Generalized anxiety disorder: Clinical presentation, diagnostic features, and guidelines for clinical practice

Journal of Clinical Psychology

Volumn 67, Issue 1, 2011, Pages 58-73

  Van Der Heiden, Colin ^a   Methorst, Gerda ^a   Muris, Peter ^b   Van Der Molen, Henk T ^b  

^a PsyQ Rijnmond ^*  (Netherlands)

^b ERASMUS UNIVERSITY ROTTERDAM   (Netherlands)

Author keywords

Diagnostic guidelines; Generalized anxiety disorder; Symptomatology; Worrying

Indexed keywords

ANXIETY DISORDER; ARTICLE; DIFFERENTIAL DIAGNOSIS; HUMAN; MENTAL HEALTH SERVICE; PATHOPHYSIOLOGY; PRACTICE GUIDELINE;

ANXIETY DISORDERS; DIAGNOSIS, DIFFERENTIAL; GUIDELINES AS TOPIC; HUMANS; MENTAL HEALTH SERVICES;

EID: 78650039794     PISSN: 00219762     EISSN: 10974679     Source Type: Journal    
DOI: 10.1002/jclp.20743     Document Type: Article

References (97)

1. Aikins, D.E., & Craske, M.G. (2001). Cognitive theories of generalized anxiety disorder. The Psychiatric Clinics of North America, 24, 57-74.
2. Altamura, A.C., Dell'Osso, B., D'Urso, N., Russo, M., Fumagalli, S., & Mundo, E. (2008). Duration of untreated illness as a predictor of treatment response and clinical course in generalized anxiety disorder. CNS Spectrums, 13, 415-422.
3. American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: APA.
4. American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd rev. ed.). Washington, DC: APA.
5. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: APA.
6. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, (4th ed. text rev.). Washington, DC: APA.
7. Andrews, G. (1996). Comorbidity in neurotic disorders: The similarities are more important than the differences. In R.M. Rapee (Ed.), Current controversies in the anxiety disorders (pp. 3-20). New York: Guilford Press.
8. Andrews, G., Hobbs, M.J., Borkovec, T.D., Beesdo, K., Craske, M.G., Heimberg, R.G., et al. (2010). Generalized worry disorder: A review of DSM-IV generalized anxiety disorder and options for DSM-V. Depression and Anxiety, 27, 134-147.
9. Angst, J., Gamma, A., Baldwin, D.S., Ajdacic-Gross, V., & Rössler, W. (2006). The generalized anxiety spectrum: Prevalence, onset, course and outcome. European Archives of Psychiatry and Clinical Neuroscience, 259, 37-45.
10. Ballenger, J.C., Davidson, J.R., Lecrubier, Y., Nutt, D.J., Borkovec, T.D., Rickels, K., et al. (2001). Consensus statement on generalized anxiety disorder from the International Consensus Group on Depression and Anxiety. Journal of Clinical Psychiatry, 62, 53-58.
11. Barlow, D.H. (2002). Anxiety and its disorders: The nature and treatment of anxiety and panic (2nd ed.). New York: The Guilford Press.
12. Beesdo, K., Hoyer, J., Jacobi, F., Low, N.C.P., Höfler, M., & Wittchen, H.-U. (2009). Association between generalized anxiety levels and pain in a community sample: Evidence for diagnostic specificity. Journal of Anxiety Disorders, 23, 684-693.
13. Bienvenu, O.J., Nestadt, G., & Eaton, W. (1998). Characterizing generalized anxiety: Temporal and symptomatic tresholds. Journal of Nervous and Mental Disease, 186, 51-56.
14. Borkovec, T.D. (1994). The nature, functions and origins of worry. In G.C.L. Davey & F. Tallis (Eds.), Worrying: Perspectives on theory, assessment and treatment (pp. 5-33). Chichester, UK: Wiley.
15. Borkovec, T.D. (2002). Life in the future versus life in the present. Clinical Psychology: Science and Practice, 9, 76-80.
16. Borkovec, T.D., Abel, J.L., & Newman, H. (1995). The effects of therapy on comorbid conditions in generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 63, 479-483.
17. Borkovec, T.D., Alcaine, O.M., & Behar, E. (2004). Avoidance theory of worry and generalized anxiety disorder. In R.G. Heimberg, C.L. Turk, & D.S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 77-108). New York/London: The Guilford Press.
