Generalized worry disorder: a review of DSM-IV generalized anxiety disorder and options for DSM-V
Open accessAbstract
BACKGROUND: Generalized anxiety disorder (GAD) has undergone a series of substantial classificatory changes since its first inclusion in DSM-III. The majority of these revisions have been in response to its poor inter-rater reliability and concerns that it may lack diagnostic validity. This article provides options for the revision of the DSM-IV GAD criteria for DSM-V. METHOD: First, searches were conducted to identify the evidence that previous DSM Work Groups relied upon when revising the DSM-III-R GAD and the overanxious disorder classifications. Second, the literature pertaining to the DSM-IV criteria for GAD was examined. CONCLUSIONS: The review presents a number of options to be considered for DSM-V. One option is for GAD to be re-labeled in DSM-V as generalized worry disorder. This would reflect its hallmark feature. Proposed revisions would result in a disorder that is characterized by excessive anxiety and worry generalized to a number of events or activities for 3 months or more. Worry acts as a cognitive coping strategy that manifests in avoidant behaviors. The reliability and validity of the proposed changes could be investigated in DSM-V validity tests and field trials.
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Andrews et al. point out that individuals with symptoms that have persisted for less than 3 months likely include those experiencing transient responses to life stressors.
“Andrews et al. [71] point out that individuals with symptoms that have persisted for less than 3 months likely include those experiencing transient responses to life stressors.”
From The Classification of Anxiety and Fear-Related Disorders in the ICD-11: Review: Anxiety and Fear-Related Disorders in ICD-11 (2016) · cites this paper as [71]
In “DSM-V Options for ‘A Number of Events or Activities’” (page unavailable), the review says the former 1-month threshold reduced GAD’s distinction from ordinary anxious reactions to life events. It does not say that people with symptoms lasting less than 3 months likely include those having transient responses to stressors; it presents the concern as a possible criticism of shorter thresholds while recommending a 3-month threshold. (LLM, conf=0.82)
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Developmental epidemiology of anxiety disorders
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“Observed effect sizes in the overall disability measure and in individual dimensions are large enough to be considered of clinical relevance, and particularly in the participation in society dimension, which seems to be sound given the definition of the disorder (Andrews et al., 2010; Behar et al., 2009).”
BackgroundEpidemiology of anxiety disorders: from surveys to nosology and back.
Stein, D. J., Scott, K. M., de Jonge, P., & Kessler, R. C. (2017) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2017.19.2/dstein · Cited by 283 · see citing works
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“…dCBT appears to be equally beneficial, with equivalent reductions in symptoms and disability and equivalent improvement in quality of life (Andrews et al., 2010a, 2018; Olthuis et al., 2016) and has the advantages of reduced cost, broader availability and consistent fidelity to the manual…”
BackgroundSelf-citationBody dysmorphic disorder: some key issues for DSM-V
Phillips, K. A., Wilhelm, S., Koran, L. M., Didie, E. R., Fallon, B. A., Feusner, J. D., & Stein, D. J. (2010) · Depression and Anxiety · doi:10.1002/da.20709 · Cited by 249 · see citing works
“The event usually has a low probability of occurrence and/or is outside the person’s control.([40]) In DSM-IIIR,([7]) worry became a feature of generalized anxiety disorder and was retained in DSM-IV, which defines it as ‘‘apprehensive expectation.”
BackgroundReliability and validity of the Portuguese version of the Generalized Anxiety Disorder (GAD-7) scale
Sousa, T. V., Viveiros, V., Chai, M. V., Vicente, F. L., Jesus, G., Carnot, M. J., Gordo, A. C., & Ferreira, P. L. (2015) · Health and Quality of Life Outcomes · doi:10.1186/s12955-015-0244-2 · Cited by 237 · see citing works
“Introduction Anxiety is the manifestation of an emotion, characterized by a physical and psychological discomfort described by individuals as a feeling of restlessness, nervousness and excessive concern [1-3].”
BackgroundTully, P. J., Cosh, S. M., & Baune, B. T. (2013) · Psychology, Health & Medicine · doi:10.1080/13548506.2012.749355 · Cited by 230 · see citing works
“Email: phillip.tully@adelaide.edu.au Psychology, Health & Medicine, 2013 Vol. 18, No. 6, 627–644, http://dx.doi.org/10.1080/13548506.2012.749355 2013 Taylor & Francis and scholars debate whether these do form separate disorders (Andrews et al., 2010).”
