Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-18T20:21:12.411Z Has data issue: false hasContentIssue false
  • English
  • Français

Dimensional anxiety scales for DSM-5: Sensitivity to clinical severity

Published online by Cambridge University Press:  15 April 2020

S. Knappe ,
J. Klotsche ,
A. Strobel ,
R.T. LeBeau ,
M.G. Craske ,
H.-U. Wittchen  and
K. Beesdo-Baum
S. Knappe*
Affiliation:
Institute of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
J. Klotsche
Affiliation:
Institute of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
A. Strobel
Affiliation:
Department of Process-oriented Assessment, TU Dresden, Dresden, Germany
R.T. LeBeau
Affiliation:
Department of Psychology, University of California, Los Angeles, California, United States
M.G. Craske
Affiliation:
Department of Psychology, University of California, Los Angeles, California, United States
H.-U. Wittchen
Affiliation:
Institute of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
K. Beesdo-Baum
Affiliation:
Institute of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
*
*Corresponding author. TU Dresden, Institute of Clinical Psychology and Psychotherapy, Chemnitzer Straβe Street 46, 01187 Dresden, Germany. Tel.: +49 351 463 39727; fax: +49 351 463 36984. E-mail address:[email protected] (S. Knappe).
Get access

Abstract

Purpose

Psychometric properties and clinical sensitivity of brief self-rated dimensional scales to supplement categorical diagnoses of anxiety disorders in the DSM-5 were recently demonstrated in a German treatment seeking sample of adults. The present study aims to demonstrate sensitivity of these scales to clinical severity levels.

Methods

The dimensional scales were administered to 102 adults at a university outpatient clinic for psychotherapy. Diagnostic status was assessed using the Munich-Composite International Diagnostic Interview. To establish a wide range of clinical severity, we considered subthreshold (n = 83) and threshold anxiety disorders (n = 49, including Social Phobia, Specific Phobia, Agoraphobia, Panic Disorder, and Generalized Anxiety Disorder).

Results

Individuals with either subthreshold or threshold anxiety disorder scored higher on all dimensional scales relative to individuals without anxiety. In addition, individuals with a threshold anxiety disorder scored higher on the dimensional scales than individuals with a subthreshold anxiety disorder (except for specific phobia). Disorder-related impairment ratings, global functioning assessments and number of panic attacks were associated with higher scores on dimensional scales. Findings were largely unaffected by the number of anxiety disorders and comorbid depressive disorders.

Conclusion

The self-rated dimensional anxiety scales demonstrated sensitivity to clinical severity, and a cut-off based on additional assessment of impairment and distress may assist in the discrimination between subthreshold and threshold anxiety disorders. Findings suggest further research in various populations to test the utility of the scales for use in DSM-5.

Keywords

DSMAnxietyAssessmentDiagnosisSensitivity
Type
Original article
Information
European Psychiatry , Volume 28 , Issue 7 , September 2013 , pp. 448 - 456
Copyright
Copyright © European Psychiatric Association

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

☆

This article was generated as part of the DSM-5 Work Group activities, ©2012 by the American Psychiatric Association.

