DSM-III classification of the anxiety disorders: A psychometric study.

Abstract

A sample of 89 patients meeting DSM-III (Diagnostic and Statistical Manual, 3rd ed.) criteria for anxiety disorders were administered a battery of self-report inventories designed to assess general anxiety, fear, frequency of medical complaints, and level of depression. The validity of the DSM-III subgroups of anxiety states and phobias was substantiated. However, the results indicated that agoraphobia is more similar to the anxiety state than the phobia group, where it is presently classified. The anxiety state group was highly homogeneous. On the other hand, the phobia group showed some degree of heterogeneity. The results are discussed in terms of the validity of the DSM-III subcategories of phobias and anxiety states, the rectification of agoraphobia as an anxiety state, and whether phobias should be included in the anxiety disorders category. Classification of the anxiety disorders underwent considerable revision in the third edition of the Diagnostic and StatisticalManual of Menial Disorders (DSM-III; American Psychiatric Association, 1980). Among the changes was the creation of two subgroups (anxiety states and phobias) and a distinct panic disorder category within the anxiety state subgroup. Recent reports have revealed that there is considerable overlap of symptoms among the anxiety disorders (e.g., Spitzer, 1985;Turner & Michelson, 1984). Moreover, the presence of one anxiety symptom is associated with an increased likelihood of another. Because all of the disorders are characterized by somatic (e.g., blushing, rapid heart beat) and psychic (e.g., thinking unpleasant thoughts) dimensions, the question arises as to the similarity or differences of the various disorders, both within and across the subgroups.The primary distinction between the anxiety states and phobic conditions appears to be related to the specificity of the symptom pattern. In the case of phobias, anxiety is attached to circumscribed stimuli. Anxiety states, on the other hand, are characterized by pervasive nonspecific anxiety. Although the DSM-III categories of anxiety disorders show a reasonable, if not high, degree of diagnostic reliability (e.g., American Psychiatric Association, 1980), the question of validity is essentially unanswered. In one case where validity has been examined empirically, the data do not support the existence of panic disorder and agoraphobia with panic attacks as independent diagnostic entities.Rather, the two conditions were found to be virtually indistinguishable (Garvey & Tuason, 1984;Turner, Williams, Mezzich, & Beidel, 1985). Similarly, with respect to the categorization of agoraphobia, Hallam (1978) has made the argument that agoraphobia is an anxiety state rather than a phobia. Our own clinical experience strongly supports Hallam's conclusion.The present study examined the performance of individuals diagnosed with a major anxiety disorder on a variety of psycho-

The psychophysiology of anxiety disorder: Fear memory imagery

“…The present findings replicate and extend the Cook et al (1988) results: Panic patients consistently scored higher than phobics or the socially anxious on depression and anxiety questionnaires (see also Turner, McCann, Beidel, & Mezzich, 1986), consistent with high trait negative affect (Zinbarg & Barlow, 1996). In the present research, furthermore, patients diagnosed with panic had a higher incidence of comorbid depression (42%) and additional anxiety disorder (77%).…”

“…Friedman, Thayer, Borkovec, and Tyrell (1993) have reported a resting cardiac pattern in panic patients that is similar to that found for GAD, whereas this reduced heart rate variability was not found in specific (blood) phobics. An affinity between panic (with agoraphobia) and generalized anxiety disorder, compared to more focused phobic states, is suggested by studies of personality questionnaire patterns (e.g., Turner et al, 1986). Thus, different habitual patterns of worry and an associated reduced cardiac variability, along with high negative affect, could be a determinant of the response reactivity differences seen here between panic and phobia.…”

Panic disorder and agoraphobia in daily life

“…On the average, panic patients with agoraphobia in this study scored higher on the STAI state and trait anxiety scales than anxiety patients (Spielberger et al, 1970). In other studies, mean state anxiety scores between 46.5 and 51.6 and mean trait anxiety scores between 42.8 and 55.5 have been reported for patients with panic disorder and agoraphobia (Anderson et al, 1984;Chambless, 1985;Barlow etal., 1986;Turner et al, 1986b). The mean trait anxiety score of panic patients without agoraphobia was also higher; their mean state anxiety score was comparable to those reported in other studies.…”

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“…Social performance. The Social Performance Rating Scale (SPRS; Fydrich et al, 1998) is a rating system for the behavioral evaluation of social skills modified from earlier rating systems (Trower, Bryant, & Argyle, 1978;Turner, Beidel, Dancu, & Keys, 1986) to be used specifically in socially anxious populations. Evidence for good convergent, divergent, and criterion-related validity, as well as acceptable internal consistencies, have been found for the SPRS (Fydrich et al, 1998).…”