BackgroundInfluentialTowards a model of uncertainty distress in the context of Coronavirus (COVID-19)
Freeston, M., Tiplady, A., Mawn, L., Bottesi, G., & Thwaites, S. (2020) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x2000029x · Cited by 221 · see citing works
“(Andrews et al., 2010, pp. 141–142)’. Although not finally accepted, this is a first proposal that GAD, with worry at its core and with IU as an empirically based underlying driver of worry, has some specific behavioural signatures. Especially pertinent are (b) time and effort preparing for possible negative outcomes…”
Rosellini, A. J., & Brown, T. A. (2011) · Assessment · doi:10.1177/1073191110382848 · Cited by 217 · see citing works
“…of strain were viewed as consistent with arguments that the excessiveness and uncontrollability criteria of GAD may be highly overlapping (e.g., Andrews et al., 2010) and research demonstrating the strong phenotypic overlap between GAD and depression (e.g., high comorbidity between GAD and…”
BackgroundComposite International Diagnostic Interview screening scales for DSM-IV anxiety and mood disorders
Kessler, R. C., Calabrese, J. R., Farley, P. A., Gruber, M. J., Jewell, M. A., Katon, W. J., Keck, P. E., Nierenberg, A. A., Sampson, N. A., Shear, M. K., et al. (2012) · Psychological Medicine · doi:10.1017/s0033291712002334 · Cited by 218 · see citing works
“2005), leading to the suggestion that more concrete guidance be given in DSM-5 about defining excessiveness (Andrews et al. 2010).”
BackgroundHeart rate variability in patients with anxiety disorders: A systematic review and meta‐analysis
Cheng, Y., Su, M., Liu, C., Huang, Y., & Huang, W. (2022) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.13356 · Cited by 175 · see citing works
“even using the same diagnostic system, different raters may give different diagnoses; this is especially important for GAD, which is not as distinct as other AD diagnoses in some studies).(37) The heterogeneity of the challenge topics was even higher; it may be associated with the negative finding of HRV reactivity.”
Mao, J. J., Xie, S. X., Keefe, J. R., Soeller, I., Li, Q. S., & Amsterdam, J. D. (2016) · Phytomedicine · doi:10.1016/j.phymed.2016.10.012 · Cited by 161 · see citing works
“…Clinical Trials; Generalized Anxiety Disorder Introduction Generalized Anxiety Disorder (GAD) is characterized by excessive worry about daily matters and the presence of restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep problems (Andrews et al., 2010).”
BackgroundThe history of generalized anxiety disorder as a diagnostic category
Crocq, M.-A. (2017) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2017.19.2/macrocq · Cited by 159 · see citing works
Hall, J., Kellett, S., Berrios, R., Bains, M. K., & Scott, S. (2016) · The American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2016.06.006 · Cited by 157 · see citing works
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“For the co-occurring MDD-GAD group, we did not apply the DSM-IV hierarchical exclusion criterion (reviewed in Andrews et al., 2010).”
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“Earlier proposals on the diagnostic criteria of GAD in the DSM 5 (Andrews et al., 2010) included several behavioral symptoms as well, for instance behavioral avoidance.”
BackgroundNeural markers of positive reappraisal and their associations with trait reappraisal and worry.
Moser, J. S., Hartwig, R., Moran, T. P., Jendrusina, A. A., & Kross, E. F. (2014) · Journal of Abnormal Psychology · doi:10.1037/a0035817 · Cited by 129 · see citing works
The effects of postnatal maternal depression and anxiety on the processing of infant faces
Arteche, A. X., Joormann, J., Harvey, A. G., Craske, M., Gotlib, I. H., Lehtonen, A., Counsell, N., & Stein, A. L. (2011) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.04.015 · Cited by 126 · see citing works
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“…over the DSM-IV (APA 2000) hierarchical rule, in which GAD is not diagnosed if it occurs exclusively within the course of a mood disorder (e.g., Andrews et al. 2010; Lawrence et al. 2009; Zimmerman and Chelminski 2003), we also performed alternative analyses in which diagnosis of GAD was made…”
MethodGeneralized anxiety and C-reactive protein levels: a prospective, longitudinal analysis
Copeland, W. E., Shanahan, L., Worthman, C., Angold, A., & Costello, E. J. (2012) · Psychological Medicine · doi:10.1017/s0033291712000554 · Cited by 123 · see citing works
“One goal of this addition is indeed to increase differentiation with other anxiety and mood disorders (Andrews et al. 2010).”
