DSM5广泛性焦虑障碍
作者: DSM / 10035次阅读 时间: 2014年8月11日
标签: DSM DSM5 广泛性焦虑 焦虑
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Generalized Anxiety Disorder 广泛性焦虑障碍
300.02(F41.1)

  1. 在至少6 个月的多数日子里,对于诸多事件或活动(例如工作或学校表现) ,表现出过分的焦虑和担心(焦虑性期待)。
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  2. 个体难以控制这种担心。心理学空间c2G+k1GF,A!U4y c.?

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  3. 这种焦虑和担心与下列6 种症状中至少3 种有关(在过去6个月中,至少一些症状在多数日子里存在)。
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    1. 坐立不安或感到激动或紧张。
    *m]G ^(lC-}:R$E+q02. 容易疲倦。
    B1u\b.|Y.l"o03 注意力难以集中或头脑一片空白。心理学空间w&o8T ^&Pz4\[ i8Z
    4. 易怒。
    /UCG%]e~b0H05. 肌肉紧张。
    PQ2w1I'q2K06. 睡眠障碍(难以入睡或保持睡眠状态,或休息不充分、质量不满意的睡眠)。心理学空间I1{ Z6I7irBn#g
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  4. 这种焦虑、担心或躯体症状引起有临床意义的痛苦,或导致社交、职业或其他重要功能方面的损害。
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  5. 这种障碍不能归因于某种物质(例如,滥用的毒品、药物)的生理效应,或其他躯体疾病(例如,甲状腺功能亢进) 。心理学空间k5D)H%HJA @$q,r
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  6. 这种障碍不能用其他精神障碍来更好地解释(例如,像惊恐碍中的焦虑或担心发生惊恐发作,像社交焦虑障碍[社交恐怖症]中的负性评价,像强迫症中的被污染或其他强迫思维,像分离焦虑障碍中的与依恋对象的离别,像创伤后应激障碍中的创伤性事件的提示物,像神经性厌食症中的体重增加,像躯体症状障碍中的躯体不适,像躯体变形障碍中的感到外貌存在瑕疵,像疾病焦虑障碍中的感到有严重的疾病,或像精神分裂症或妄想障碍中的妄想信念的内容)。

Diagnostic Features 诊断特征心理学空间 P }&z\g

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The essential feature of generalized anxiety disorder is excessive anxiety and worry (apprehensive expectation) about a number of events or activities. The intensity, duration, or frequency of the anxiety and worry is out of proportion to the actual likelihood or impact of the anticipated event. The individual finds it difficult to control the worry and to keep worrisome thoughts from interfering with attention to tasks at hand. Adults with generalized anxiety disorder often worry about everyday, routine life circumstances, such as possible job responsibilities, health and finances, the health of family members, misfortune to their children, or minor matters (e.g., doing household chores or being late for appointments). Children with generalized anxiety disorder tend to worry excessively about their competence or the quality of their performance. During the course of the disorder, the focus of worry may shift from one concern to another.心理学空间*Muz M Up B{+oL%r

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广泛性焦虑障碍的基本特征是对于诸多事件或活动产生过度的焦虑和担心(焦虑性期待)。紧张度、持续时间或焦虑和担心出现的频率都与现实可能性或预期事件的冲击不成比例。个体发觉很难控制担心的情绪,难以令担心的想法不打搅注意力,无法专注于手头上的任务。有广泛性焦虑障碍的成年人经常担心常规的生活情况,例如,可能的工作责任、健康状况和财务账目、家庭成员的健康、担心不幸的事儿会发生在孩子身上,或一些很小的事情(例如,做家务或约会迟到)。有广泛性焦虑障碍的儿童倾向于过分担心他们的能力或表现的水准。在这个障碍的病程中,担心的焦点会在不同主题之间迁移。

