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Mixed Anxiety Depression Should Not Be Included in DSM-5

Batelaan, Neeltje M. MD, PhD*†; Spijker, Jan MD, PhD‡§∥; de Graaf, Ron PhD; Cuijpers, Pim PhD†¶

Journal of Nervous & Mental Disease:
doi: 10.1097/NMD.0b013e318257c4c9
Original Article

Abstract: Subthreshold anxiety and subthreshold depressive symptoms often co-occur in the general population and in primary care. Based on their associated significant distress and impairment, a psychiatric classification seems justified. To enable classification, mixed anxiety depression (MAD) has been proposed as a new diagnostic category in DSM-5. In this report, we discuss arguments against the classification of MAD. More research is needed before reifying a new category we know so little about. Moreover, we argue that in patients with MAD symptoms and a history of an anxiety or depressive disorder, symptoms should be labeled as part of the course trajectories of these disorders, rather than calling it a different diagnostic entity. In patients with incident co-occurring subthreshold anxiety and subthreshold depression, subthreshold categories of both anxiety and depression could be classified to maintain a consistent classification system at both threshold and subthreshold levels.

Author Information

*Department of Psychiatry, VU University Medical Center and GGZ inGeest, Amsterdam, The Netherlands; †EMGO-Institute, VU University and VU University Medical Center, Amsterdam, the Netherlands; ‡Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands; §Pro Persona, Ede, the Netherlands; ∥Department of Clinical Psychology, Radboud University, Nijmegen, the Netherlands; and ¶Department of Clinical Psychology, VU University, Amsterdam, the Netherlands.

Editor’s note: Proposed DSM-5 criteria sets do not represent the final DSM-5 criteria for the disorders.

Send reprint requests to Neeltje M. Batelaan, MD, PhD, Department of Psychiatry and EMGO-Institute, VU University Medical Center and GGZ inGeest, A.J. Ernststraat 1187, 1081 HL Amsterdam, The Netherlands. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.