The nature of generalized anxiety disorder and pathological worry: Current evidence and conceptual models

Canadian Journal of Psychiatry

Volumn 42, Issue 8, 1997, Pages 817-825

  Brown, Timothy A ^a  

^a BOSTON UNIVERSITY   (United States)

Author keywords

Autonomic suppression; Depression; Generalized anxiety disorder; Negative affect; Pathogenesis of emotional disorders; Pathological worry

Indexed keywords

AFFECTIVE NEUROSIS; ANXIETY NEUROSIS; AUTONOMIC NERVOUS SYSTEM; COMORBIDITY; DEPRESSION; HUMAN; PSYCHIATRIC DIAGNOSIS; REVIEW; SYMPTOMATOLOGY;

EID: 0030726399     PISSN: 07067437     EISSN: None     Source Type: Journal    
DOI: 10.1177/070674379704200803     Document Type: Review

References (86)

1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington (DC): American Psychiatric Association; 1994.
2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed. Revised. Washington (DC): American Psychiatric Association; 1987.
3. Wittchen HU, Zhao S, Kessler RC, Eaves WW. DSM-III-R generalized anxiety disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1994;51:355-64.
4. Blazer DG, George LK, Hughes D. The epidemiology of anxiety disorders: an age comparison. In: Salzman C, Lebowitz BD, editors. Anxiety disorders in the elderly. New York: Free Press; 1991. p 180-203.
5. Beck JG, Stanley MA, Zebb BJ. Characteristics of generalized anxiety disorder in older adults: a descriptive study. Behav Res Ther 1996;34:225-34.
6. Wisocki PA. The experience of worry in the elderly. In: Davey GCL, Tallis F, editors. Worrying: perspectives on theory, assessment, and treatment. London: J Wiley; 1994. p 247-61.
7. Flint AJ. Epidemiology and comorbidity of anxiety disorders in the elderly. Am J Psychiatry 1994;15:640-9.
8. Himmelfarb S, Murrell SA. The prevalence and correlation of anxiety symptoms in older adults. Journal of Psychiatry 1984;116:159-67.
9. Anderson DJ, Noyes R, Crowe RR. A comparison of panic disorder and generalized anxiety disorder. Am J Psychiatry 1984;141:572-5.
10. Barlow DH, Blanchard EB, Vermilyea JA, Vermilyea BB, Di Nardo PA. Generalized anxiety and generalized anxiety disorder: description and reconceptualization. Am J Psychiatry 1986;143:40-4.
11. Cameron OG, Thyer BA, Nesse RM, Curtis GC. Symptom profiles of patients with DSM-III anxiety disorders. Am J Psychiatry 1986;143:1132-7.
12. Noyes R, Clarkson C, Crowe RR, Yates WR, McChesney CM. A family study of generalized anxiety disorder. Am J Psychiatry 1987;144:1019-24.
13. Noyes R, Woodman C, Garvey MJ, Cook BL, Suelzer M, Clancy J, and others. Generalized anxiety disorder vs. panic disorder: distinguishing characteristics and patterns of comorbidity. J Nerv Ment Dis 1992;180:369-79.
14. Rapee RM. The distinction between panic disorder and generalized anxiety disorder: clinical presentation. Aust N Z J Psychiatry 1985;19:227-32.
15. Sanderson WC, Barlow DH. A description of patients diagnosed with DSM-III-R generalized anxiety disorder. J Nerv Ment Dis 1990;178:588-91.
16. Blazer DG, Hughes D, George LK. Stressful life events and the onset of the generalized anxiety disorder syndrome. Am J Psychiatry 1987;144:1178-83.
17. Ganzini L, McFarland BH, Cutler D. Prevalence of mental disorders after catastrophic financial loss. J Nerv Ment Dis 1990;178:680-5.
18. Hoehn-Saric R, Hazlett RL, McLeod DR. Generalized anxiety disorder with early and late onset of anxiety symptoms. Compr Psychiatry 1993;34:291-8.
19. Sanderson WC, Wetzler S. Chronic anxiety and generalized anxiety disorder: issues in comorbidity. In: Rapee RM, Barlow DH, editors. Chronic anxiety: generalized anxiety disorder, and mixed anxiety depression. New York: Guilford; 1991. p 119-35.