18. Borkovec, T.D., Hazlett-Stevens, H., & Diaz, M.L. (1999). The role of positive beliefs about worry in generalized anxiety disorder and its treatment. Clinical Psychology and Psychotherapy, 6, 126-138.
19. Borkovec, T.D., & Hu, S. (1990). The effect of worry on cardiovascular response to phobic imagery. Behaviour Research and Therapy, 28, 69-73.
20. Borkovec, T.D., & Inz, J. (1990). The nature of worry in generalised anxiety disorder: A predominance of thought activity. Behaviour Research and Therapy, 28, 153-158.
21. Borkovec, T.D., Robinson, E., Pruzinsky, T., & DePree, J.A. (1983). Preliminary exploration of worry: Some characteristics and processes. Behaviour Research and Therapy, 21, 9-16.
22. Bouman, T.K., & Meijer, K.J. (1999). A preliminary study of worry and metacognitions in hypochondriasis. Clinical Psychology and Psychotherapy, 6, 96-101.
23. Brawman-Mintzer, O., Monnier, J., Wolitzky, K.B., & Falsetti, S.A. (2005). Patients with generalized anxiety disorder and a history of trauma: Somatic symptom endorsement. Journal of Psychiatric Practice, 11, 212-215.
24. Brown, T.A., & Barlow, D.H. (2005) Toward a dimensionally based taxonomy of psychopathology: Dimensional versus categorical classification of mental disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and beyond. Journal of Abnormal Psychology, 114, 551-556.
25. Brown, T.A., DiNardo, P.A., & Barlow, D.H. (1994). Anxiety disorders interview schedule for DSM-IV (ADIS-IV). Albany, NY: Graywind.
26. Brown, T.A., DiNardo, P.A., Lehman, C.L., & Campbell, L.A. (2001). Reliability of DSM-IV anxiety and mood disorders: Implications for classification of emotional disorders. Journal of Abnormal Psychology, 110, 49-58.
27. Bruce, S.E., Machan, J.T., Dyck, I., & Keller, M.B. (2001). Infrequency of "pure" GAD: Impact of psychiatric comorbidity on clinical course. Depression and Anxiety, 14, 219-225.
28. Bruce, S.E., Yonkers, K.A., Otto, M.W., Eisen, J.L., Weisberg, R.B., Pagano, M., et al. (2005). Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: A 12-year prospective study. American Journal of Psychiatry, 162, 1179-1187.
29. Carter, R.M., Wittchen, H.-U., Pfister, H., & Kessler, R.C. (2001). One-year prevalence of subthreshold and threshold DSM-IV generalized anxiety disorder in a nationally representative sample. Depression and Anxiety, 13, 78-88.
30. Coleman, S., Pietrefesa, A., Hollaway, R.M., Coles, M.E., & Heimberg, R.G. (2009). Content and mechanisms of checking related to symptoms of obsessive compulsive disorder and generalized anxiety disorder. Manuscript submitted for publication.
31. Craske, M., Rapee, R., Jackel, L., & Barlow, D. (1989). Qualitative dimensions of worry in DSM-III-R generalized anxiety disorder subjects and nonanxious controls. Behaviour Research and Therapy, 27, 397-402.
32. Culpepper, L. (2002). Generalized anxiety disorder in primary care: Emerging issues in management and treatment. Journal of Clinical Psychiatry, 63(suppl 8), 35-42.
33. Davis, R.N., & Valentiner, D.P. (2000). Does meta-cognitive theory enhance our understanding of pathological worry and anxiety? Personality and Individual Differences, 29, 513-526.
34. Dugas, M.J., & Robichaud, M. (2007). Cognitive-behavioral treatment for generalized anxiety disorder: From science to practice. New York/London: Routledge.
35. First, M.B., Spitzer, R.L., Gibbon, M., & Williams, J.B.W. (2001). Structured clinical interview for DSM-IV-TR Axis-I disorders, research version (patient ed.). New York: Biometrics Research Department, New York State Psychiatric Institute.
36. Fisher, P.L. (2006). The efficacy of psychological treatments for generalised anxiety disorder? In G.C.L. Davey & A. Wells (Eds.), Worry and its psychological disorders: Theory, assessment and treatment (pp. 359-378). Chichester: Wiley.
37. Freeston, M.H., Dugas, M.J., & Ladouceur, R. (1996). Thoughts, images, worry, and anxiety. Cognitive Therapy and Research, 20, 265-273.
