Proposed Specific Factors for Generalized Anxiety Disorder Within the Integrative Hierarchical Model of Anxiety and Depression (original) (raw)

Since its first appearance in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III, 1980), generalized anxiety disorder (GAD) has provided challenges to the discriminative validity of the mood and anxiety disorders. Although the removal of autonomic symptoms from the diagnostic criteria for GAD in DSM-IV helped to increase the diagnostic reliability from a range of .27 to . 56 (Williams et al., 1992) based on DSM-III-R criteria and .67 based on DSM-IV criteria (Brown, Di Nardo, Lehman, & Campbell, 2001), some researchers have expressed concern that this distinction further confuses the boundary between GAD and mood disorders Brown et al., 1995). It has been argued that though the removal of these symptoms from the diagnostic criteria improved the overall reliability of GAD, as well as the discriminative validity of GAD in relation to the other anxiety disorders, the overlap with depressive disorders and the discriminative difficulties therein still remain. Research based on DSM-IV criteria has shown that GAD shares a closer relationship to the mood disorders than it does to other anxiety disorders . Clark and Watson (1991) developed the tripartite model, in which depression and anxiety share a common factor of negative affectivity, depression is indicated by low positive affectivity (PA) and anxiety by high autonomic arousal (AA). Mineka, Watson, and Clark expanded on this model with the integrative hierarchical model, within which each anxiety disorder is indicated by an idiosyncratic predictor. has made the argument that this model can and should be extended to new taxonomic systems, including the approaching DSM-V. However, a specific factor remains to be determined for GAD within this model.