20. Shores MM, Glubin T, Cowley DS, Dager SR, Roy-Byrne PP, Dunner DL. The relationship between anxiety and depression: a clinical comparison of generalized anxiety disorder dysthymic disorder, panic disorder, and major depressive disorder. Compr Psychiatry 1992;33:237-44.
21. Brawman-Mintzer O, Lydiard RB, Emmanuel N, Payeur R, Johnson M, Roberts J, and others. Psychiatric comorbidity in patients with generalized anxiety disorder. Am J Psychiatry 1993;150:1216-8.
22. Brown TA, Barlow DH. Comorbidity among anxiety disorders: implications for treatment and DSM-IV. J Consult Clin Psychol 1992;60:835-44.
23. Massion AO, Warshaw MG, Keller MB. Quality of life and psychiatric morbidity in panic disorder and generalized anxiety disorder. Am J Psychiatry 1993;150:600-7.
24. Sanderson WC, Beck AT, Beck J. Syndrome comorbidity in patients with major depression or dysthymia: prevalence and temporal relationships. Am J Psychiatry 1990;147:1025-8.
25. Blanchard EB, Scharff L, Schwarz SP, Suls JM, Barlow DH. The role of anxiety and depression in the irritable bowel syndrome. Behav Res Ther 1990;28:401-5.
26. Di Nardo PA, Moras K, Barlow DH, Rapee RM, Brown TA. Reliability of DSM-III-R anxiety disorder categories using the Anxiety Disorders Interview Schedule-Revised (ADIS-R). Arch Gen Psychiatry 1993;50:251-6.
27. Mannuzza S, Fyer AJ, Martin LY, Gallops MS, Endicott J, Gorman JM, and others. Reliability of anxiety assessment, I: diagnostic agreement. Arch Gen Psychiatry 1989;46:1093-101.
28. Williams JBW, Gibbon M, First MB, Spitzer RL, Davies M, Borus J, and others. The Structured Clinical Interview for DSM-III-R (SCID), II: multisite test-retest reliability. Arch Gen Psychiatry 1992;49:630-6
29. Brown TA, Antony MM, Barlow DH. Diagnostic comorbidity in panic disorder: effect on treatment outcome and course of comorbid diagnoses following treatment. J Consult Clin Psychol 1995;63:408-18.
30. Barlow DH. Anxiety and its disorders: the nature and treatment of anxiety and panic. New York: Guilford; 1988.
31. Brown TA, Barlow DH, Liebowitz MR. The empirical basis of generalized anxiety disorder. Am J Psychiatry 1994;151:1272-80.
32. Borkovec TD. The nature, functions, and origins of worry. In: Davey GCL, Tallis F, editors. Worrying: perspectives on theory, assessment, and treatment. New York: J Wiley; 1994. p 5-33.
33. Borkovec TD, Shadick R, Hopkins M. The nature of normal and pathological worry. In: Rapee RM, Barlow DH, editors. Chronic anxiety: generalized anxiety disorder, and mixed anxiety depression. New York: Guilford; 1991. p 29-51.
34. Craske MG, Rapee RM, Jackel L, Barlow DH. Qualitative dimensions of worry in DSM-III-R generalized anxiety disorder subjects and nonanxious controls. Behav Res Ther 1989;27:189-98.
35. Abel JL, Borkovec TD. Generalizability of DSM-III-R generalized anxiety disorder to proposed DSM-IV criteria and cross-validation of proposed changes. Journal of Anxiety Disorders 1995;9:303-15.
36. Brown TA, Antony MM, Barlow DH. Psychometric properties of the Penn State Worry Questionnaire in a clinical anxiety disorders sample. Behav Res Ther 1992;30:33-7.
37. Brown TA, Moras K, Zinbarg RE, Barlow DH. Diagnostic and symptom distinguishability of generalized anxiety disorder and obsessive-compulsive disorder. Behav Ther 1993;24:227-40.
38. Meyer TJ, Miller ML, Metzger RL, Borkovec TD. Development and validation of the Penn State Worry Questionnaire. Behav Res Ther 1990;28:487-95.
39. Turner SM, Beidel DC, Stanley MA. Are obsessional thoughts and worry different cognitive phenomena? Clin Psychol Rev 1992;12:257-70.
40. Brawman-Mintzer O, Lydiard RB, Crawford MM, Emmanuel N, Payeur R, Johnson M, and others. Somatic symptoms in generalized anxiety disorder with and without comorbid psychiatric disorders. Am J Psychiatry 1994;151:930-2.