BackgroundRumination and Worry in Daily Life
Kircanski, K., Thompson, R. J., Sorenson, J. E., Sherdell, L., & Gotlib, I. H. (2015) · Clinical Psychological Science · doi:10.1177/2167702614566603 · Cited by 124 · see citing works
“…from the DSM-5 work group indicate little utility and, moreover, significant problems associated with this hierarchical exclusion criterion (e.g., Andrews et al., 2010; Lawrence, Liverant, Rosellini, & Brown, 2009), we did not impose the hierarchy rule in order to capture this important and…”
BackgroundAkkol, E. K., Çankaya, İ. İ. T., Karatoprak, G. Ş., Çarpar, E., Sobarzo‐Sánchez, E., & Capasso, R. (2021) · Frontiers in Pharmacology · doi:10.3389/fphar.2021.669638 · Cited by 122 · see citing works
“In this case, the severity of anxiety is excessive, it occurs in an inappropriate context and long in duration (Andrews et al., 2010).”
BackgroundAlfano, C. A., Reynolds, K. C., Scott, N., Dahl, R. E., & Mellman, T. A. (2012) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.08.015 · Cited by 105 · see citing works
“, 1983), methodological limitations of this research including the use of inpatient samples, sub-clinical GAD symptoms, and/or former DSM GAD criteria which demonstrated poor diagnostic reliability should be considered (Andrews et al., 2010).”
BackgroundGarcía‐Campayo, J., Zamorano, E., Ruiz, M. Á., Pérez‐Páramo, M., López-Gómez, V., & Rejas, J. (2012) · Health and Quality of Life Outcomes · doi:10.1186/1477-7525-10-114 · Cited by 102 · see citing works
“Both the DSM-IV and ICD-10 classification systems [11,12] distinguish GAD from other anxiety and depressive disorders [13].”
BackgroundNewman, M. G., Jacobson, N. C., Zainal, N. H., Shin, K. E., Szkodny, L. E., & Sliwinski, M. J. (2019) · Clinical Psychological Science · doi:10.1177/2167702619827019 · Cited by 96 · see citing works
Anema, A., Chan, K., Chen, Y., Weiser, S. D., Montaner, J. S. G., & Hogg, R. S. (2013) · PLoS ONE · doi:10.1371/journal.pone.0061277 · Cited by 97 · see citing works
“Obsessive or chronic worrying is recognized as a symptom of generalized anxiety disorder within the DSM-V [57].”
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Kogan, C. S., Stein, D. J., Maj, M., First, M. B., Emmelkamp, P. M. G., & Reed, G. M. (2016) · Depression and Anxiety · doi:10.1002/da.22530 · Cited by 93 · see citing works
Who worries most? Worry prevalence and patterns across the lifespan
Gonçalves, D. C., & Byrne, G. J. (2013) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.3788 · Cited by 91 · see citing works
“Worry is integral to many forms of anxiety disorder, being the defining characteristic of generalized anxiety disorder (GAD), to the extent that it was suggested that this disorder should be renamed as generalized worry disorder (Andrews et al., 2010).”
BackgroundBurstein, M., Beesdo-Baum, K., He, J.-P., & Merikangas, K. R. (2014) · Psychological Medicine · doi:10.1017/s0033291713002997 · Cited by 87 · see citing works
“Thus, in line with one study of clinically referred youth (Comer et al. 2012b), the current study supports the decision to retain all associated symptoms of GAD in the DSM-5.”
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Mahoney, A. E. J., Hobbs, M. J., Newby, J. M., Williams, A. D., Sunderland, M., & Andrews, G. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.06.020 · Cited by 84 · see citing works
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The everyday dynamics of rumination and worry: Precipitant events and affective consequences
Kircanski, K., Thompson, R. J., Sorenson, J., Sherdell, L., & Gotlib, I. H. (2018) · Cognition and Emotion · doi:10.1080/02699931.2017.1278679 · Cited by 76 · see citing works
“…caseness is not met when this disorder occurs only in the context of MDD, the empirical literature and a DSM-5 work group have indicated multiple problems with this criterion (e.g., Andrews et al., 2010; Lawrence, Liverant, Rosellini, & Brown, 2009); therefore, the hierarchy rule was not applied.”
