Generalized anxiety disorder historical perspective
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Irfan Dotani
Overview
Generalized anxiety disorder was first recognized as a symptom by Sigmund Freud. In 1980, 'The American Psychiatric Association' introduced GAD as a diagnosis in the DSM-III.
Historical Perspective
- In the late 19th century, Sigmund Freud recognized anxiety as:[1]
- A "signal of danger"
- A cause of "defensive behavior"
- He believed we acquire anxious feelings through classical conditioning and traumatic experiences.
- In the 19th century into the 20th century, the terms used to diagnose generalized anxiety included:[2]
- “Pantophobia”
- “Anxiety neurosis”
- Such terms designated paroxysmal manifestations (panic attacks) as well as interparoxysmal phenomenology (the apprehensive mental state).
- Generalized anxiety was considered one of the numerous symptoms of neurasthenia, a vaguely defined illness.
- In 1980, 'The American Psychiatric Association' introduced GAD as a diagnosis in the DSM-III.
- Anxiety neurosis was split into:[3]
- GAD
- Panic disorder
- We maintain anxiety through operant conditioning;
- When we see or encounter something associated with a previous traumatic experience, anxious feelings resurface.
- We feel temporarily relieved when we avoid situations which make us anxious.
- Anxiety neurosis was split into:[3]
Development of Diagnostic Criteria for Generalized Anxiety Disorder
- In 1980, DSM-III portrayed GAD as:[4]
- Generalized, persistent anxiety
- In 1987, DMS-III-R portrayed GAD as:
- Unrealistic/excessive anxiety and worry (apprehensive expectation) about 2 or more life circumstances
- In 1992, ICD-10 portrayed GAD as:
- Generalized and persistent anxiety, not restricted to or even predominating in any environmental circumstances (ie, “free-floating”)
- The ICD-11, beta draft, portrayed GAD as:
- Marked symptoms of anxiety accompanied by either general apprehension (ie, “free-floating anxiety”) or worry focused on multiple everyday events (family, health, finances, school, or work)
- In 1994, DSM-IV portrayed GAD as:
- Excessive anxiety and worry (apprehensive expectation) about a number of events or activities
- Difficult to control the worry
- In 2013, DSM-V portrayed GAD as:
- Excessive anxiety and worry (apprehensive expectation) about a number of events or activities
- Difficult to control the worry
References
- ↑ Kessler RC, Keller MB, Wittchen HU (2001). "The epidemiology of generalized anxiety disorder". Psychiatr Clin North Am. 24 (1): 19–39. PMID 11225507.
- ↑ Crocq MA (2017). "The history of generalized anxiety disorder as a diagnostic category". Dialogues Clin Neurosci. 19 (2): 107–116. PMC 5573555. PMID 28867935.
- ↑ Torpy JM, Burke AE, Golub RM (2011). "JAMA patient page. Generalized anxiety disorder". JAMA. 305 (5): 522. doi:10.1001/jama.305.5.522. PMID 21285432.
- ↑ Wittchen HU, Kessler RC, Zhao S, Abelson J (1995). "Reliability and clinical validity of UM-CIDI DSM-III-R generalized anxiety disorder". J Psychiatr Res. 29 (2): 95–110. PMID 7666382.