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vd%B,zG @*L"D%Uo0Several features distinguish generalized anxiety disorder from nonpathological anxiety. First, the worries associated with generalized anxiety disorder are excessive and typically interfere significantly with psychosocial functioning, whereas the worries of everyday life are not excessive and are perceived as more manageable and may be put off when more pressing matters arise. Second, the worries associated with generalized anxiety disorder are more pervasive, pronounced, and distressing; have longer duration; and frequently occur without précipitants. The greater the range of life circumstances about which a person worries (e.g., finances, children's safety, job performance), the more likely his or her symptoms are to meet criteria for generalized anxiety disorder. Third, everyday worries are much less likely to be accompanied by physical symptoms (e.g., restlessness or feeling keyed up or on edge). Individuals with generalized anxiety disorder report subjective distress due to constant worry and related impairment in social, occupational, or other important areas of functioning.心理学空间`$~xj#u2v1Ue2d

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用来鉴别广泛性焦虑障碍与非病理性焦虑的特征为:第一,与广泛性焦虑障碍有关的担心是过度的,且通常显著干扰心理社交功能,然而日常生活性的担心不过度且更可控,当更为紧急的事情出现时,可以暂时放下。第二,与广泛性焦虑障碍有关的担心更广泛、明显、令人痛苦,病程更长,在没有促发因素的前提下频繁发生。一个人对生活状况的焦虑越广泛(例如,财务情况、孩子的安全、工作业绩),他的症状就越可能符合广泛性焦虑障碍的诊断标准。第三,日常的担心伴随躯体症状(例如,坐立不安,感觉紧张或烦躁不安)的可能性较小。有广泛性焦虑障碍的个体会报告由于持续的焦虑和相关的社交、职业或其他重要功能领域受损所致的主观痛苦。

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Cf^"]S4`!s0The anxiety and worry are accompanied by at least three of the following additional symptoms: restlessness or feeling keyed up or on edge, being easily fatigued, difficulty concentrating or mind going blank, irritability, muscle tension, and disturbed sleep, although only one additional symptom is required in children.

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*C Sz R3cTq-E F0除了焦虑和担心外,还需具备下列额外症状中的至少三种:坐立不安,感觉紧张或烦躁,容易疲劳,注意力集中困难或思维出现空白,易激惹,肌肉紧张,睡眠紊乱;而在儿童身上,只需具备一种额外症状即可。心理学空间uz8Y#C~

Associated Features Supporting Diagnosis 支持诊断的有关特征心理学空间A9u-a4?j3oN

s8? w-jII0Associated with muscle tension, there may be trembling, twitching, feeling shaky, and muscle aches or soreness. Many individuals with generalized anxiety disorder also experience somatic symptoms (e.g., sweating, nausea, diarrhea) and an exaggerated startle response. Symptoms of autonomic hyperarousal (e.g., accelerated heart rate, shortness of breath, dizziness) are less prominent in generalized anxiety disorder than in other anxiety disorders, such as panic disorder. Other conditions that may be associated with stress (e.g., irritable bowel syndrome, headaches) frequently accompany generalized anxiety disorder.

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E'\H'_w0与肌肉紧张有关,可能出现震颤、抽搐、感觉颤抖、肌肉酸痛。许多有广泛性焦虑障碍的个体也经历过躯体症状(例如,出汗、恶心、腹泻)和过度的惊跳反射。自主神经过度觉醒的症状(例如,心跳加快、呼吸急促、眩晕)在广泛性焦虑障碍中不如其他焦虑障碍中明显(例如,惊恐障碍)。那些与应激有关的其他疾病(例如,肠易激综合征、头痛)频繁伴随广泛性焦虑障碍。

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Prevalence 患病率

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UKU fe s&tkX0The 12-month prevalence of generalized anxiety disorder is 0.9% among adolescents and 2.9% among adults in the general community of the United States. The 12-month prevalence for the disorder in other countries ranges from 0.4% to 3.6%. The lifetime morbid risk is 9.0%. Females are twice as likely as males to experience generalized anxiety disorder. The prevalence of the diagnosis peaks in middle age and declines across the later years of life. Individuals of European descent tend to experience generalized anxiety disorder more frequently than do individuals of non-European descent (i.e., Asian, African, Native American and Pacific Islander). Furthermore, individuals from developed countries are more likely than individuals from nondeveloped countries to report that they have experienced symptoms that meet criteria for generalized anxiety disorder in their lifetime.

