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Generalized Anxiety Disorder: Between Neglect and an Epidemic

Starcevic, Vladan MD, PhD*; Portman, Michael E. DPhil, LISW-S; Beck, Aaron T. MD

The Journal of Nervous and Mental Disease: August 2012 - Volume 200 - Issue 8 - p 664–667
doi: 10.1097/NMD.0b013e318263f947
Original Articles

This article reviews the main issues associated with the concept and the diagnosis of generalized anxiety disorder (GAD) and examines the proposed DSM-5 diagnostic criteria for GAD. The lack of specific features, which is the primary issue for GAD, will not be addressed in DSM-5. The hallmark of the condition will remain pathological worry, although it also characterizes other disorders. Likewise, the proposed behavioral diagnostic criteria lack specificity for GAD, and it is not clear how these will be assessed. The proposed changes will lower the diagnostic threshold for GAD in DSM-5. Although this will not necessarily lead to a better recognition of GAD and an improvement in the perception of its relevance and clinical utility, many currently subthreshold cases will qualify for this diagnosis. The likely inclusion of many such “false-positives” will result in an artificial increase in the prevalence of GAD and will have further negative consequences.

*University of Sydney, Sydney Medical School–Nepean, Discipline of Psychiatry, Sydney, NSW, Australia; †Private Practice, Jerusalem, Israel; and ‡University of Pennsylvania, Perelman School of Medicine, Philadelphia.

Send reprint requests to Vladan Starcevic, MD, PhD, Nepean Hospital, Department of Psychiatry, P.O. Box 63 Penrith NSW 2751, Australia. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.