Contract grant sponsor: National Institutes of Health (NIH); Contract grant numbers: K23 MH090247, R01 MH068277, R01 MH078308.
GENERALIZED ANXIETY DISORDER AND THE PROPOSED ASSOCIATED SYMPTOMS CRITERION CHANGE FOR DSM-5 IN A TREATMENT-SEEKING SAMPLE OF ANXIOUS YOUTH
Article first published online: 5 SEP 2012
© 2012 Wiley Periodicals, Inc.
Depression and Anxiety
Volume 29, Issue 12, pages 994–1003, December 2012
How to Cite
Comer, J. S., Pincus, D. B. and Hofmann, S. G. (2012), GENERALIZED ANXIETY DISORDER AND THE PROPOSED ASSOCIATED SYMPTOMS CRITERION CHANGE FOR DSM-5 IN A TREATMENT-SEEKING SAMPLE OF ANXIOUS YOUTH. Depress. Anxiety, 29: 994–1003. doi: 10.1002/da.21999
- Issue published online: 3 DEC 2012
- Article first published online: 5 SEP 2012
- Manuscript Revised: 10 AUG 2012
- Manuscript Accepted: 10 AUG 2012
- Manuscript Received: 15 JUN 2012
- National Institutes of Health (NIH). Grant Numbers: K23 MH090247, R01 MH068277, R01 MH078308
- anxiety disorders;
- diagnostic and statistical manual of mental disorders;
A current proposal for the DSM-5 general anxiety disorder (GAD) definition is to remove fatigue, difficulty concentrating, irritability, and sleep disturbance from the list of associated symptoms, and to require the presence of one of two retained symptoms (restlessness or muscle tension) for diagnosis. Relevant evaluations in youth to support such a change are sparse.
The present study evaluated patterns and correlates of the DSM-IV GAD associated symptoms in a large outpatient sample of anxious youth (N = 650) to empirically consider how the proposed diagnostic change might impact the prevalence and sample composition of GAD in children.
Logistic regression found irritability to be the most associated, and restlessness to be the least associated, with GAD diagnosis. Fatigue, difficulty concentrating, and sleep disturbances—which have each been suggested to be nonspecific to GAD due to their prevalence in depression—showed sizable associations with GAD even after accounting for depression and attention problems. Among GAD youth, 10.9% would not meet the proposed DSM-5 associated symptoms criterion. These children were comparable to GAD youth who would meet the proposed criteria with regard to clinical severity, symptomatology, and functioning.
A substantial proportion of youth with excessive, clinically impairing worry may be left unclassified by the DSM-5 if the proposed GAD associated symptoms criterion is adopted. Despite support for the proposed criterion change in adult samples, the present findings suggest that in children it may increase the false negative rate. This calls into question whether the proposed associated symptoms criterion is optimal for defining childhood GAD.