Classification Diagnosis DSM criteria

In DSM-III, GAD was essentially a residual category for individuals with somatic symptoms of anxiety who did not meet diagnostic criteria for another, more specific, anxiety disorder. Diagnosis required the presence, for at least a month, of symptoms from three of four symptom clusters: motor tension, autonomic hyperactivity, apprehensive expectation, and vigilance and scanning. Unfortunately, clinicians had difficulty applying those criteria. Even in studies that used structured diagnostic interviews, kappa coefficients reflecting rates of agreement between independent evaluators were low (0.47 to 0.57). (1.,2) In addition, because GAD was not diagnosed if another anxiety disorder was present, its diagnosis also depended on the application of the criteria for other diagnoses.

In DSM-IIIR, apprehensive expectation was removed from the diagnostic symptom clusters, was redefined as unrealistic or excessive anxiety and worry about two or more life circumstances, and was made the essential feature of GAD. In addition, the duration criterion was changed from 1 to 6 months, and the hierarchical exclusion rule was dropped, allowing GAD to be diagnosed in addition to other disorders.

Despite those changes, the diagnostic reliability of GAD remained essentially unchanged. (3) Investigations revealed that the new worry criterion was problematic. Interviewers commonly disagreed as to whether two distinct spheres of worry were present, whether the worry was unrealistic or excessive, or whether the focus of the worry could be construed to be part of the symptomatology of another disorder. Moreover, studies indicated that patients with GAD did not differ substantially from control subjects in the content of their worries. (!5) The main difference between patients and controls was that the former experienced their worrying to be uncontrollable while the latter did not.

Based on those and other findings, the GAD criteria were revised again in DSM-IV. The 'unrealistic' descriptor and the requirement for anxiety or worry to involve at least two spheres of life circumstances were deleted, and a new criterion was added that the worry must be experienced as difficult to control. In addition, the associated symptom criterion was modified to require only three of six symptoms from the previous motor tension and vigilance and scanning clusters ( Table 1). For additional information about the evolution of the DSM criteria for GAD, see Barlow and Wincze (6) or Brown et al.(D

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Table 1 DSM-IV inclusion criteria for GAD

ICD-10 criteria

Like DSM-IIIR and DSM-IV, ICD-10 requires a period of 6 months of generalized anxiety and worry accompanied by certain somatic symptoms (Tabled). The specified symptoms include 16 of the 18 DSM-IIIR GAD symptoms plus six additional symptoms that are listed under panic attacks in the American classification system (feeling of choking, chest pain or discomfort, derealization or depersonalization, fear of losing control or going crazy, and fear of dying). Most of the symptoms ICD-10 shared with DSM-IIIR were in the autonomic hyperactivity cluster, which was deleted during the 1994 DSM revision. Thus, of the 22 symptoms listed in ICD-10, 16, including the four that comprise the essential autonomic arousal cluster, do not appear in DSM-IV. One DSM-IV symptom (being easily fatigued) does not appear in ICD-10, nor does ICD-10 require that the person find it difficult to control the worry, which is an essential criterion in DSM-IV.

Table 2 ICD-10 inclusion criteria for GAD

Free Yourself from Panic Attacks

Free Yourself from Panic Attacks

With all the stresses and strains of modern living, panic attacks are become a common problem for many people. Panic attacks occur when the pressure we are living under starts to creep up and overwhelm us. Often it's a result of running on the treadmill of life and forgetting to watch the signs and symptoms of the effects of excessive stress on our bodies. Thankfully panic attacks are very treatable. Often it is just a matter of learning to recognize the symptoms and learn simple but effective techniques that help you release yourself from the crippling effects a panic attack can bring.

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