References

American Psychiatric Association, DSM-IV-TR. Diagnostic and Statistical Manual of Mental Disorders. Text revision, 4 edWashingston, DC: Author; 2000.CrossRefGoogle Scholar
Andrews, G, Goldberg, DP, Krueger, RF, Carpenter, W.T. Jr., Hyman, SE, Sachdev, P, et al.Exploring the feasibility of a meta-structure for DSM-V and ICD-11: Could it improve utility and validity? Psychol Med 2009;39(12):1993–2000.CrossRefGoogle ScholarPubMed
Balon, RMeasuring anxiety. Are we getting what we need?. Depress Anxiety 2005;22:1–10.CrossRefGoogle ScholarPubMed
Beesdo, K, Bittner, A, Pine, DS, Stein, MB, Höfler, M, Lieb, R, et al.Incidence of social anxiety disorder and the consistent risk for secondary depression in the first three decades of life. Arch Gen Psychiatry 2007;64:903–912.CrossRefGoogle ScholarPubMed
Beesdo, K, Knappe, S, Pine, DSAnxiety and anxiety disorders in children and adolescents: developmental issues and implications for DSM-V. Psychiatr Clin North Am 2009;32:483–524.CrossRefGoogle ScholarPubMed
Beesdo-Baum, K, Höfler, M, Gloster, A, Klotsche, J, Lieb, R, Beauducel, A, et al.The structure of common mental disorders: a replication study in a community sample of adolescents and young adults. Int J Methods Psychiatr Res 2009;18:204–220.Google Scholar
Beesdo-Baum, K, Knappe, S, Fehm, L, Lieb, R, Wittchen, HUSocial anxiety disorder: natural course and persistence in the first three decades of life. Acta Psychiatr Scand 2012;126:411–425.CrossRefGoogle Scholar
Beesdo-Baum, K, Klotsche, J, Knappe, S, Craske, MG, LeBeau, RT, Hoyer, J, et al.Psychometric properties of the dimensional anxiety scales for DSM-5 in an unselected sample of treatment seeking patients. Depress Anxiety 2012;29(12):1014–1022.CrossRefGoogle Scholar
Beesdo-Baum, K, Winkel, S, Pine, DS, Hoyer, J, Höfler, M, Lieb, R, et al.The diagnostic threshold of generalized anxiety disorder in the community: a developmental perspective. J Psychiatr Res 2011;45:962–972.CrossRefGoogle ScholarPubMed
Bittner, A, Goodwin, RD, Wittchen, HU, Beesdo, K, Höfler, M, Lieb, RWhat characteristics of primary anxiety disorders predict subsequent major depression. J Clin Psychiatry 2004;65:618–626.CrossRefGoogle Scholar
Bögels, SM, Stein, MB, Beidel, DC, Clark, LA, Pine, DS, Voncken, MSocial anxiety disorder: questions and answers for the DSM-V. Depress Anxiety 2010;27:168–189.CrossRefGoogle ScholarPubMed
Brown, TA, DiNardo, P, Barlow, DHAnxiety Disorder Interview Schedule for DSM-IV. Oxford: University Press; 2004.Google Scholar
Davidson, JRT, Hughes, DC, George, LK, Blazer, DGThe boundary of social phobia: exploring the threshold. Arch Gen Psychiatry 1994;51:975–983.CrossRefGoogle ScholarPubMed
DiNardo, PA, Barlow, DHAnxiety Disorders Interview Schedule-Revised (ADIS-R). Albany, NY: Graywind Publications; 1988.Google Scholar
Fehm, L, Beesdo, K, Jacobi, F, Fiedler, ASocial phobia above and below the diagnostic threshold: prevalence, comorbidity and impairment in the general population. Soc Psychiatry Psychiatr Epidemiol 2008;43:257–265.CrossRefGoogle Scholar
Goodwin, RD, Lieb, R, Höfler, M, Pfister, H, Bittner, A, Beesdo, K, et al.Panic attack as a risk factor for severe psychopathology. Am J Psychiatry 2004;161:2207–2214.CrossRefGoogle ScholarPubMed
Hoyer, J, Ruhl, U, Scholz, D, Wittchen, HUPatients’ feedback after computer-assisted diagnostic interview for mental disorders. Psychother Res 2006;16:357–363.CrossRefGoogle Scholar
Jablensky, AThe disease entity in psychiatry: fact of fiction. Epidemiol Psychiatr Sci 2012;21:255–264.CrossRefGoogle ScholarPubMed
Kessler, RC, Merikangas, KR, Berglund, P, Eaton, WW, Koretz, DS, Walters, EEMild disorders should not be eliminated from the DSM-V. Arch Gen Psychiatry 2003;60:1117–1122.CrossRefGoogle Scholar
Knappe, S, Beesdo, K, Fehm, L, Lieb, R, Wittchen, HUAssociations of familial risk factors with social fears and social phobia: evidence for the continuum hypothesis in social anxiety disorder? J Neur Trans 2009;116:639–648.CrossRefGoogle ScholarPubMed