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Anxiety and Fear-Avoidance in Musculoskeletal Pain
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“(a) Muscle tension is included as a part of the diagnostic criteria for generalized anxiety disorder (GAD) according to the DSM IV [8] (b) Pain can be a common symptom and a good indicator of an anxiety disorder, particularly GAD [9] (c) Anxiety is an independent predictor of quality of life in patients with chronic M…”
BackgroundHerbert, C., Bolock, A. E., & Abdennadher, S. (2021) · BMC Psychology · doi:10.1186/s40359-021-00574-x · Cited by 77 · see citing works
A Comprehensive Review of the Generalized Anxiety Disorder
Mishra, A. K., & Varma, A. R. (2023) · Cureus · doi:10.7759/cureus.46115 · Cited by 68 · see citing works
“In Table 1 , the DSM-IV criteria are displayed [18].”
BackgroundThe relation between the five facets of mindfulness and worry in a non-clinical sample
Fisak, B., & von Lehe, A. C. (2012) · Mindfulness · doi:10.1007/s12671-011-0075-0 · Cited by 67 · see citing works
“Generalized anxiety disorder (GAD) is characterized by persistent and uncontrollable worry, and for those with GAD, the worry is often associated with cognitive and physical symptoms including difficulty concentrating, fatigue, restlessness, and irritability (Andrews et al. 2010; American Psychiatric Association 2000).”
BackgroundRipper, C. A., Boyes, M. E., Clarke, P., & Hasking, P. A. (2017) · Personality and Individual Differences · doi:10.1016/j.paid.2017.09.032 · Cited by 63 · see citing works
“panic disorder; Fava & Morton, 2009), whereas perseveration may be more strongly associated with anxiety disorders which feature prolonged symptomology (e.g. generalised anxiety disorder; Andrews et al., 2010).”
BackgroundPrenoveau, J., Craske, M., Counsell, N., West, V., Davies, B., Cooper, P., Rapa, E., & Stein, A. (2013) · Depression and Anxiety · doi:10.1002/da.22040 · Cited by 62 · see citing works
“Thus, during the 2-year postpartum period, MDD tended to be more episodic than GAD.”
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van den Heuvel, O. A., Veale, D., & Stein, D. J. (2014) · Revista Brasileira de Psiquiatria · doi:10.1590/1516-4446-2013-1218 · Cited by 58 · see citing works
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“Worry is a form of perseverative cognition characterized by recurrent thoughts about potential negative events and attempts to mentally solve these future problems [23].”
BackgroundHallion, L. S., Steinman, S. A., & Kusmierski, S. N. (2017) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2017.10.007 · Cited by 55 · see citing works
“In the leadup to DSM-5, these concerns led to a proposal to remove difficulty concentrating and other nonspecific symptoms from the GAD diagnosis (Andrews et al., 2010).”
BackgroundWright, L., Steptoe, A., & Fancourt, D. E. (2021) · Journal of Epidemiology & Community Health · doi:10.1136/jech-2020-215598 · Cited by 53 · see citing works
Ogłodek, E. A., Szota, A. M., Just, M. J., Moś, D., & Araszkiewicz, A. S. (2014) · Pharmacological Reports · doi:10.1016/j.pharep.2014.08.006 · Cited by 50 · see citing works
Should uncontrollable worry be removed from the definition of GAD? A test of incremental validity
Hallion, L. S., & Ruscio, A. M. (2013) · Journal of Abnormal Psychology · doi:10.1037/a0031731 · Cited by 47 · see citing works
Marciano, H., Eshel, Y., Kimhi, S., & Adini, B. B. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19031123 · Cited by 45 · see citing works
“It has been claimed that worries are an integral component of anxiety disorders, associated also with depression [72].”
