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generalized anxiety disorder diagnosis dsm

Generalized Anxiety Disorder Diagnosis

In many ways, generalized anxiety disorder (GAD) can be considered the basic anxiety disorder. It can be thought of almost as an expression of ‘‘pure’’ high trait anxiety. By definition, GAD is not characterized primarily by a focus on any specific situation or object. Rather, the central characteristic of GAD is what many people would see as the fundamental feature of anxiety: worry. According to DSM-IV, a diagnosis of GAD requires a report of excessive worry over a number of events or activities, more days than not, over at least 6 months. In addition, the person must report difficulty controlling the worry and must also experience three out of a list of six symptoms.

The symptoms are related mainly to various features of excessive arousal. However, these symptoms are probably not a particularly important defining characteristic of GAD because many subjects with other anxiety disorders report a number of the same symptoms. Thus, it seems that chronic worry is the best distinguishing characteristic of GAD. Of course, worry about specific areas is naturally present in all of the anxiety disorders; however, DSM-IV specifies that the source of worry must not be another Axis I disorder. For example, if someone met criteria for a diagnosis of social phobia, then worry about social situations would not count toward a diagnosis of GAD. The exclusion of worry about other diagnoses is essential to distinguish GAD from other anxiety disorders, but this feature makes the diagnosis of GAD sometimes difficult. In addition, the overlap between many of the features of GAD and other anxiety disorders also adds to this difficulty. For these reasons, agreement among raters regarding a diagnosis of GAD in an individual (measured by the kappa statistic) is generally the lowest for GAD of any of the anxiety disorders. It should be noted that these studies have all used DSM-III-R criteria, and studies using DSM-IV are still awaited.

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