Reliability and validity of DSM-IV generalized anxiety disorder features☆
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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2019, Handbook of Behavioral NeuroscienceCitation Excerpt :Earlier versions of DSM diagnostic criteria were based on the presence of symptoms for at least 1 month and had low interrater reliability (Di Nardo et al., 1983; Mannuzza et al., 1989), but the subsequent stipulations of a 6-month duration and perception of uncontrollable worry have enhanced the overall reliability of diagnosis (Brown et al., 2001). However, there are persisting concerns about diagnostic validity, such as the distinction from major depression and the threshold for symptom severity (Brown et al., 2001; Brown, Chorpita, & Barlow, 1998), and a more dimensional approach based on measuring worry, distress, and other symptoms might help delineate the condition (Gordon & Heimberg, 2011; Rutter & Brown, 2015). Symptom severity is usually assessed through observer-rated scales, such as the Hamilton Rating Scale for Anxiety (HAMA) (Hamilton, 1959): a HAMA score of less than 9 may correspond to symptom remission, whereas a score of 24 or more indicates anxiety symptoms of at least moderate intensity (Bandelow et al., 2006), HAMA scores being strongly correlated with self-rated impairments (Stein et al., 2009).
Difficulty concentrating in generalized anxiety disorder: An evaluation of incremental utility and relationship to worry
2018, Journal of Anxiety DisordersCitation Excerpt :Difficulty concentrating was significantly correlated with other GAD symptoms, and this association remained significant after controlling for depression symptoms (Comer, Pincus, & Hofmann, 2012). In a sample of treatment-seeking adults with GAD, difficulty concentrating as assessed by the Anxiety Disorders Interview Schedule for DSM-IV-Lifetime version (ADIS-IV-L; Brown, DiNardo, & Barlow, 1994) showed a small but significant association with GAD clinical severity (Gordon & Heimberg, 2011). In contrast to these findings, in a large undergraduate sample, self-reported difficulty concentrating as assessed by the Generalized Anxiety Disorder Questionnaire (GADQ; Roemer, Borkovec, Posa, & Borkovec, 1995) was uniquely associated with depression symptoms and did not correlate with other GAD symptoms after depression was statistically controlled (Joormann & Stöber, 1999).
Reliability and validity of the dimensional features of generalized anxiety disorder
2015, Journal of Anxiety DisordersCitation Excerpt :We explored inter-rater agreement, moderators of reliability, and the unique contribution of excessiveness and uncontrollability in predicting variables such as GAD severity, negative affect, depression symptoms, and number of diagnoses. Our research adds to Gordon and Heimberg's (2011) work by utilizing a larger clinical sample and a more thorough assessment (full ADIS-IV-L), with interviewers blind to each other's diagnoses and dimensional ratings. As noted earlier, Gordon and Heimberg's (2011) estimates may have been attenuated by range restriction through using a GAD-only sample.
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2023, Journal of Mental Health
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Portions of this work were presented at the November 2010 meeting of the Association for Behavioral and Cognitive Therapies, San Francisco, CA.