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

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Overview

Anxiety was recognized as a symptom by Sigmund Freud.

Historical Perspective

• In the late 19th century, Sigmund Freud recognized anxiety as:
  • 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:
  • “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:
    • 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.
      • This only increases anxious feelings the next time we are in the same position, and we will want to escape the situation again and therefore will not make any progress against the anxiety.

Development of Diagnostic Criteria for Generalized Anxiety Disorder

• In 1980, DSM-III portrayed GAD as:
  • 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