The Contribution of Worry Behaviors to the Diagnosis of Generalized Anxiety Disorder
Worry behaviors (i.e., overt acts to avoid or cope with worry-induced distress) have been recognized as being important in the psychopathology and treatment of generalized anxiety disorder (GAD). This study evaluated the worry behaviors criterion proposed for DSM-5 GAD, but was ultimately not adopted due to insufficient evidence. In 800 outpatients with emotional disorders (366 with GAD), most patients with GAD (92.6%) met the proposed worry behaviors criterion, which was at a rate significantly higher than other patient groups (e.g., patients with mood disorders). Patients who met the worry behaviors criterion had more severe GAD than patients who did not. The worry behaviors criterion, and 3 of its 4 constituent behaviors, were associated with no better than “fair” interrater reliability. Diagnostic reliability of GAD was not improved in cases where both interviewers agreed the worry behaviors criterion was met. The worry behaviors criterion significantly predicted DSM-5 GAD holding core GAD features constant (e.g., excessive worry), but this contribution was weak and did not appreciably improve the classification accuracy of GAD diagnostic status. Mixed support was obtained for the discriminant validity of the worry behaviors criterion in relation to mood disorders. Raising the proposed threshold of the criterion (requiring 2 instead of 1 behaviors) did not result in a substantial improvement in reliability, prediction, and classification accuracy. Although additional research is warranted (e.g., importance of worry behaviors in the treatment and natural course of GAD), the results raise questions about the role of worry behaviors in the diagnostic classification of GAD.
KeywordsGeneralized anxiety disorder Worry behaviors Diagnostic criteria DSM-5
The authors thank Anthony J. Rosellini for his comments on this manuscript.
This research was funded by a grant from the National Institute of Mental Health. (R01 MH039096; PI: Brown).
Compliance with Ethical Standards
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Conflict of Interest
Timothy A. Brown and Esther S. Tung declare that they have no conflict of interest.
Informed consent was obtained from all individual participants included in the study.
- American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.Google Scholar
- Brown, T. A., & Barlow, D. H. (2002). Classification of anxiety and mood disorders. In D. H. Barlow (Ed.), Anxiety and its disorders: The nature and treatment of anxiety and panic (2nd ed., pp. 292–327). New York: Guilford Press.Google Scholar
- Brown, T. A., & Barlow, D. H. (2014). Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5). New York: Oxford University Press.Google Scholar
- Regier, D. A., Narrow, W. E., Clarke, D. E., Kraemer, H. C., Kuramoto, S. J., Kuhl, E. A., & Kupfer, D. J. (2013). DSM-5 field trials in the United States and Canada, part II: Test-retest reliability of selected categorical diagnoses. American Journal of Psychiatry, 170, 59–70.CrossRefGoogle Scholar
- Townsend, M. H., Weissbecker, K. A., Barbee, J. G., Peña, J. M., Snider, L. M., Tynes, L. L., Tynes, S. F., Boudoin, C., Green-Liebovitz, M. I., & Winstead, D. (1999). Compulsive behaviors in generalized anxiety disorder and obsessive-compulsive disorder. Journal of Nervous and Mental Disease, 187, 697–699.CrossRefGoogle Scholar
- Williams, J. B. W., Gibbon, M., First, M. B., Spitzer, R. L., Davies, M., Borus, J., Howes, M. J., Kane, J., Pope, H. G., Rounsaville, B., & Wittchen, H. (1992). The structured clinical interview for DSM-III-R (SCID): II. Multisite test-retest reliability. Archives of General Psychiatry, 49, 630–636.CrossRefGoogle Scholar