38. Ghafoori, B., Neria, Y., Gameroff, M.J., Olfson, M., Lantigua, R., Shea, S., et al. (2009). Screening for generalized anxiety disorder symptoms in the wake of terrorist attacks: A study in primary care. Journal of Traumatic Stress, 22, 218-226.
39. Goodwin, R.D., & Gorman, J.M. (2002). Psychopharmacologic treatment of generalized anxiety disorders and the risk of major depression. American Journal of Psychiatry, 159, 1935-1937.
40. Harvey, A.G. (2000). Pre-sleep cognitive activity: A comparison of sleep-onset insomniacs and good sleepers. British Journal of Clinical Psychology, 39, 275-286.
41. Harvey, A.G. (2001). I can't sleep, my mind is racing! An investigation of strategies of thought control in insomnia. Behavioural and Cognitive Psychotherapy, 29, 3-12.
42. Harvey, A.G., Watkins, E., Mansell, W., & Shafran, R. (2004). Cognitive behavioural processes across psychological disorders: A transdiagnostic approach to research and treatment. Oxford: Oxford University Press.
43. Heimberg, R.G. (1995). Social phobia: Diagnosis, assessment and treatment. New York: Guilford.
44. Holaway, R.M., Rodebaugh, T.L., & Heimberg, R.G.M. (2006). The epidemiology of worry and generalized anxiety disorder. In G.C.L. Davey & A. Wells (Eds.), Worry and its psychological disorders: Theory, assessment and treatment (pp. 3-20). Chichester: John Wiley & Sons.
45. Hoyer, V.J., Krause, P., Hofler, M., Beesdo, K., & Wittchen, H.-U. (1998). Recognition of generalized anxiety disorder and depression and its predictors in primary care. MMW Fortschritte der Medizin, 143, 26-35.
46. Joormann, J., & Stöber, J. (1999). Somatic symptoms of generalized anxiety disorder from the DSM-IV: Associations with pathological worry and depression symptoms in a nonclinical sample. Journal of Anxiety Disorders, 13, 491-503.
47. Kendler, K.S., Neale, M.C., Kessler, R.C., Heath, A.C., & Eaves, L.J. (1992). Major depression and generalized anxiety disorder: Same genes, (partly) different environments? Archives of General Psychiatry, 49, 716-722.
48. Kessler, R.C. (2002). Evidence that generalized anxiety disorder is an independent disorder. In D. Nutt, K. Rickels, & D.J. Stein (Eds.), Generalized anxiety disorder: Symptomatology, pathogenesis and management (pp. 3-10). London: Martin Dunitz.
49. Kessler, R.C., Brandenburg, N., Lane, M., Roy-Byrne, P., Stang, P.D., Stein, D.J., et al. (2005a). Rethinking the duration requirement for generalized anxiety disorder: Evidence from the National Comorbidity Survey Replication. Psychological Medicine, 35, 1073-1082.
50. Kessler, R.C., Chiu, W.T., Demler, O., Merkikangas, K.R., & Walters, E.E. (2005b). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 617-627.
51. Kessler, D., Lloyd, K., Lewis, G., & Gray, D.P. (1999). Cross-sectional study of symptom attribution and recognition of depression and anxiety in primary care. British Medical Journal, 318, 436-439.
52. Kessler, R.C., & Wittchen, H.-U. (2002). Patterns and correlates of generalized anxiety disorder in community samples. Journal of Clinical Psychiatry, 63(suppl 8), 4-10.
53. Krueger, R.F. (1999). The structure of common mental disorders. Archives of General Psychiatry, 56, 921-926.
54. Lawrence, A.E., & Brown, T.A. (2009). Differentiating generalized anxiety disorder from anxiety disorder not otherwise specified. The Journal of Nervous and Mental Disease, 197, 879-886.
55. Lawrence, A.E., Liverant, G.I., Rosellini, A.J., & Brown, T.A. (2009). Generalized anxiety disorder within the course of major depressive disorder: Examining the utility of the DSM-IV hierarchy rule. Depression and Anxiety, 26, 909-996.
56. Lieb, R., Becker, E., & Altamura, C. (2005). The epidemiology of generalized anxiety disorder in Europe. European Neuropsychopharmacology, 15, 445-452.
