The concept of generalized anxiety disorder: between the too narrow and too wide diagnostic criteria.

The Structured Clinical Interview for DSM-III-R, modified for DSM-IV and ICD-10 Diagnostic Criteria for Research (ICD-10-DCR), was administered to 73 consecutive patients with agoraphobia/panic disorder in order to determine diagnostic agreement for comorbid generalized anxiety disorder (GAD) between DSM-IV and ICD-10-DCR and reexamine the GAD symptom structure and significance of each symptom as diagnostic criterion for GAD. The diagnostic agreement for GAD (kappa) was 0.86. The analysis of the frequency of GAD symptoms in 45 patients suggests that in order to better differentiate GAD from depression and other anxiety disorders, a diagnostic conceptualization of GAD may be improved with the requirement of the presence of at least 4 of the 7 first-rank symptoms (pertaining to tension, vigilance and scanning) and 1 of the 5 second-rank symptoms (pertaining to physiological hyperarousal).