PHILADELPHIA — Should “excessive worry” be a requirement for a diagnosis of generalized anxiety disorder?
A new international study tackled that question, pointing out, “Around the world, people living in objectively difficult circumstances who experience symptoms of generalized anxiety disorder (GAD) do not qualify for a diagnosis because their worry is not ‘excessive’ relative to the context.”
The large study was led by researchers from the University of Pennsylvania and included participation from the VA San Diego Healthcare System. With results published in Psychological Medicine, they sought to elucidate the implications of removing the excessiveness requirement.
Using data from the World Health Organization World Mental Health Survey Initiative, the study included 133 614 adults from 12 surveys in Low- or Middle-Income Countries (LMICs) and 16 surveys in High-Income Countries (HICs). Responses were assessed with the Composite International Diagnostic Interview.
The authors compared nonexcessive worriers meeting all other DSM-5 criteria for GAD to respondents meeting all criteria for GAD, and to respondents without GAD, on clinically-relevant correlates.
“Removing the excessiveness requirement increases the global lifetime prevalence of GAD from 2.6% to 4.0%, with larger increases in LMICs than HICs,” the researchers reported. “Non-excessive and excessive GAD cases worry about many of the same things, although non-excessive cases worry more about health/welfare of loved ones and less about personal or nonspecific concerns, than excessive cases. Non-excessive cases closely resemble excessive cases in socio-demographic characteristics, family history of GAD, and risk of temporally secondary comorbidity and suicidality. Although non-excessive cases are less severe on average, they report impairment comparable to excessive cases and often seek treatment for GAD symptoms.”
The study team concluded that adults with non-excessive worry who meet all other DSM-5 criteria for GAD are clinically significant cases. “Eliminating the excessiveness requirement would lead to a more defensible GAD diagnosis,” according to the report.
- Ruscio AM, Rassaby M, Stein MB, Stein DJ, et. Al. World Mental Health Survey collaborators. The case for eliminating excessive worry as a requirement for generalized anxiety disorder: a cross-national investigation. Psychol Med. 2024 Oct 4:1-12. doi: 10.1017/S003329172400182X. Epub ahead of print. PMID: 39364896.