41. Marten PA, Brown TA, Barlow DH, Borkovec TD, Shear MK, Lydiard RB. Evaluation of the ratings comprising the associated symptom criterion of DSM-III-R generalized anxiety disorder. J Nerv Ment Dis 1993;181:676-82.
42. Brown TA, Marten PA, Barlow DH. Discriminant validity of the symptoms constituting the DSM-III-R and DSM-IV associated symptom criterion of generalized anxiety disorder. Journal of Anxiety Disorders 1995;9:317-28.
43. Hazlett RL, McLeod DR, Hoehn-Saric R. Muscle tension in generalized anxiety disorder: elevated muscle tonus or agitated movement? Psychophysiology 1994;31:189-95.
44. Hoehn-Saric R, McLeod DR, Zimmerli WD. Somatic manifestations in women with generalized anxiety disorder: psychophysiological responses to psychological stress. Arch Gen Psychiatry 1989;46:1113-9.
45. Hoehn-Saric R, McLeod DR. The peripheral sympathetic nervous system: its role in normal and pathological worry. Psychiatr Clin North Am 1988;11:375-86.
46. Borkovec TD, Robinson E, Pruzinsky T, DePree JA. Preliminary exploration of worry: some characteristics and processes. Behav Res Ther 1983;21:9-16.
47. Borkovec TD, Hu S. The effect of worry on cardiovascular response to phobic imagery. Behav Res Ther 1990;28:69-73.
48. Borkovec TD, Lyonfields JD, Wiser SL, Diehl L. The role of worrisome thinking in the suppression of cardiovascular response to phobic imagery. Behav Res Ther 1993;31:321-4.
49. Lyonfields JD, Borkovec TD, Thayer JF. Vagal tone in generalized anxiety disorder and the effects of aversive imagery and worrisome thinking. Behav Ther 1995;26:457-66.
50. Starcevic V. Pathological worry in major depression: a preliminary report. Behav Res Ther 1995;33:55-6.
51. Clark LA, Watson D. Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications. J Abnorm Psychol 1991;100:316-36.
52. Clark LA, Watson D, Mineka S. Temperament, personality, and the mood and anxiety disorders. J Abnorm Psychol 1994;103:103-16.
53. Costa PT, McCrae RR. Personality in adulthood: a six-year longitudinal study of self-reports and spouse ratings on the NEO Personality Inventory. J Pers Soc Psychol 1988;54:853-63.
54. Tellegen A, Lykken DT, Bouchard TJ, Wilcox KJ, Segal NL, Rich S. Personality similarity in twins reared apart and together. J Pers Soc Psychol 1988;54:1031-9.
55. Watson D, Clark LA. Negative affectivity: the disposition to experience aversive emotional states. Psychol Bull 1984;96:465-90.
56. Brown TA, Chorpita BF, Barlow DH. Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal. J Abnorm Psychol. Forthcoming.
57. Clark DA, Steer RA, Beck AT. Common and specific dimensions of self-reported anxiety and depression: implications for the cognitive and tripartite models. J Abnorm Psychol 1994;103:645-54.
58. Joiner TE, Catanzaro SJ, Laurent J. Tripartite structure of positive and negative affect, depression, and anxiety in child and adolescent psychiatric inpatients. J Abnorm Psychol 1996;105:401-9.
59. Watson D, Clark LA, Weber K, Assenheimer JS, Strauss ME, McCormick RA. Testing a tripartite model, II: exploring the symptom structure of anxiety and depression in student, adult, and patient samples. J Abnorm Psychol 1995;104:15-25.
60. Clark DA, Beck AT, Beck JS. Symptom differences in major depression, dysthymia, panic disorder, and generalized anxiety disorder. Am J Psychiatry 1994;151:205-9.
61. Zinbarg RE, Barlow DH. Structure of anxiety and anxiety disorders: a hierarchical model. J Abnorm Psychol 1996;105:181-93
62. Rapee RM. Generalized anxiety disorder: a review of clinical features and theoretical concepts. Clin Psychol Rev 1991;11:419-40.
63. Clark DM. A cognitive approach to panic. Behav Res Ther 1986;24:461-70.