BackgroundSex and age‐related anxiety in a community sample of Norwegian adolescents
Leikanger, E., Ingul, J. M., & Larsson, B. S. (2011) · Scandinavian Journal of Psychology · doi:10.1111/j.1467-9450.2011.00915.x · Cited by 45 · see citing works
Asselmann, E., Wittchen, H., Lieb, R., Perkonigg, A., & Beesdo-Baum, K. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.10.004 · Cited by 43 · see citing works
“Especially in females, traumatic events might have increased sensitivity to potential negative events and outcomes in various domains of life, resulting in excessive anxiety and worry as well as behavioral changes such as avoidance, reassurance seeking and safety behaviors being linked to GAD (Andrews et al., 2010; Be…”
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Comer, J. S., Pincus, D. B., & Hofmann, S. G. (2012) · Depression and Anxiety · doi:10.1002/da.21999 · Cited by 44 · see citing works
“A current proposal for DSM-5 GAD is to remove fatigue, difficulty concentrating, irritability, and sleep disturbance from the list of possible associated symptoms, and to require the presence of one of only two retained symptoms (restlessness or muscle tension) for GAD diagnosis.[10, 11] The theoretical rationale and…”
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Freeston, M. H., Tiplady, A., Mawn, L., Bottesi, G., & Thwaites, S. (2020) · doi:10.31234/osf.io/v8q6m · Cited by 44 · see citing works
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Public Health Humanitarian Responses to Natural Disasters
Chan, E. Y. Y. (2017) · Routledge eBooks · doi:10.4324/9781315667218 · Cited by 43 · see citing works
Bradford, A., Cully, J. A., Rhoades, H., Kunik, M., Kraus-Schuman, C. A., Wilson, N. L., & Stanley, M. (2011) · The American journal of geriatric psychiatry · doi:10.1097/jgp.0b013e3181f18061 · Cited by 34 · see citing works
Self-citationBeesdo‐Baum, K., Winkel, S., Pine, D. S., Hoyer, J., Höfler, M., Lieb, R., & Wïttchen, H. (2011) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2010.12.007 · Cited by 36 · see citing works
“In addition to broader appraisals of DSM-IV GAD criteria (Andrews et al., 2010), specific questions arise regarding developmental aspects: Are the current diagnostic criteria for GAD too strict particularly for youth?”
BackgroundInfluentialWright, L., Steptoe, A., & Fancourt, D. E. (2020) · medRxiv · doi:10.1101/2020.05.14.20101717 · Cited by 34 · see citing works
Zhu, S., Zhang, X., Zhou, M., Kendrick, K. M., & Zhao, W. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.1000758 · Cited by 32 · see citing works
“Excessive fear and anxiety are shared features of anxiety disorders, and uncontrollable and excessive worrying is a typical symptom of generalized anxiety disorder (GAD) in particular (109).”
BackgroundClinical characteristics of generalized anxiety disorder: older vs. young adults
Altunöz, U., Kokurcan, A., Kirici, S., Baştuğ, G., & Ozel-Kizil, E. T. (2017) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2017.1390607 · Cited by 33 · see citing works
“[28] frequently encountered in young and older GAD patients.”
BackgroundMethodInfluentialStarčević, V., Portman, M. E., & Beck, A. T. (2012) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0b013e318263f947 · Cited by 33 · see citing works
“In fact, it was noted that there was no evidence to support either the DSM-IV cutoff of three associated symptoms or an alternative symptom threshold (Andrews et al., 2010).”
InfluentialVlemincx, E., Vigo, D. E., Vansteenwegen, D., den Bergh, O. V., & Diest, I. V. (2012) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2012.12.002 · Cited by 34 · see citing works
“Akey feature of GAD is excessiveworry (Andrews et al., 2010).”
Differentiating Procrastinators from Each Other: A Cluster Analysis
Rozental, A., Forsell, E., Svensson, A., Forsström, D., Andersson, G., & Carlbring, P. (2015) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2015.1059353 · Cited by 31 · see citing works
“Worry, and more specifically, generalized anxiety disorder, has recently also gained the attention of researchers and clinicians (Andrews et al., 2010), suggesting that marked procrastination in decision-making or beha- vior due to worry could be a potential criteria for generalized anxiety…”
BackgroundMöller, E. L., & Bögels, S. M. (2016) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.1515 · Cited by 31 · see citing works
“This may be due to worry being the de fi ning characteristic of GAD, compared to all other anxiety disorders of which anxiety is the core feature (Andrews et al., 2010).”
Starčević, V., & Portman, M. E. (2013) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867413503719 · Cited by 29 · see citing works
“On the contrary, a proposal was made to rename GAD as generalized worry disorder (Andrews et al., 2010), thereby erroneously implying that worry is synonymous with anxiety and that pathological worry and GAD are interchangeable concepts.”
BackgroundJones, S. M. W., Walker, R. L., Fujii, M., Nekhlyudov, L., Rabin, B. A., & Chubak, J. (2018) · Psycho-Oncology · doi:10.1002/pon.4677 · Cited by 31 · see citing works
“detriment.(11,12) High levels of uncontrollable worry can be associated with worse health, both concurrently and prospectively.”
