Recent research has provided empirical support for a dimensional structure of worry, suggesting that normal and pathological worry represent opposite ends of a continuum, not discrete constructs. However, in most cases, investigations of normal and pathological worry have typically examined people with a diagnosis of GAD (generalized anxiety disorder) and have rarely examined pathological worry independent of GAD, leaving pathological worry outside the context of GAD poorly understood.
In an attempt to identify delimiting characteristics of pathological worry and GAD, high worriers with and without a diagnosis of GAD were compared. Surprisingly, only 20% of people who reported experiencing extreme levels of pathological worry (worry scores above the threshold commonly associated with GAD) actually met diagnostic criteria for the disorder.
68%–78% of people who reported high levels of worry but not GAD met only 0–1 of the four required DSM-IV criteria, with chronic/excessive worry and associated distress and impairment best differentiating people with GAD from high worriers without GAD.
People with GAD also reported greater levels of depression, more frequent worry, and less control over their worry. People with high levels of worry but without GAD experienced all symptoms of GAD less severely than people with GAD, even though they reported their worry to be excessive and uncontrollable.
These findings underscore the need for future studies to distinguish GAD from pathological worry. Specifically, they suggest that examining differences between worry in normal participants and participants with GAD may not actually provide information about the differences between nonpathological and pathological worry. In a recent comparison of people with high worry who either did or did not have GAD, it was found that negative beliefs about worry were specific to participants with GAD.
Worry may function as a strategy for avoidance of more emotional topics among persons with GAD. People with GAD reported experiencing their emotions as more intense and more confusing than people without GAD who experienced high levels of worry. These results uggest that pathological worry within the context of GAD may be subject to additional factors that may render it significantly different from pathological worry without GAD.
The diagnostic criteria for GAD have been revised repeatedly, with revisions resulting in a greater focus on the presence of excessive and uncontrollable worry, an increase in the required duration of symptoms, fewer required physical symptoms, and the added requirement that worry and associated symptoms be accompanied by significant distress or impairment. GAD was no longer considered a residual category that could only be diagnosed in the absence of other anxiety disorders.
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