MIDAS Project Publication Abstracts
Zimmerman, M. & Chelminski, I. Generalized anxiety disorder
in patients with major depressive disorder: Is DSM-IV's hierarchy
correct? American Journal of Psychiatry, 2005, 160, 504-512.
Objective: In DSM-III a hierarchical relationship was imposed
in diagnosing anxiety disorders in depressed patients, i.e. anxiety
disorders could not be diagnosed if their occurrence was limited
to the course of a mood disorder. In the subsequent versions of
the DSM this hierarchy was eliminated for all anxiety disorders
except generalized anxiety disorder (GAD). In the present report
we examined the validity of this remaining hierarchical relationship
between mood and anxiety disorders.
Method: Three hundred thirty-two psychiatric outpatients
with major depressive disorder (MDD) were evaluated with a semistructured
diagnostic interview and completed some paper-and-pencil questionnaires
upon presentation for treatment. To study the validity of the DSM-IV
hierarchical relationship between GAD and mood disorders we made
a diagnosis of modified GAD in those patients with MDD who met all
GAD criteria except for the exclusion criterion. In our analyses
we compared three nonoverlapping groups of patients: 1.) patients
with DSM-IV MDD and GAD; 2.) depressed patients with modified GAD;
and 3.) MDD patients without GAD.
Results: Compared to depressed patients without GAD, depressed
patients with DSM-IV and modified GAD had higher levels of suicidal
ideation, poorer social functioning, greater frequency of other
anxiety disorders, eating disorders, and somatoform disorders, higher
scores on most subscales of a multidimensional self-report measure
of DSM-IV Axis I disorders, greater level of pathological worry,
and a higher morbid risk for GAD in first-degree family members.
The two GAD groups did not differ from each other.
Conclusions: Our findings question the validity of the DSM-IV
hierarchical relationship between MDD and GAD, and suggest that
the exclusion criterion should be eliminated.
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