Brown T A, Barlow D H, Liebowitz M R
Center for Stress and Anxiety Disorders, University at Albany, State University of New York 12203.
Am J Psychiatry. 1994 Sep;151(9):1272-80. doi: 10.1176/ajp.151.9.1272.
The authors review the empirical data on generalized anxiety disorder, a diagnostic category that has been among the more conceptually challenging in psychiatric nosology.
Published studies and recent findings that were considered by the Generalized Anxiety Disorder Subcommittee of the DSM-IV Anxiety Disorders Work Group are reviewed. Among the issues examined are diagnostic reliability, comorbidity, boundaries with other disorders, and clinical features.
A variety of data on the reliability and validity of generalized anxiety disorder have been produced. Some authors have suggested that generalized anxiety disorder is better conceptualized as a vulnerability that should be located on axis II, and others have recommended that the category be eliminated. Although the diagnostic reliability of generalized anxiety disorder is lower than that of other anxiety disorders, the features constituting the diagnostic criteria for generalized anxiety disorder have been found to be reliable. An important development has been the determination of a set of somatic symptoms associated with generalized anxiety disorder that differs substantially from those for other anxiety disorders. These findings led to reduction in the number of items in the symptom criterion, from 18 in DSM-III-R to six in DSM-IV. Another substantial revision is greater emphasis on the uncontrollability of worry.
Whereas the data on construct and discriminant validity, age at onset, course, familial transmission, and response to treatment generally support the DSM-IV definition of generalized anxiety disorder, the construct continues to have weaknesses and further research is needed.
作者回顾了关于广泛性焦虑症的实证数据，广泛性焦虑症是精神疾病分类学中在概念上较具挑战性的诊断类别之一。
回顾了《精神疾病诊断与统计手册》第四版焦虑症工作组广泛性焦虑症小组委员会所考虑的已发表研究和近期发现。所探讨的问题包括诊断可靠性、共病情况、与其他疾病的界限以及临床特征。
已产生了关于广泛性焦虑症可靠性和有效性的各种数据。一些作者认为，广泛性焦虑症更好地被概念化为一种应位于轴II上的易感性，而另一些作者则建议取消该类别。尽管广泛性焦虑症的诊断可靠性低于其他焦虑症，但构成广泛性焦虑症诊断标准的特征已被发现是可靠的。一个重要进展是确定了一组与广泛性焦虑症相关的躯体症状，这些症状与其他焦虑症的症状有很大不同。这些发现导致症状标准中的项目数量从《精神疾病诊断与统计手册》第三版修订本中的18项减少到《精神疾病诊断与统计手册》第四版中的6项。另一项重大修订是更加强调担忧的不可控性。
虽然关于结构效度、判别效度、发病年龄、病程、家族遗传以及对治疗的反应的数据总体上支持《精神疾病诊断与统计手册》第四版对广泛性焦虑症的定义，但该结构仍存在弱点，需要进一步研究。
