Am J Psychiatry 1994; 151:1272-1280
Copyright © 1994 by American Psychiatric Association
The empirical basis of generalized anxiety disorder
TA Brown, DH Barlow and MR Liebowitz
Center for Stress and Anxiety Disorders, University at Albany, State University of New York 12203.
OBJECTIVE: The authors review the empirical data on generalized anxiety
disorder, a diagnostic category that has been among the more conceptually
challenging in psychiatric nosology. METHOD: Published studies and recent
findings that were considered by the Generalized Anxiety Disorder
Subcommittee of the DSM-IV Anxiety Disorders Work Group are reviewed. Among
the issues examined are diagnostic reliability, comorbidity, boundaries
with other disorders, and clinical features. RESULTS: A variety of data on
the reliability and validity of generalized anxiety disorder have been
produced. Some authors have suggested that generalized anxiety disorder is
better conceptualized as a vulnerability that should be located on axis II,
and others have recommended that the category be eliminated. Although the
diagnostic reliability of generalized anxiety disorder is lower than that
of other anxiety disorders, the features constituting the diagnostic
criteria for generalized anxiety disorder have been found to be reliable.
An important development has been the determination of a set of somatic
symptoms associated with generalized anxiety disorder that differs
substantially from those for other anxiety disorders. These findings led to
reduction in the number of items in the symptom criterion, from 18 in
DSM-III-R to six in DSM-IV. Another substantial revision is greater
emphasis on the uncontrollability of worry. CONCLUSIONS: Whereas the data
on construct and discriminant validity, age at onset, course, familial
transmission, and response to treatment generally support the DSM-IV
definition of generalized anxiety disorder, the construct continues to have
weaknesses and further research is needed.