BackgroundJacobson, N. C. (2016) · Journal of Abnormal Psychology · doi:10.1037/abn0000185 · Cited by 29 · see citing works
“…a single diagnostic criterion (e.g., the removal of the single diagnostic criterion, autonomic hyperarousal, from generalized anxiety disorder [Andrews et al., 2010] and the inclusion of the single diagnostic criterion, fear of showing anxiety symptoms, for social phobia or social anxiety…”
A community-based epidemiological study of health anxiety and generalized anxiety disorder
Lee, S., Lam, I. M. H., Kwok, K. P. S., & Leung, C. M. C. (2013) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2013.10.002 · Cited by 28 · see citing works
“Of the different types of anxiety disorders, GAD has undergone various diagnostic controversies and changes over the decades (Andrews et al., 2010; APA, 1980, 1987, 1994; Kessler, 2000).”
BackgroundMenta, C., Bisol, L. W., Nogueira, E. L., Engroff, P., & Neto, A. C. (2020) · Jornal Brasileiro de Psiquiatria · doi:10.1590/0047-2085000000267 · Cited by 27 · see citing works
Orgilés, M., Fernández‐Martínez, I., Espada, J. P., & Morales, A. (2019) · Anxiety Stress & Coping · doi:10.1080/10615806.2019.1645836 · Cited by 27 · see citing works
“Since this condition is characterized by excessive worry and anxiety in a wide range of situations (Andrews et al., 2010), it is possible that the children did not generalize learning during the program to the diverse anxiety-provoking events that may have arisen during the one-year period.”
BackgroundDemertzis, K. H., & Craske, M. G. (2006) · Springer eBooks · doi:10.1007/978-0-387-28370-8_30 · Cited by 27 · see citing works
Self-citationAlimehdi, M., Ehteshamzadeh, P., Naderi, F., Eftekharsaadi, Z., & Pasha, R. (2016) · Asian Social Science · doi:10.5539/ass.v12n4p179 · Cited by 25 · see citing works
“This component resorts to avoidance strategy to reduce temporary worry and preserve the anxiety (Andrews et al., 2010).”
BackgroundButnorienė, J., Steiblienė, V., Saudargienė, A., & Bunevičius, A. (2018) · BMC Psychiatry · doi:10.1186/s12888-017-1576-8 · Cited by 26 · see citing works
“Untreated GAD causes extreme distress, severe functional impairment [11, 12] significant economic costs [10], and is independently associated with elevated suicide risk [13, 14].”
BackgroundKircanski, K., Waugh, C. E., Camacho, M. C., & Gotlib, I. H. (2016) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-015-9493-y · Cited by 26 · see citing works
“DSM-IV-TR contains a hierarchical exclusion criterion in which GAD caseness cannot be met when the syndrome occurs only in the context of MDD; however, because the epidemiological and experimental literature and a DSM-5 work group have indicated that there is little utility and potentially significant problems associa…”
Milkins, B., Notebaert, L., MacLeod, C., & Clarke, P. (2016) · Clinical Psychological Science · doi:10.1177/2167702615626898 · Cited by 20 · see citing works
Factors That Influence the Diagnoses of Asian Americans in Mental Health: An Exploration
Kwok, J. (2013) · Perspectives In Psychiatric Care · doi:10.1111/ppc.12017 · Cited by 25 · see citing works
The Effect of the Draft DSM-5 Criteria for GAD on Prevalence and Severity
Andrews, G., & Hobbs, M. J. (2010) · Australian & New Zealand Journal of Psychiatry · doi:10.3109/00048671003781798 · Cited by 25 · see citing works
Self-citationThe role of family relationships in the psychological wellbeing of interracially dating adolescents
Tillman, K. H., & Miller, B. (2016) · Social Science Research · doi:10.1016/j.ssresearch.2016.11.001 · Cited by 25 · see citing works
“68) (Andrews et al. 2010), with each item ranging from 0 (never) to 4 (every day).”
Yang, T. Y., Jang, E. Y., Ryu, Y., Lee, G. W., Lee, E.-B., Chang, S., Lee, J. H., Koo, J. S., Yang, C. H., & Kim, H. Y. (2017) · BMC Complementary and Alternative Medicine · doi:10.1186/s12906-017-2039-y · Cited by 25 · see citing works
Toward Linguistic Recognition of Generalized Anxiety Disorder
Rook, L., Mazza, M. C., Lefter, I., & Brazier, F. M. T. (2022) · Frontiers in Digital Health · doi:10.3389/fdgth.2022.779039 · Cited by 24 · see citing works
“This is theoretically in line with behavioral avoidance models of worry and GAD (5, 7, 8, 11, 26).”
