Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104, USA.
J Abnorm Psychol. 2013 May;122(2):369-75. doi: 10.1037/a0031731.
In its current instantiation in DSM-IV, a diagnosis of generalized anxiety disorder (GAD) requires the presence of excessive and uncontrollable worry. It has been proposed that the uncontrollability criterion be removed from future editions of the DSM, primarily on the basis of empirical and conceptual overlap between excessiveness and uncontrollability and a relative lack of research on uncontrollability. However, no research has directly investigated the incremental validity of the uncontrollability criterion-that is, the extent to which uncontrollability predicts important clinical information over and above excessiveness. This question was examined in a community sample of 126 adults diagnosed with GAD. After controlling for excessiveness, uncontrollability explained a significant proportion of additional variance in a variety of relevant clinical measures, including GAD severity, clinician-rated anxiety, number and severity of comorbid disorders, and use of psychotropic medication and psychotherapy. The results remained statistically significant even when other features of GAD were controlled. By contrast, excessiveness did not significantly predict any clinical measure over and above uncontrollability. These findings suggest that uncontrollability contributes to the validity of the GAD diagnosis and should be retained as a core feature of pathological worry.
在 DSM-IV 中，广泛性焦虑障碍（GAD）的诊断需要存在过度和无法控制的担忧。有人提议从 DSM 的未来版本中删除无法控制的标准，主要基于过度和无法控制之间的经验和概念重叠，以及对无法控制的相对缺乏研究。然而，没有研究直接调查无法控制标准的增量有效性，即无法控制在多大程度上超过过度来预测重要的临床信息。在一个由 126 名被诊断为 GAD 的成年人组成的社区样本中，研究了这个问题。在控制了过度之后，无法控制可以解释各种相关临床指标的额外差异，包括 GAD 的严重程度、临床医生评定的焦虑、共病障碍的数量和严重程度，以及精神药物和心理治疗的使用。即使控制了 GAD 的其他特征，结果仍然具有统计学意义。相比之下，过度并不能显著预测任何超过无法控制的临床指标。这些发现表明，无法控制有助于 GAD 诊断的有效性，应该作为病理性担忧的核心特征保留。