57. Mennin, D.S., Heimberg, R.G., Fresco, D.M., & Ritter, M.R. (2008). Is generalized anxiety disorder an anxiety or mood disorder? Considering the multiple factors as we ponder the fate of GAD. Depression and Anxiety, 25, 289-299.
58. Newman, M.G., Przeworski, A., Fisher, A.J., & Borkovec, T.D. (2010). Diagnostic comorbidity in adults with generalized anxiety disorder: Impact of comorbidity on psychotherapy outcome and impact of psychotherapy on comorbid diagnoses. Behavior Therapy, 41, 59-72.
59. Nutt, D., Argyropoulos, S., Hood, S., & Potokar, J. (2006). Generalized anxiety disorder: A comorbid disease. European Neuropharmacology, 16, S109-S118.
60. Petersen, T., Gordon, J.A., Kant, A., Fava, M., Rosenbaum, J.F., & Nierenberg, A.A. (2001). Treatment resistant depression and Axis I co-morbidity. Psychological Medicine, 31, 1223-1229.
61. Pincus, H.A., Davis, W.W., & McQueen, L.E. (1999). "Subtreshold" mental diosrders: A review and synthesis of studies on "minor" depression and other brand names. British Journal of Psychiatry, 174, 288-296.
62. Rapee, R.M. (1993). The utilization of working memory by worry. Behaviour Research and Therapy, 31, 617-620.
63. Rapee, R.R., Craske, M.G., Brown, D.A., & Barlow, D.H. (1996). Measurement of perceived control over anxiety-related events. Behavior Therapy, 27, 279-293.
64. Rickels, K., & Rynn, M.A. (2001). What is generalized anxiety disorder? Journal of Clinical Psychiatry, 62(suppl 11), 4-12.
65. Rickels, K., Rynn, M., & Khalid-Khan, S. (2002). Diagnosis and evaluation of generalized anxiety disorder patients. In D. Nutt, K. Rickels, & D.J. Stein (Eds.), Generalized anxiety disorder: Symptomatology, pathogenesis and management (pp. 28-40). London: Martin Dunitz.
66. Roemer, L., Molina, S., Litz, B.T., & Borkovec, T.D. (1997). Preliminary investigation of the role of previous exposure to potentially traumatizing events in generalized anxiety disorder. Depression and Anxiety, 4, 134-138.
67. Roemer, L., Orsillo, S.M., & Barlow, D.H. (2002). Generalized anxiety disorder. In D.H. Barlow (Ed.), The nature and treatment of anxiety and panic (2nd ed., pp. 477-515). New York: Guilford.
68. Ruscio, A., & Borkovec, T. (2004). Experience and appraisal of worry among high worriers with and without generalized anxiety disorder. Behaviour Research and Therapy, 42, 1469-1482.
69. Ruscio, A.M., Lane, M., Roy-Byrne, P., Stang, P.E., Stein, D.J., Wittchen, H.-U., et al. (2005). Should excessive worry be required for a diagnosis of generalized anxiety disorder? Results from the US National Comorbidity Survey Replication. Psychological Medicine, 35, 1761-1772.
70. Ruscio, A.M., Chiu, W.T., Roy-Byrne, P., Stang, P.E., Stein, D.J., Wittchen, H.-U., et al. (2007). Broadening the definition of generalized anxiety disorder: Effects on prevalence and associations with other anxiety disorders in the National Comorbidity Survey Replication. Journal of Anxiety Disorders, 21, 662-676.
71. Sanderson, K., & Andrews, G. (2002). Prevalence and severity of mental-health related disability and relationship to diagnosis. Psychiatric Services, 53, 80-86.
72. Sanderson, W.C., & Barlow, D.H. (1990). A description of patients diagnosed with DSM-III-R generalized anxiety disorder. Journal of Nervous and Mental Disease, 178, 588-591.
73. Schut, A.J., Castonguay, L.G., & Borkovec, T.D. (2001). Compulsive checking behaviors in generalized anxiety disorder. Journal of Clinical Psychology, 57, 705-715.
74. Scott, M.J., & Sembi, S. (2006). Cognitive behaviour therapy treatment failures in practice: The neglected role of diagnostic inaccuracy. Behavioural and Cognitive Psychotherapy, 34, 491-495.
75. Simon, N.M. (2009). Generalized anxiety disorder and psychiatric comorbidities such as depression, bipolar disorder, and substance abuse. Journal of Clinical Psychiatry, 70(suppl 2), 10-14.
76. Stein, D.J., Walker, J.R., Hazen, A.L., & Forde, D.R. (1997). Full and partial posttraumatic stress disorder: Findings from a community survey. American Journal of Psychiatry, 154, 1114-1119.