64. Garvey MJ, Cook B, Noyes R. The occurrence of a prodrome of generalized anxiety in panic disorder. Compr Psychiatry 1988;29:445-9.
65. Nisita C, Petracca A, Akiskal HS, Galli L, Gepponi I, Cassano GB. Delimitation of generalized anxiety disorder: clinical comparisons with panic and major depressive disorders. Compr Psychiatry 1990;31:409-15.
66. Cowley DS, Roy-Byrne PP. The biology of generalized anxiety disorder and chronic anxiety. In: Rapee RM, Barlow DH, editors. Chronic anxiety: generalized anxiety disorder, and mixed anxiety depression. New York: Guilford; 1991. p 52-75.
67. Gray JS. The neuropsychology of anxiety. New York: Oxford University Press; 1992.
68. Andrews G, Stewart G, Allen R, Henderson AS. The genetics of six neurotic disorders: a twin study. J Affect Disord 1990;19:23-9.
69. Torgersen S. Genetic factors in anxiety disorders. Arch Gen Psychiatry 1983;40:1085-9.
70. Kendler KS, Neale MC, Kessler RC, Heath AC, Eaves LJ. Generalized anxiety disorder in women: a population-based twin study. Arch Gen Psychiatry 1992;49:267-72.
71. Kendler KS, Neale MC, Kessler RC, Heath AC, Eaves LJ. Major depression and generalized anxiety disorder: same genes, (partly) different environments? Arch Gen Psychiatry 1992;49:716-22.
72. Kendler KS, Walters EE, Neale MC, Kessler RC, Heath AC, Eaves LJ. The structure of the genetic and environmental risk factors for six major psychiatric disorders in women: phobia, generalized anxiety disorder, panic disorder, bulimia, major depression, and alcoholism. Arch Gen Psychiatry 1995;52:374-83.
73. Roy MA, Neale MC, Pedersen NL, Mathé AA, Kendler KS. A twin study of generalized anxiety disorder and major depression. Psychol Med 1995;25:1037-40.
74. Skre I, Onstad S, Torgersen S, Lygren S, Kringlen E. A twin study of DSM-III-R anxiety disorders. Acta Psychiatr Scand 1993;88:85-92.
75. Alloy LB, Kelly KA, Mineka S, Clements CM. Comorbidity of anxiety and depressive disorders: a helplessness-hopelessness perspective. In: Maser JD, Cloninger CR, editors. Comorbidity of mood and anxiety disorders. Washington (DC): American Psychiatric Press; 1990. p 499-543.
76. Borkovec TD, Inz J. The nature of worry in generalized anxiety disorder: a predominance of thought activity. Behav Res Ther 1990;28:153-8.
77. Carter WR, Johnson MC, Borkovec TD. Worry: an electrocortical analysis. Adv Behav Res Ther 1986;8:193-204.
78. Tucker DM. Lateral brain function, emotion, and conceptualization. Psychol Bull 1981;87:380-3.
79. Mathews A. Why worry? the cognitive function of anxiety. Behav Res Ther 1990;28:455-68.
80. Foa EB, Kozak MJ. Emotional processing of fear: exposure to corrective information. Psychol Bull 1986;99:20-35.
81. Clark DA, de Silva P. The nature of depressive and anxious intrusive thoughts: distinct or uniform phenomena? Behav Res Ther 1985;23:383-93.
82. Parkinson L, Rachman S. The nature of intrusive thoughts. Adv Behav Res Ther 1981;3:101-10.
83. Butler G, Wells A, Dewick H. Differential effects of worry and imagery after exposure to a stressful stimulus: a pilot study. Behavioural and Cognitive Psychotherapy 1995;23:44-55.
84. Brown TA, Chorpita BF. Reply to Andrews: on the validity and comorbidity of the DSM-III-R and DSM-IV anxiety disorders. In: Rapee RM, editor. Current controversies in the anxiety disorders. New York: Guilford; 1996. p 48-52.
85. Costello CG. Research on symptoms versus research on syndromes: arguments in favour of allocating more research time to the study of symptoms. Br J Psychiatry 1992;60:304-8.
86. Livesley WJ, Schroeder ML, Jackson DN, Jang KL. Categorical distinctions in the study of personality disorder: implications for classification. J Abnorm Psychol 1994;103:6-17.