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美国普通社区的青少年12个月的广泛性焦虑障碍患病率为0.9%,成年人为2.9%。在其他国家,该障碍12个月的患病率为0.4%-3.6%。终生患病的风险为9.0%。女性经历广泛性焦虑障碍的概率可能是男性的2倍。患病率在中年达到顶峰,随着年龄的增长逐步降低。欧洲人后裔比非欧洲人后裔(例如,亚洲人、非洲人、印第安人和太平洋岛屿居民)更容易经历广泛性焦虑障碍。而且,来自发达国家的个体比非发达国家的个体报告在他们的一生中曾经历过符合广泛性焦虑障碍诊断标准的症状的可能性要大。

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Development and Course 发展与病程心理学空间QaW _%wO9P+H

*P6b2M@r2v-c1r0Many individuals with generalized anxiety disorder report that they have felt anxious and nervous all of their lives. The median age at onset for generalized anxiety disorder is 30 years; however, age at onset is spread over a very broad range. The median age at onset is later than that for the other anxiety disorders. The symptoms of excessive worry and anxiety may occur early in life but are then manifested as an anxious temperament. Onset of the disorder rarely occurs prior to adolescence. The symptoms of generalized anxiety disorder tend to be chronic and wax and wane across the lifespan, fluctuating between syndromal and subsyndromal forms of the disorder. Rates of full remission are very low.心理学空间8kY!S r is

OMp:e hU0许多有广泛性焦虑障碍的个体报告他们在整个生命中都感到焦虑和紧张。广泛性焦虑障碍起病的中位年龄为30岁,而起病年龄的跨度很大。这一障碍起病的中位年龄比其他焦虑障碍更晚。过度担忧和焦虑的症状可能发生在生命早期,但后来表现为焦虑的气质。该障碍很少在青春期之前起病。广泛性焦虑障碍的症状倾向于是慢性的,在一生中有加重和减轻,经常在该疾病的临床症状和亚临床症状的形式之间波动,完全缓解的概率非常低。心理学空间8hw*L:J,l([

8@e+A;Y%{)_-U1n0The clinical expression of generalized anxiety disorder is relatively consistent across the lifespan. The primary difference across age groups is in the content of the individual's worry. Children and adolescents tend to worry more about school and sporting performance, whereas older adults report greater concern about the well-being of family or their own physical heath. Thus, the content of an individual's worry tends to be age appropriate. Younger adults experience greater severity of symptoms than do older adults.

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广泛性焦虑障碍的临床表现在一生中相对稳定。在不同年龄群体间最主要的差异是个体担忧的内容。儿童和青少年更多地担忧学业和体育成绩,而老年人更多地担忧家庭的幸福和他们自己的身体健康。因此,个体担忧的内容与其年龄相符。年轻人比老年人经历的症状更为严重。心理学空间 ue.V/f5E_ D

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The earlier in life individuals have symptoms that meet criteria for generalized anxiety disorder, the more comorbidity they tend to have and the more impaired they are likely to be. The advent of chronic physical disease can be a potent issue for excessive worry in the elderly. In the frail elderly, worries about safety—and especially about falling—may limit activities. In those with early cognitive impairment, what appears to be excessive worry about, for example, the whereabouts of things is probably better regarded as realistic given the cognitive impairment.

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x"a9j(S3A?1`}6N#|M0在生命越早期体验符合广泛性焦虑障碍症状的个体,可能会有更多的共病,也可能在功能上造成更严重的受损。慢性躯体疾病的出现可以成为老年人过度担心的严重问题。在那些体弱的老年人中,因为担忧安全(特别是跌倒),可能会限制他们的活动。在那些早期认知受损的个体中,似乎会更过度地担忧。例如,那些看起来过度担忧东西的位置的个体,考虑到其认知损害,应该被认为是现实的担忧。心理学空间l"CU3vK6J,Mxy

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In children and adolescents with generalized anxiety disorder, the anxieties and worries often concern the quality of their performance or competence at school or in sporting events, even when their performance is not being evaluated by others. There may be excessive concerns about punctuality. They may also worry about catastrophic events, such as earthquakes or nuclear war. Children with the disorder may be overly conforming, perfectionist, and unsure of themselves and tend to redo tasks because of excessive dissatisfaction with less-than-perfect performance. They are typically overzealous in seeking reassurance and approval and require excessive reassurance about their performance and other things they are worried about.心理学空间5en,OA+zqHR!E

