ABSTRACT
OBJECTIVE: The main aim of the present research was to evaluate the coherence of generalized anxiety disorder (GAD) psychopathological pattern, the robustness of its diagnostic criteria, and the clinical utility of considering this disorder as a discrete condition rather than assigning it a dimensional value. METHOD: The study was designed in a purely naturalistic setting and carried out using a community sample; data from the Sesto Fiorentino Study were reanalyzed. RESULTS: Of the 105 subjects who satisfied the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for the diagnosis of GAD, only 18 (17.1%) had no other comorbid DSM-IV disorder. The most frequent comorbid condition was major depressive disorder (70.4 %). Only 2 of the GAD diagnostic symptoms (excessive worry and muscle tension) showed a specific association with the diagnosis itself, whereas the others, such as feeling wound up, tense, or restless, concentration problems, and fatigue, were found to be more prevalent in major depressive disorder than in GAD. CONCLUSION: Our study demonstrates that GAD, as defined by DSM-IV criteria, shows a substantial overlap with other DSM-IV diagnoses (especially with mood disorders) in the general population. Furthermore, GAD symptoms are frequent in all other disorders included in the mood/anxiety spectrum. Finally, none of the GAD symptoms, apart from muscle tension, distinguished GAD from patients without GAD.
Subject(s)
Anxiety Disorders/diagnosis , Anxiety Disorders/psychology , Adult , Anxiety Disorders/epidemiology , Comorbidity , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/epidemiology , Depressive Disorder, Major/psychology , Diagnosis, Differential , Diagnostic and Statistical Manual of Mental Disorders , Female , Health Surveys , Humans , Italy , Male , Mass Screening , Mental Disorders/diagnosis , Mental Disorders/epidemiology , Mental Disorders/psychology , Middle AgedABSTRACT
The present article focused on the problem of validity, reliability and specificity of psychiatric diagnoses.The authors moved by the concept of syndrome, defined by Sydenham in the 18th century as a constellation of several interrelated symptoms, showing a stable, characteristic structure and a peculiar prognosis, in order to analyse the peculiarity of the current psychiatric nosology. In our opinion, the current nosographic system based on DSM-IV criteria, prevents psychiatry from benefiting of the significant technological progress that has led the rest of medical sciences to important clinical achievements in the last 20 years. The case of Generalized Anxiety Disorder was taken as an example of a disease characterized by unstable diagnostic criteria, high rate of comorbidity and uncertain boundaries. An analysis of the data from the Sesto Fiorentino study was performed to investigate the presence of common mood and anxiety symptoms across the most represented DSM IV diagnoses, in order to evaluate the specificity of these symptoms.The results supported the hypothesis of a low specificity of these symptoms, suggesting the need for psychiatry to find new and more specific markers and instruments.
