartite model (e.g., the higher order factors, negative affect and positive affect, influenced emotional disorder factors in the expected manner). The latent factor, GAD, influenced the latent factor, autonomic arousal, in a direction consistent with recent laboratory findings (autonomic suppression); Findings are discussed in the context of the growing literature on higher order trait dimensions (e.g., negative affect) that may be of considerable importance to the understanding of the pathogenesis, course, and co-occurrence of emotional disorders.
In recent studies of the structure of affect, positive and negative affect have consistently emerged as two dominant and relatively independent dimensions. A number of mood scales have been created to measure these factors; however, many existing measures are inadequate, showing low reliability or poor convergent or discriminant validity. To fill the need for reliable and valid Positive Affect and Negative Affect scales that are also brief and easy to administer, we developed two 10-item mood scales that comprise the Positive and Negative Affect Schedule (PANAS). The scales are shown to be highly internally consistent, largely uncorrelated, and stable at appropriate levels over a 2-month time period. Normative data and factorial and external evidence of convergent and discriminant validity for the scales are also presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
J. A. Gray (1981, 1982) holds that 2 general motivational systems underlie behavior and affect: a behavioral inhibition system (BIS) and a behavioral activation system (BAS). Self-report scales to assess dispositional BIS and BAS sensitivities were created. Scale development (Study 1) and convergent and discriminant validity in the form of correlations with alternative measures are reported (Study 2). In Study 3, a situation in which Ss anticipated a punishment was created. Controlling for initial nervousness, Ss high in BIS sensitivity (assessed earlier) were more nervous than those low in BIS sensitivity. In Study 4, a situation in which Ss anticipated a reward was created. Controlling for initial happiness, Ss high in BAS sensitivity (Reward Responsiveness and Drive scales) were happier than those low in BAS sensitivity. In each case the new scales predicted better than an alternative measure. Discussion is focused on conceptual implications. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This study examined the long-term temporal stability and predictive utility of trait Positive Affect and Negative Affect scales. Participants were assessed initially as undergraduates: They rated how they felt generally (general sample) or during the past year (year sample). They were retested on a general affect measure and on scales assessing current depression and anxiety approximately 6 (general sample) or 7 (year sample) years later. By this time, all of them had graduated from college and most were working full-time. Negative Affect scores declined significantly over the study. Nevertheless, the Negative and Positive Affect scales both displayed a significant, moderate level of stability. Moreover, initial scores on both scales correlated significantly with measures of current symptoms that were completed several years later. Thus, trait affect scales were substantially stable--and maintained significant predictive power--even across extended time spans.
The comorbidity of current and lifetime DSM-IV anxiety and mood disorders was examined in 1,127 outpatients who were assessed with the Anxiety Disorders Interview Schedule for DSM-IV: Lifetime version (ADIS-IV-L). The current and lifetime prevalence of additional Axis I disorders in principal anxiety and mood disorders was found to be 57% and 81%, respectively. The principal diagnostic categories associated with the highest comorbidity rates were mood disorders, posttraumatic stress disorder (PTSD), and generalized anxiety disorder (GAD). A high rate of lifetime comorbidity was found between the anxiety and mood disorders; the lifetime association with mood disorders was particularly strong for PTSD, GAD, obsessive-compulsive disorder, and social phobia. The findings are discussed in regard to their implications for the classification of emotional disorders.
The reliability of current and lifetime Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) anxiety and mood disorders was examined in 362 outpatients who underwent 2 independent administrations of the Anxiety Disorders Interview Schedule for DSM-IV: Lifetime version (ADIS-IV-L). Good to excellent reliability was obtained for the majority of DSM-IV categories, For many disorders, a common source of unreliability was disagreements on whether constituent symptoms were sufficient in number, severity, or duration to meet DSM-IV diagnostic criteria. These analyses also highlighted potential boundary problems for some disorders (e.g., generalized anxiety disorder and major depressive disorder), Analyses of ADIS-IV-L clinical ratings (0-8 scales) indicated favorable interrater agreement for the dimensional features of DSM-IV anxiety and mood disorders. The findings are discussed in regard to their implications for the classification of emotional disorders.