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有广泛性焦虑障碍的儿童和青少年,经常焦虑和担忧他们在学校或运动会上的成绩或能力,即使当他人并未评价他们的成绩。他们可能存在对准时的过度在意。他们也可能担忧灾难性事件,例如地震或核战争。有该障碍的儿童可能过度遵守纪律,是完美主义者,对自己不确定,倾向于对不完美表现过度不满而一再返工。他们经常过分热衷于寻求确认和被赞同,对自己的成绩和其他担忧之事需要过多的反复确认。心理学空间:~ j0duX&r&z2m:]'[)v

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Generalized anxiety disorder may be overdiagnosed in children. When this diagnosis is being considered in children, a thorough evaluation for the presence of other childhood anxiety disorders and other mental disorders should be done to determine whether the worries may be better explained by one of these disorders. Separation anxiety disorder, social anxiety disorder (social phobia), and obsessive-compulsive disorder are often accompanied by worries that may mimic those described in generalized anxiety disorder. For example, a child with social anxiety disorder may be concerned about school performance because of fear of humiliation. Worries about illness may also be better explained by separation anxiety disorder or obsessive-compulsive disorder.心理学空间"V}wt7~?

[^:\E&b:Mp0在儿童中,广泛性焦虑障碍可能被过度诊断。当考虑儿童是否可诊断为这一障碍时,需对儿童期其他焦虑障碍和其他精神障碍进行全面的评估,以确定这些担忧是否可以更好地用其他障碍来解释。分离焦虑障碍、社交焦虑障碍(社交恐惧症)和强迫症通常伴随着担忧,他们与广泛性焦虑障碍中所描述的担忧相似。例如,有社交焦虑障碍的儿童可能担忧在学校的成绩,因为害怕被羞辱。关于担忧疾病可能更好地用分离焦虑障碍或强迫症来解释。

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Risk and Prognostic Factors 风险与预后因素

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.V Z/JZ Z0Temperamental.Behavioral inhibition, negative affectivity (neuroticism), and harm avoidance have been associated with generalized anxiety disorder.

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igO:Y.h:k)l3j0气质的:行为抑制,负面情感(神经质),以及对伤害的回避,与广泛性焦虑障碍相关。

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Environmental.Although childhood adversities and parental overprotection have been associated with generalized anxiety disorder, no environmental factors have been identified as specific to generalized anxiety disorder or necessary or sufficient for making the diagnosis.心理学空间u+q _n7\/x&}:`y,@,dz-jy

W.MJ#tHBXc0环境的:尽管儿童期负性事件和养育中的过度保护与广泛性焦虑障碍有关,但不确定是否有环境因素与广泛性焦虑障碍有特定关联,做诊断时,环境因素既不是必需的,也不是充分的。心理学空间%n$ab"eP

(agj"o Z aQ4De0Genetic and physiological.One-third of the risk of experiencing generalized anxiety disorder is genetic, and these genetic factors overlap with the risk of neuroticism and are shared with other anxiety and mood disorders, particularly major depressive disorder.心理学空间&g"GX \yCG

bzV6Nl`0遗传与生理的:经历广泛性焦虑障碍风险的个体有三分之一是遗传的,这些遗传因素与神经质风险重叠,与其他焦虑和心境障碍共享,尤其是重性抑郁障碍。

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Culture-Related Diagnostic Issues 文化相关的诊断问题心理学空间wH%~9t3{j}'HV

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There is considerable cultural variation in the expression of generalized anxiety disorder. For example, in some cultures, somatic symptoms predominate in the expression of the disorder, whereas in other cultures cognitive symptoms tend to predominate. This difference may be more evident on initial presentation than subsequently, as more symptoms are reported over time. There is no information as to whether the propensity for excessive worrying is related to culture, although the topic being worried about can be culture specific. It is important to consider the social and cultural context when evaluating whether worries about certain situations are excessive.

