Richard G. Heimberg

Generalized worry disorder : a review of DSM-IV generalized anxiety disorder and options for DSM-V

Background: Generalized anxiety disorder (GAD) has undergone a series of substantial classificatory changes since its first inclusion in DSM‐III. The majority of these revisions have been in response to its poor inter‐rater reliability and concerns that it may lack diagnostic validity. This article provides options for the revision of the DSM‐IV GAD criteria for DSM‐V. Method: First, searches were conducted to identify the evidence that previous DSM Work Groups relied upon when revising the DSM‐III‐R GAD and the overanxious disorder classifications. Second, the literature pertaining to the DSM‐IV criteria for GAD was examined. Conclusions: The review presents a number of options to be considered for DSM‐V. One option is for GAD to be re‐labeled in DSM‐V as generalized worry disorder. This would reflect its hallmark feature. Proposed revisions would result in a disorder that is characterized by excessive anxiety and worry generalized to a number of events or activities for 3 months or more. Worry acts as a cognitive coping strategy that manifests in avoidant behaviors. The reliability and validity of the proposed changes could be investigated in DSM‐V validity tests and field trials. Depression and Anxiety, 2010.

Subtypes of social phobia in adolescents.

Thirty‐three social phobic adolescents were asked to name their ten most feared social situations. Two independent judges classified each situation reported by the participants into one of four situational domains: formal speaking/interactions, informal speaking/interactions, observation by others, and assertion. Fifteen participants (45.5%) were assigned a generalized subtype of social phobia because they endorsed at least moderate anxiety in all four situational domains. This subgroup scored higher on self‐report measures of anxiety and depression than the rest of the sample. These results provide empirical support for the existence of subtypes of social phobia in adolescents. Depression and Anxiety 9:15–18, 1999.

Social anxiety disorder in DSM-5

With the publication of DSM‐5, the diagnostic criteria for social anxiety disorder (SAD, also known as social phobia) have undergone several changes, which have important conceptual and clinical implications. In this paper, we first provide a brief history of the diagnosis. We then review a number of these changes, including (1) the primary name of the disorder, (2) the increased emphasis on fear of negative evaluation, (3) the importance of sociocultural context in determining whether an anxious response to a social situation is out of proportion to the actual threat, (4) the diagnosis of SAD in the context of a medical condition, and (5) the way in which we think about variations in the presentation of SAD (the specifier issue). We then consider the clinical implications of changes in DSM‐5 related to these issues.

Childhood Maltreatment and Social Anxiety Disorder: Implications for Symptom Severity and Response to Pharmacotherapy

Childhood maltreatment has been associated with symptom severity, reduced quality of life, and impaired functioning in adults with social anxiety disorder (SAD). No study has investigated how childhood maltreatment impacts pharmacotherapy outcomes in this population, despite evidence for such a link in depression. The current study replicates previous work on childhood maltreatment within SAD and examines its impact on response to pharmacotherapy.

RELATION OF MARITAL STATUS TO SOCIAL PHOBIA SEVERITY

Columbia University and Anxiety Disorders Clinic of theNew York State Psychiatric Institute, New York, New YorkPortions of this study were presented at the 32nd Annual Meet-ing of the Association for Advancement of Behavior Therapy,Washington, DC, November 5–8, 1998.Contract grant sponsor: National Institute of Mental Health; Con-tract grant numbers: 44119, 40201.*Correspondence to: Richard G. Heimberg, Ph.D., Adult AnxietyClinic, Department of Psychology, Temple University, Weiss Hall,1701 N. 13th Street, Philadelphia, PA 19122-6085. E-mail:rheimber@nimbus.ocis.temple.eduReceived for publication 5 January 1999; Accepted 25 May 1999

THE PUBLIC'S KNOWLEDGE AND BELIEFS ABOUT OBSESSIVE COMPULSIVE DISORDER

Obsessive compulsive disorder (OCD) is a disabling condition associated with significant personal and societal burdens. Despite the availability of efficacious treatments, in most cases, the disorder remains unrecognized and untreated. Lack of knowledge (i.e. poor mental health literacy, MHL) regarding OCD may be an impediment to seeking treatment. Therefore, the current study assessed public knowledge and beliefs about OCD and examined factors influencing MHL.

Anxiety sensitivity in social phobia: Comparison between social phobics with and without panic attacks

The current study examines levels of anxiety sensitivity among social phobic patients with and without panic attacks. Two‐hundred fourteen individuals with a primary diagnosis of social phobia completed the Anxiety Sensitivity Index (ASI) prior to treatment. Social phobics who experienced panic attacks reported higher levels of anxiety sensitivity than those without panic attacks. Patterning of response to ASI items differed between panicking and non‐panicking patients, with the panicking patients reporting greater fear of catastrophic consequences of bodily sensations. Individuals with an additional diagnosis of panic disorder did not differ from those with exclusively situational panic attacks. The findings suggest the importance of examining differences between anxiety‐disordered individuals who experience panic attacks and their non‐panicking counterparts. Depression and Anxiety 12:189–192, 2000.

CHILDHOOD MALTREATMENT AND RESPONSE TO COGNITIVE BEHAVIORAL THERAPY AMONG INDIVIDUALS WITH SOCIAL ANXIETY DISORDER

The association between childhood maltreatment—particularly emotional maltreatment—and social anxiety disorder (SAD) has been established by research. Only recently have researchers begun to look at the impact of childhood maltreatment on treatment outcomes, and findings have been mixed. Because prior studies have focused on pharmacotherapy outcomes, or used global measures of childhood adversity or abuse, it is not clear how specific types of maltreatment impact outcomes in cognitive‐behavioral therapy (CBT) for SAD. The current study reports on how specific types of childhood maltreatment such as physical abuse, emotional abuse, sexual abuse, physical neglect, and emotional neglect impact response to CBT in adults with SAD.