Generalized anxiety disorder (GAD) is a chronic, pervasive disorder for which we have yet to develop sufficiently efficacious interventions. In this article we propose that recent research and theory regarding this disorder supports the integration of acceptance-based treatments with existing cognitive-behavioral treatments for GAD to improve the efficacy and clinical significance of such approaches. The bases for this proposal (from both the GAD and the acceptance-based treatment literature) are reviewed, and a new treatment stemming from this conceptual integration is described.
Resting anterior brain electrical activity, self-report measures of Behavioral Approach and Inhibition System (BAS and BIS) strength, and general levels of positive and negative affect (PA and NA) were collected from 46 unselected undergraduates on two separate occasions Electroencephalogram (EEG) measures of prefrontal asymmetry and the self-report measures showed excellent internal consistency reliability and adequate test-retest stability Aggregate measures across the two assessments were computed for all indices Subjects with greater relative left prefrontal activation reported higher levels of BAS strength, whereas those with greater relative right prefrontal activation reported higher levels of BIS strength Prefrontal EEG asymmetry accounted for more than 25% of the variance in the self-report measure of relative BAS-BIS strength Prefrontal EEG, however, was not significantly correlated with PA or NA, or the relative strength of PA versus NA Posterior asymmetry was unrelated to the self-report measures
anxiety disorders are the most commonly reported psychiatric disorders in recent community-based epidemiologic surveys / there have been few studies, however, of the epidemiology of the anxiety disorders across the life cycle
to explore the epidemiology of the anxiety disorders among older adults, we take advantage of the Piedmont Health Survey, part of the Epidemiologic Catchment Area Project / individuals in mid life (45 to 64) were compared with late life distribution across demographic factors of the anxiety disorders, with special attention to generalized anxiety
the Piedmont Health Survey / results of the survey
the results reported suggest that older adults do suffer relatively frequent generalized anxiety, compared with other psychiatric syndromes, though the prevalence is lower than for the middle-aged group (PsycINFO Database Record (c) 2012 APA, all rights reserved)
in discussing the contributions of these authors [A. Jablensky and R. Spitzer], I focus primarily on definitional issues and on the relationship of anxiety to depressive states, and then present some of our data—including recent sleep electroencephalographic (EEG) findings / I raise some general questions about etiologic models, and present a heuristic attempt to integrate various approaches to anxiety (PsycINFO Database Record (c) 2012 APA, all rights reserved)
significance of comorbidity / frequency of comorbidity / chronic anxiety as a dimension of psychopathology / comorbidity of GAD [generalized anxiety disorder] and personality disorders / GAD as a personality disorder (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The Behavioural Inhibition System and Behavioural Activation System (BIS/BAS) scales of Carver and White (1994)were used in an Australian community sample of 2725 individuals aged 18–79. Factor analysis of the BIS/BAS items supported the 4-factor structure found by Carver and White, as well as a 2-factor structure reflecting separate behavioural inhibition and behavioural activation systems. The BIS scale was related to neuroticism and negative affectivity, while the BAS scale was related to extraversion and positive affectivity. The BIS scale was less correlated with anxiety and depression symptoms than are neuroticism and negative affectivity scales, probably because it is designed to measure predisposition to anxiety rather than the experience of anxiety. BIS scores were higher in females, while the BAS subscales showed a more complex pattern, with reward responsiveness scores higher in females and drive scores higher in males. Both BIS and BAS scores were lower in older age groups, suggesting the possibility that the behavioural inhibition and behavioural activation systems become less responsive with age.
In a study of 2,902 subjects from the National Institute of Mental Health Epidemiologic Catchment Area Project in North Carolina, the association between life events and the onset of new cases of generalized anxiety syndrome varied across demographic subgroups and type of life event measure. Men reporting four or more life events had a risk of generalized anxiety syndrome 8.5 times that of men reporting zero to three life events; no association was found for women. Both men and women reporting one or more unexpected, negative, very important life events had a threefold increase in the risk of developing generalized anxiety syndrome.