InfluentialVasey, M. W., Chriki, L. S., & Toh, G. Y. (2016) · Cognitive Therapy and Research · doi:10.1007/s10608-016-9809-6 · Cited by 24 · see citing works
“4 The duration criterion has been called into question (e.g., see Andrews et al. 2010).”
BackgroundReliability and validity of DSM-IV generalized anxiety disorder features
Gordon, D., & Heimberg, R. G. (2011) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2011.04.001 · Cited by 24 · see citing works
Self-citation(2022) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9780890425787.x05_anxiety_disorders · Cited by 24 · see citing works
Boyes, M. E., Carmody, T. M., Clarke, P., & Hasking, P. A. (2016) · Personality and Individual Differences · doi:10.1016/j.paid.2016.09.025 · Cited by 23 · see citing works
“panic disorder; Fava & Morton, 2009) and that perseveration may be more strongly associated with disorders characterised by more enduring anxiety symptoms (e.g. generalised anxiety disorder; Andrews et al., 2010).”
BackgroundSomatosensory amplification, health anxiety, and alexithymia in generalized anxiety disorder
Grover, S., Kumar, V., & Avasthi, A. (2018) · Industrial Psychiatry Journal · doi:10.4103/ipj.ipj_72_17 · Cited by 23 · see citing works
“there was a recommendation to name it as generalized worry disorder that would have undermined the importance of somatic symptoms.[7]”
BackgroundShrestha, S., Ramos, K., Fletcher, T. L., Kraus-Schuman, C. A., Stanley, M. A., Ramsey, D. J., & Amspoker, A. B. (2019) · Aging & Mental Health · doi:10.1080/13607863.2018.1544217 · Cited by 23 · see citing works
“GAD consists of persistent, difficult-to-control intrusive worry (Andrews et al., 2010) and is associated with increased disability (Brenes et al., 2005), poor quality of life (Porensky et al., 2009; Wetherell et al., 2004), memory difficulties (Mantella et al., 2007) and increased service use…”
BackgroundSelf-citationContent-specific interpretation biases in clinically anxious children
Klein, A. M., Rapee, R. M., Hudson, J. L., Morris, T. M., Schneider, S. C., Schniering, C. A., Becker, E. S., & Rinck, M. (2019) · Behaviour Research and Therapy · doi:10.1016/j.brat.2019.103452 · Cited by 23 · see citing works
Self-citationvan der Heiden, C., Methorst, G., Muris, P., & van der Molen, H. T. (2010) · Journal of Clinical Psychology · doi:10.1002/jclp.20743 · Cited by 23 · see citing works
“In the meantime, if the excessiveness criterion would be omitted from the GAD definition in DSM-V, the classification would identify a milder form of the disorder, and the prevalence of the disorder would increase substantially (Andrews et al., 2010).”
BackgroundInfluentialFranklin, A. R., Mathersul, D. C., Raine, A., & Ruscio, A. M. (2020) · Behavior Therapy · doi:10.1016/j.beth.2020.09.004 · Cited by 22 · see citing works
“However, while autonomic measures may be well suited for disorders in which fear and alterations in the fear response play a central role (Grillon et al., 2009), they may be a poorer match for disorders marked by worry and “ anxious expectation ” (Andrews et al., 2010).”
Self-citationPharmacology of GABA and Its Receptors
Kaur, S., Singh, S., Arora, A., Ram, P., Kumar, S., Kumar, P., & Abed, S. N. (2020) · Springer eBooks · doi:10.1007/978-981-15-3556-7_8 · Cited by 23 · see citing works
Panic Disorder and Agoraphobia in OCD patients: Clinical profile and possible treatment implications
Torres, A. R., Ferrão, Y. A., Shavitt, R. G., Diniz, J. B., Costa, D. L. C., do Rosário, M. C., Miguel, E. C., & Fontenelle, L. F. (2013) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2013.11.017 · Cited by 22 · see citing works
“However, by displaying PD, a condition that is frequently associated with concerns about the implications of additional panic attacks, patients with PD may also be more prone towards exhibiting disorders characterized by excessive preoccupations or worries, such as GAD [72] and PTSD [73] which, by the way, may also in…”
BackgroundReliability and validity of the dimensional features of generalized anxiety disorder
Rutter, L. A., & Brown, T. A. (2014) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2014.10.003 · Cited by 22 · see citing works
“Some researchers (e.g., Andrews et al., 2010) have suggested that the excessiveness and uncontrollability criteria are redundant due to their conceptual similarity and strong association (e.g., r = .91; Brown et al., 2001).”
