The Role of Hypervigilance, Checking, and Avoidance Behaviours in the Diagnosis of Generalized Anxiety Disorder During the Perinatal Period

Abstract

Generalized anxiety disorder (GAD) is common during the perinatal period. Since its inception, substantial efforts have been put forth to improve the specificity and interrater reliability of GAD. More recently, increased attention has been given to the behavioral features of GAD, with evidence to suggest that hypervigilance, checking, and avoidance may be particularly relevant. It is unknown however if these behaviors lead to improved classification and understanding of GAD. The present study examines: (1) the proportion of perinatal individuals with and without GAD who endorse hypervigilance, checking and avoidance; (2) interrater reliability of GAD during the perinatal period; (3) whether inclusion of hypervigilance, checking, and avoidance in GAD diagnostic criteria leads to improved interrater reliability; and (4) if hypervigilance, checking and avoidance significantly predict GAD diagnostic status beyond current features of the disorder. Thirty-eight perinatal women, who were predominantly white and highly educated were randomized to one of two assessors to complete a semi-structured diagnostic assessment. Interviewers queried about the presence of current mental health disorders and engagement in behaviors of interest. Each assessment was independently rated by three assessors. More participants with GAD reported engaging in hypervigilance, checking, and avoidance than those without GAD. Interrater agreement of GAD diagnoses was excellent (κ = 0.91). Inter-rater agreement of GAD diagnoses was comparable (κ = 0.92) when checking was included in the diagnostic criteria of GAD. Checking also significantly predicted GAD diagnostic status beyond existing features of the disorder. These results support continued evaluation of the role of checking in GAD.

Full text

Journal of Psychopathology and Behavioral Assessment (2025) 47:34
https://doi.org/10.1007/s10862-025-10210-2
endorsement of excessive and dicult to control anxiety
and worry about several events or activities, occurring more
days than not for at least six months, in addition to three
or more of six physical symptoms [feeling restless, keyed
up, or on edge; fatigue; diculty concentrating or mind
going blank; irritability; muscle tension; sleep disturbance;
American Psychiatric Association (APA), 2022]. GAD is a
chronic condition with high likelihood of recurrence (Weis-
berg, 2009), and is associated with signicant distress, high
healthcare costs (Pelletier et al., 2017; Wittchen, 2002),
impaired family interactions, and high co-occurrence with
other mental health disorders (Weisberg, 2009). During the
perinatal period, GAD is associated with additional con-
sequences to mothers and infants, including maternal dis-
tress and impaired psychosocial functioning (Ali, 2018),
Introduction
Generalized anxiety disorder (GAD) is a leading mental
health concern during pregnancy and the postpartum (peri-
natal) period, aecting up to 4.1% of perinatal individuals
(Dennis et al., 2017). Presently, diagnosis of GAD requires
Briar E. Inness
innessbe@mcmaster.ca
1 Department of Psychology, Neuroscience and Behaviour,
McMaster University, Hamilton, Canada
2 Department of Psychiatry and Behavioural Neurosciences,
McMaster University, Hamilton, Canada
3 St. Joseph’s Healthcare Hamilton, Hamilton, Canada
Abstract
Generalized anxiety disorder (GAD) is common during the perinatal period. Since its inception, substantial eorts have
been put forth to improve the specicity and interrater reliability of GAD. More recently, increased attention has been
given to the behavioral features of GAD, with evidence to suggest that hypervigilance, checking, and avoidance may
be particularly relevant. It is unknown however if these behaviors lead to improved classication and understanding
of GAD. The present study examines: (1) the proportion of perinatal individuals with and without GAD who endorse
hypervigilance, checking and avoidance; (2) interrater reliability of GAD during the perinatal period; (3) whether inclu-
sion of hypervigilance, checking, and avoidance in GAD diagnostic criteria leads to improved interrater reliability; and
(4) if hypervigilance, checking and avoidance signicantly predict GAD diagnostic status beyond current features of the
disorder. Thirty-eight perinatal women, who were predominantly white and highly educated were randomized to one of
two assessors to complete a semi-structured diagnostic assessment. Interviewers queried about the presence of current
mental health disorders and engagement in behaviors of interest. Each assessment was independently rated by three
assessors. More participants with GAD reported engaging in hypervigilance, checking, and avoidance than those without
GAD. Interrater agreement of GAD diagnoses was excellent (κ = 0.91). Inter-rater agreement of GAD diagnoses was com-
parable (κ = 0.92) when checking was included in the diagnostic criteria of GAD. Checking also signicantly predicted
GAD diagnostic status beyond existing features of the disorder. These results support continued evaluation of the role of
checking in GAD.
Keywords Generalized anxiety disorder · Perinatal · Behavior · Checking · Diagnosis
Accepted: 25 March 2025
© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2025
The Role of Hypervigilance, Checking, and Avoidance Behaviours in
the Diagnosis of Generalized Anxiety Disorder During the Perinatal
Period
Briar E.Inness1· Sheryl M.Green2,3· MelissaFurtado1· BethanyEasterbrook1· David L.Streiner2·
AlyssaGeorgescu3· Randi E.McCabe2,3
1 3
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