77. Tallis, F., Davey, G., & Capuzzo, N. (1994). The phenomenology of non-pathological worry: A preliminary investigation. In G. Davey & F. Tallis (Eds.), Worrying: Perspectives on theory, assessment and treatment (pp. 61-89). Chichester: John Wiley & Sons.
78. Thayer, J.F., Friedman, B.H., Borkovec, T.D., Johnsen, B.H., & Molina, S. (2000). Phasic heart period reactions to cued threat and non-threat stimuli in generalized anxiety disorder. Psychophysiology, 37, 361-368.
79. Vollebergh, W.A.M., Iedema, J., Bijl, R.V., de Graaf, R., Smit, F., & Ormel, J. (2001). The structure and stability of common mental disorders: The NEMESIS Study. Archives of General Psychiatry, 58, 597-603.
80. Vrana, S.R., Cuthbert, B.N., & Lang, P.J. (1986). Fear imagery and text processing. Psychophysiology, 23, 247-253.
81. Watkins, E., & Baracaia, S. (2001). Rumination and social problem-solving in depression. Behaviour Research and Therapy, 40, 1179-1189.
82. Watson, D. (2005). Rethinking the mood and anxiety disorders: A quantitative hierarchical model for DSM-V. Journal of Abnormal Psychology, 114, 522-536.
83. Weiller, E., Bisserbe, J.C., Maier, W., & Lecrubier, Y. (1998). Prevalence and recognition of anxiety syndromes in five European primary care settings: A report from the WHO study on psychological problems in general health care. British Journal of Psychiatry, 173, 18-23.
84. Weisberg, R.B. (2009). Overview of generalized anxiety disorder: Epidemiology, presentation, and course. Journal of Clinical Psychiatry, 70(suppl 2), 4-9.
85. Wells, A. (1995). Metacognition and worry: A cognitive model of generalized anxiety disorder. Behavioural and Cognitive Psychotherapy, 23, 301-320.
86. Wells, A., & Hackmann, A. (1993). Imagery and core beliefs in health anxiety: Contents and origins. Behavioural and Cognitive Psychotherapy, 21, 265-273.
87. Wells, A., & Matthews, G. (1994). Attention and emotion: A clinical perspective. Hove, UK: Erlbaum.
88. Wittchen, H.-U. (2002). Generalized anxiety disorder: Prevalence, burden and cost to society. Depression and Anxiety, 16, 162-171.
89. Wittchen, H.-U., Beesdo, K., & Kessler, R.C. (2002a). The impact of generalized anxiety disorder. In D. Nutt, K. Rickels, & D.J. Stein (Eds.), Generalized anxiety disorder: Symptomatology, pathogenesis and management (pp. 11-26). London: Martin Dunitz.
90. Wittchen, H.-U., Kessler, R.C., Beesdo, K., Krause, P., Höfler, M., & Hoyer, J. (2002b). Generalized anxiety and depression in primary care: Prevalence, recognition and management. Journal of Clinical Psychiatry, 63, 24-34.
91. Wittchen, H.-U., Kessler, R.C., Zhao, S., & Abelson, J. (1995). Reliability and clinical validity of UM-CIDI DSM-III-R generalized anxiety disorder. Journal of Psychiatric Research, 29, 95-110.
92. Wittchen, H.-U., Zhao, Z., Kessler, R.C., & Eaton, W.W. (1994). DSM-III-R generalized anxiety disorder in the National Comorbidity Survey. Archives of General Psychiatry, 51, 355-364.
93. Yonkers, K.A., Massion, A.O., Warshaw, M.G., & Keller, G. (1996). Phenomenology and course of generalized anxiety disorder. British Journal of Psychiatry, 168, 308-313.
94. Yonkers, K.A., Dyck, I.R., Warshaw, M.G., & Keller, G. (2000). Factors predicting the clinical course of generalized anxiety disorder. British Journal of Psychiatry, 176, 544-549.
95. Zimmermann, M., & Chelminski, I. (2003a). Generalized anxiety disorder in patients with major depression: Is DSM-IV's hierarchy correct? American Journal of Psychiatry, 160, 504-512.
96. Zimmermann, M., & Chelminski, I. (2003b). Clinical recognition of anxiety disorders in depressed outpatients. Journal of Psychiatry Research, 37, 325-333.
97. Zimmermann, M., & Mattia, J.I. (1999). Psychiatric diagnosis in clinical practice: Is comorbidity being missed? Comprehensive Psychiatry, 40, 182-191.