The authors review the empirical data on generalized anxiety disorder, a diagnostic category that has been among the more conceptually challenging in psychiatric nosology.
Published studies and recent findings that were considered by the Generalized Anxiety Disorder Subcommittee of the DSM-IV Anxiety Disorders Work Group are reviewed. Among the issues examined are diagnostic reliability, comorbidity, boundaries with other disorders, and clinical features.
A variety of data on the reliability and validity of generalized anxiety disorder have been produced. Some authors have suggested that generalized anxiety disorder is better conceptualized as a vulnerability that should be located on axis II, and others have recommended that the category be eliminated. Although the diagnostic reliability of generalized anxiety disorder is lower than that of other anxiety disorders, the features constituting the diagnostic criteria for generalized anxiety disorder have been found to be reliable. An important development has been the determination of a set of somatic symptoms associated with generalized anxiety disorder that differs substantially from those for other anxiety disorders. These findings led to reduction in the number of items in the symptom criterion, from 18 in DSM-III-R to six in DSM-IV. Another substantial revision is greater emphasis on the uncontrollability of worry.
Whereas the data on construct and discriminant validity, age at onset, course, familial transmission, and response to treatment generally support the DSM-IV definition of generalized anxiety disorder, the construct continues to have weaknesses and further research is needed.
Some generalized anxiety disorder (GAD) patients experience subclinical or clinical levels of anxiety before adulthood, whereas others have a later onset. To determine whether patients who experienced subclinical or clinical anxiety in the first two decades of life differed from those with a later onset, we reviewed the history, ratings on various scales, and psychophysiological recordings obtained from 103 GAD patients. Early-onset patients were younger and more likely to develop GAD without a precipitating stressful event. With the exception of depression in the early-onset group, present-state measures did not differentiate the two groups. During childhood, patients in the early-onset group were exposed to more domestic disturbances, experienced more childhood fears, and were more inhibited and socially maladjusted. As adults, they scored higher on trait anxiety and neuroticism, tended to have obsessional traits, were more sensitive in interpersonal relationships, and experienced more marital difficulties. These findings may be explained by (1) constitutional traits that make early-onset GAD patients more vulnerable to stressors; (2) a more disturbed environment during childhood that adversely affects personality development; or (3) a more severe disorder with an early subclinical onset that also affects personality development.
Despite the prevalence of Generalized Anxiety Disorder (GAD) in older adults, little is known about psychopathological features of excessive worry in the elderly. This investigation compared 44 GAD patients (mean age 67.6), diagnosed using structured interview, with a matched sample free of psychiatric disorders on self-report and clinician measures. Results indicated that GAD in the elderly is associated with elevated anxiety, worry, social fears, and depression. Using self-report measures alone, near-perfect classification of Ss into groups was achieved with four measures (PSWQ, WS-Soc, FQ-Soc, and BDI). Using clinician ratings, near-perfect classification was achieved with Hamilton anxiety ratings. Comparison of GAD patients whose symptoms began in childhood vs middle adulthood revealed few differences on these dimensions. Results are discussed in light of features of GAD in the elderly, highlighting implications for further study.
The reliability of current and lifetime Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) anxiety and mood disorders was examined in 362 outpatients who underwent 2 independent administrations of the Anxiety Disorders Interview Schedule for DSM-IV: Lifetime version (ADIS-IV-L). Good to excellent reliability was obtained for the majority of DSM-IV categories. For many disorders, a common source of unreliability was disagreements on whether constituent symptoms were sufficient in number, severity, or duration to meet. DSM-IV diagnostic criteria. These analyses also highlighted potential boundary problems for some disorders (e.g., generalized anxiety disorder and major depressive disorder). Analyses of ADIS-IV-L clinical ratings (0-8 scales) indicated favorable interrater agreement for the dimensional features of DSM-IV anxiety and mood disorders. The findings are discussed in regard to their implications for the classification of emotional disorders.