Kraemer, HCEvaluating medical tests: objective and quantitative guidelines. Newbury Park, CA: Sage Publications; 1992.Google Scholar
LeBeau, RT, Glenn, DE, Hanover, L, Beesdo-Baum, K, Wittchen, HU, Craske, MGA dimensional approach to measuring anxiety for DSM-5. Int J Methods Psychiatr Res 2012;21(4):258–272.CrossRefGoogle ScholarPubMed
McNeil, BJ, Keeler, E, Adelstein, SJPrimer on certain elements of medical decision making. N Engl J Med 1975;293:211–215.CrossRefGoogle ScholarPubMed
Pini, S, Perkonigg, A, Tansella, M, Wittchen, HUPrevalence and 12-month outcome of threshold and subthreshold mental disorders in primary care. J Affect Disord 1999;56:37–48.CrossRefGoogle ScholarPubMed
Raykov, TBehavioral scale reliability and measurement invariance evaluation using latent variable modeling. Behav Ther 2004;35:299–331.CrossRefGoogle Scholar
Reed, V, Gander, F, Pfister, H, Steiger, A, Sonntag, H, Trenkwalder, C, et al.To what degree the Composite International Diagnostic Interview (CIDI) correctly identifies DSM-IV disorders. Testing validity issues in a clinical sample. Int J Methods Psychiatr Res 1998;7:142–155.CrossRefGoogle Scholar
Regier, DMerging categorical and dimensional diagnoses of mental disorders. Epidemiol Psychiatr Sci 2012;21:267–269.CrossRefGoogle ScholarPubMed
Savitz, DA, Olshan, AFMultiple comparisons and related issues in the interpretation of epidemiologic data. Am J Epidemiol 1995;142:904–908.CrossRefGoogle ScholarPubMed
Shear, KM, Bjelland, I, Beesdo, K, Gloster, AT, Wittchen, HUSupplementary dimensional assessment in anxiety disorders. Int J Methods Psychiatr Res 2007;16:S52–S64.CrossRefGoogle ScholarPubMed
Söderberg, P, Tungström, S, Armelius, BAReliability of global assessment of functioning ratings made by clinical psychiatric staff. Psychiatr Serv 2005;56:434–438.Google ScholarPubMed
StataCorp, Stata Statistical Software: Release 12. College Station, TX: StataCorp; 2011.Google Scholar
Wittchen, HUReliability and validity studies of the WHO-Composite International Diagnostic Interview (CIDI): a critical review. J Psychiatr Res 1994;28:57.CrossRefGoogle ScholarPubMed
Wittchen, HU, Beesdo, K, Gloster, AA new metastructure of mental disorders: helpful step into the future or a harmful step back to the past? Commentary. Psychol Med 2009;39:2083–2089.CrossRefGoogle Scholar
Wittchen, HU, Höfler, M, Gloster, AT, Craske, MG, Beesdo, KOptions and dilemmas of dimensional measures for DSM-5. Which types of measures fare best in predicting course and outcome? In: Regier, D.A., Narrow, W.E., Kuhl, E.A., Kupfer, D.J., editors. The conceptual evolution of DSM-5. Arlington: American Psychiatric Publishing, Inc; 2010.Google Scholar
Wittchen, HU, Kessler, RC, Üstün, TBProperties of the Composite International Diagnostic Interview (CIDI) for measuring mental health outcome. In: Tansella, M., Thornicroft, G., editors. Mental Health Outcome Measures. 2nd ed, London: Gaskell; 2001. p. 212–227.Google Scholar
Wittchen, HU, Lachner, G, Wunderlich, U, Pfister, HTest-retest reliability of the computerized DSM-IV version of the Munich-Composite International Diagnostic Interview (M-CIDI). Soc Psychiatry Psychiatr Epidemiol 1998;33:568–578.CrossRefGoogle Scholar
Wittchen, HU, Lieb, R, Schuster, P, Oldehinkel, AJWhen is onset? Investigations into early developmental stages of anxiety and depressive disorders. In: Rapoport, J.L., editors. Childhood onset of adult psychopathology, clinical and research advances. Washington: American Psychiatric Press; 1999. p. 259–302.Google Scholar
Wittchen, HU, Pfister, HDIA-X-Interviews. Manual für Screening-Verfahren und Interview; Interviewheft Längsschnittuntersuchung (DIA-X-Lifetime); Ergänzungsheft (DIA-X-Lifetime); Interviewheft Querschnittuntersuchung (DIA-X-12 Monate); Ergänzungsheft (DIA-X-12Monate); PC-Programm zur Durchführung des Interviews (Längs- und Querschnittuntersuchung); Auswertungsprogramm. Frankfurt: Swets & Zeitlinger; 1997.Google Scholar
Submit a response

Comments

No Comments have been published for this article.