Reliability and validity of DSM-IV generalized anxiety disorder features

https://doi.org/10.1016/j.janxdis.2011.04.001Get rights and content

Abstract

The reliability of generalized anxiety disorder (GAD) features has been shown to be moderate, based on research utilizing the Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV), a semi-structured diagnostic interview. This may be a function of the criteria for the diagnosis of GAD, which have undergone much revision since its first inclusion in the Diagnostic and Statistical Manual of Mental Disorders. The reliability and validity of disorder feature ratings were examined in a diverse sample of patients who presented for assessment and treatment of excessive worry, generalized anxiety, or tension at an anxiety specialty clinic and who met criteria for a principal diagnosis of GAD (N = 129). Internal consistency of the ratings of excessiveness of worry, uncontrollability of worry, and the associated symptom cluster was moderate to low and varied by disorder feature. Inter-rater reliability for all features of GAD and severity of the disorder varied between good and poor. Additional findings showed that the GAD features, as measured using the ADIS-IV module, have modest to strong convergent validity, varying by feature, and poor discriminant validity when tested against measures of social anxiety. Potential reasons for rater disagreement are discussed. Results are also considered in terms of how they may inform the evolving criteria for GAD in DSM-V.

Highlights

► The current study explored features of GAD by examining internal consistency, inter-rater reliability, and associations among symptoms. ► Convergent and discriminant validity of GAD features were also examined. ► Internal consistency of the ratings of excessiveness of worry, uncontrollability of worry, and the associated symptom cluster was moderate to low and varied by disorder feature. ► Inter-rater reliability for all features of GAD and severity of the disorder varied between good and poor. ► The GAD features have modest to strong convergent validity, varying by feature, and poor discriminant validity when tested against measures of social anxiety. ► Findings may inform the evolving criteria for GAD in DSM-V.

Section snippets

Participants

Participants were 129 patients presenting for assessment and treatment of excessive worry, generalized anxiety, or tension at the Adult Anxiety Clinic at Temple between January of 1999 and January of 2010. Women constituted the larger portion of the sample (65%); average age was 33.21 (SD = 12.32, range = 18–81). Of the 126 patients providing information on ethnicity, the breakdown was 98 (78%) Caucasian, 17 (13%) African American, 2 (2%) Native American, 2 (2%) Pacific Islander, and 7 (5%) other.

Internal consistency

Internal consistency (Cronbach's alpha) of the dimensional ratings of excessiveness and uncontrollability for each of the eight worry domains, along with that of the six associated symptoms, was calculated to examine whether each of these item sets should be treated as scales and to explore any meaningful relationships among the six associated symptoms. Given the heterogeneity of concerns in GAD, we were uncertain of whether the severity of excessiveness and uncontrollability among worry

Discussion

The current study utilized the ADIS-IV interview to explore features of GAD by examining internal consistency, inter-rater reliability, and associations among symptoms. We were also interested in convergent and discriminant validity of GAD features as demonstrated by their correlation with scores on measures of varying relation to the disorder. Features of GAD were emphasized in present analyses, as ratings of features of the disorder are the basis on which diagnoses are ultimately determined.

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