BackgroundMahoney, A., Hobbs, M. J., Newby, J. M., Williams, A. D., & Andrews, G. (2018) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465818000127 · Cited by 22 · see citing works
“Although behavioural symptoms are included in other anxiety diagnostic categories (e.g. social anxiety disorder, panic disorder, and agoraphobia) and were proposed for the DSM-5 GAD classification (Andrews et al., 2010), the relevance of maladaptive behaviours to the disorder is unclear.”
BackgroundMethodResultInfluentialSelf-citationMahoney, A., Hobbs, M. J., Newby, J. M., Williams, A. D., & Andrews, G. (2017) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465817000455 · Cited by 22 · see citing works
“Behaviors are used to classify most of the other anxiety disorders in DSM-5 and were proposed for the DSM-5 classification of GAD (Andrews et al., 2010; APA, 2013).”
MethodSelf-citationThe impact of generalized anxiety disorder in obsessive-compulsive disorder patients.
Sharma, P. R., do Rosário, M. C., Ferrão, Y. A., Albertella, L., Miguel, E. C., & Fontenelle, L. F. (2021) · Psychiatry Research · doi:10.1016/j.psychres.2021.113898 · Cited by 21 · see citing works
Classroom stress promotes motivated forgetting of mathematics knowledge.
Ramirez, G., McDonough, I. M., & Ling, J. (2017) · Journal of Educational Psychology · doi:10.1037/edu0000170 · Cited by 21 · see citing works
Association of worry about cancer to benefit finding and functioning in long-term cancer survivors
Jones, S. M. W., Ziebell, R. A., Walker, R. L., Nekhlyudov, L., Rabin, B. A., Nutt, S., Fujii, M., & Chubak, J. (2016) · Supportive Care in Cancer · doi:10.1007/s00520-016-3537-z · Cited by 22 · see citing works
SPECIFYING CHILD ANXIETY DISORDERS NOT OTHERWISE SPECIFIED IN THE DSM-IV
Comer, J. S., Gallo, K. P., Korathu-Larson, P. A., Pincus, D. B., & Brown, T. A. (2012) · Depression and Anxiety · doi:10.1002/da.21981 · Cited by 20 · see citing works
“Research conducted with adult samples has suggested there may be diagnostic utility in retaining the multiple domains and more days than not worry criteria, but relaxing the 6-month duration criteria in DSM-5.”
BackgroundThe increase in interest in GAD: Commentary on Asmundson & Asmundson
Newman, M. G., & Przeworski, A. (2018) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2018.04.006 · Cited by 19 · see citing works
“Andrews et al. (2010) suggested that the duration criterion should be reduced to 3 months and the criterion of worry being difficult to control should be deleted because it overlapped with the criterion that worry be excessive.”
Background
- Authors
- Andrews, G., Hobbs, M. J., Borkovec, T. D., Beesdo, K., Craske, M. G., Heimberg, R. G., Rapee, R. M., Ruscio, A. M., & Stanley, M. A.
- Affiliations
- UNSW Sydney (AU)
- Pennsylvania State University (US)
- University of California, Los Angeles (US)
- Temple University (US)
- Macquarie University (AU)
- University of Pennsylvania (US)
- Baylor College of Medicine (US)
- Corresponding author
- Andrews, Gavin
- ORCID
- Venue
- Depression and Anxiety
- Publisher
- Hindawi Limited
- Published
- 2010-02
- Volume
- 27
- Issue
- 2
- Pages
- 134-147
- ISSN
- 1091-4269 (ISSN-L)
- 1520-6394
- OpenAlex
- W2109019333
- Cited by
- 273
- References
- 125
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 19 · 2023: 13 · 2022: 11 · 2021: 15 · 2020: 12 · 2019: 10 · 2018: 16 · 2017: 25 · 2016: 28 · 2015: 15 · 2014: 24 · 2013: 18 · 2012: 24
- FWCI
- 2.79
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Depression and Anxiety (publishedVersion)
- PubMed (publishedVersion)
- RUNE (Research UNE) (submittedVersion)
- Funders
- Medical Research Council
- National Health and Medical Research Council (510137)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- generalized anxiety disorder, DSM-V, DSM-IV diagnostic criteria, diagnostic classification, overanxious disorder, excessive worry, avoidance behavior, inter-rater reliability, diagnostic validity
- MeSH terms
- Anxiety Disorders, Diagnosis, Differential, Humans, Diagnostic and Statistical Manual of Mental Disorders
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