Magazine article Clinical Psychiatry News

GAD Makeover in DSM-5 Might Include a New Name

Magazine article Clinical Psychiatry News

GAD Makeover in DSM-5 Might Include a New Name

Article excerpt

TUCSON -- Generalized anxiety disorder, already the most common of the anxiety disorders, could double in prevalence in clinical practice with adoption of changes now under consideration for the coming edition of psychiatry's diagnostic and statistical manual, the DSM-5.

The DSM-5 Anxiety, Obsessive-Compulsive Spectrum, Posttraumatic, and Dissociative Disorders Work Group is planning to give generalized anxiety disorder (GAD) a major overhaul. The makeover could very well begin with its name, which might be changed to Generalized Worry Disorder in recognition that excessive worry is the disorder's cardinal feature.

But it's the DSM-5 working group's current weighing of a shortening in the duration criterion that would result in a potentially dramatic increase in the number of individuals meeting the diagnostic standard for GAD. Since the introduction of DSM-IV in 1994, the diagnosis of GAD has required excessive anxiety and worry for a minimum of 6 months, up from at least 1 month in the 1980 DSM-III, where GAD first burst on the scene as a formal new diagnostic entity.

"GAD was a residual diagnosis--a wastebasket diagnosis--in DSM-III. The duration criterion was somewhat arbitrarily elevated to 6 months in DSM-IV. That 6-month requirement is now very much in play" Dr. Alan J. Gelenberg said at the meeting.

"I think what we will see in DSM-5 is that the duration criterion will probably go back to 1 month," predicted Dr. Gelenberg, an authority on GAD who is professor and chair of the department of psychiatry at Pennsylvania State University, Hershey.

A study by Dr. Jules Angst and his colleagues at Zurich University Psychiatric Hospital concluded that the 6-month duration criterion for GAD could not be confirmed as clinically meaningful. Based upon data from the prospective Zurich Cohort Study, the investigators found no significant differences in terms of distress, work impairment, family history of anxiety, or comorbid major depression, bipolar disorder, or suicide attempts in groups of patients diagnosed with GAD based upon symptom durations of 2 weeks, 1 month, 3 months, and 6 months. Moreover, twice as many patients were identified as having GAD based upon a 1-month criterion compared with the current 6-month requirement (Psychol. …

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