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6m~D.A1|_E&|5j0在广泛性焦虑障碍的表现上,存在相当多的文化差异。例如,在一些文化中,躯体症状在障碍表现中很突出,反之,在另外一些文化中,认知症状更为突出。初始表现比后期表现在这一差异中更为明显,因为随着时间推移,更多症状被报告。尚无信息显示过度担忧的倾向是否与文化有关,尽管被担忧的主题可以有文化的特异性。重要的是,当评估有关特定情境的担忧是否过分时,需考虑社会和文化的语境。心理学空间],}2aJ.Tfn

Gender-Related Diagnostic Issues 性别相关的诊断问题

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h"g&v~6r.z|+`0In clinical settings, generalized anxiety disorder is diagnosed somewhat more frequently in females than in males (about 55%-60% of those presenting with the disorder are female). In epidemiological studies, approximately two-thirds are female. Females and males who experience generalized anxiety disorder appear to have similar symptoms but demonstrate different patterns of comorbidity consistent with gender differences in the prevalence of disorders. In females, comorbidity is largely confined to the anxiety disorders and unipolar depression, whereas in males, comorbidity is more likely to extend to the substance use disorders as well.

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N4go`#G\0临床环境下,女性比男性更多地被诊断为广泛性焦虑障碍(表现为该障碍的个体中大约55%-60%为女性)。流行病学研究中,大约三分之二的个体是女性。经历广泛性焦虑障碍的女性和男性似乎拥有相同的症状,但是表现为不同的共病模式,在患病率上也体现出性别差异。女性中,共病很大程度上限于焦虑障碍和单相抑郁;而男性中,似乎更多地并发物质使用障碍。

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Functional Consequences of Generalized Anxiety Disorder 广泛性焦虑障碍的功能性后果心理学空间/e!@4p ZXe1nDKQ

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Excessive worrying impairs the individual's capacity to do things quickly and efficiently, whether at home or at work. The worrying takes time and energy; the associated symptoms of muscle tension and feeling keyed up or on edge, tiredness, difficulty concentrating, and disturbed sleep contribute to the impairment. Importantly the excessive worrying may impair the ability of individuals with generalized anxiety disorder to encourage confidence in their children.心理学空间/V2\+PW{`){9[

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不论在家庭中还是在工作中,过度担心损害了个体快速高效处理事务的能力。担忧会耗时、耗力;与肌肉紧张有关的症状,紧张或焦躁不安的感受,倦怠,难以集中注意力,以及睡眠紊乱都会加重损害。重要的是,过度担忧可能会损害有广泛性焦虑障碍的个体鼓励其孩子的自信的能力。

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TzDq#^OHM0Generalized anxiety disorder is associated with significant disability and distress that is independent of comorbid disorders, and most non-institutionalized adults with the disorder are moderately to seriously disabled. Generalized anxiety disorder accounts for 110 million disability days per annum in the U.S. population.

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不考虑共病障碍,广泛性焦虑障碍也与显著的残疾和痛苦有关,绝大多数不在养老机构居住的个体为中度到重度残疾。在美国,每年广泛性焦虑障碍的个体残疾天数达到1.1亿天。

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Differential Diagnosis 鉴别诊断

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Anxiety disorder due to another medical condition.The diagnosis of anxiety disorder associated with another medical condition should be assigned if the individual's anxiety and worry are judged, based on history, laboratory findings, or physical examination, to be a physiological effect of another specific medical condition (e.g., pheochromocytoma, hyperthyroidism).

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由于其他躯体疾病所致的焦虑障碍:如果基于病史、实验室检验或体格检查,可判断个体的焦虑和担忧是其他特定躯体疾病(例如,嗜铬细胞瘤、甲状腺功能亢进)的生理效应,就应诊断为与其他躯体疾病有关的焦虑障碍。心理学空间OD;?'d;Jc0x([

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Substance/medication-induced anxiety disorder.A substance/medication-induced anxiety disorder is distinguished from generalized anxiety disorder by the fact that a substance or medication (e.g., a drug of abuse, exposure to a toxin) is judged to be etiologically related to the anxiety. For example, severe anxiety that occurs only in the context of heavy coffee consumption would be diagnosed as caffeine-induced anxiety disorder. Social anxiety disorder. Individuals with social anxiety disorder often have anticipatory anxiety that is focused on upcoming social situations in which they must perform or be evaluated by others, whereas individuals with generalized anxiety disorder worry, whether or not they are being evaluated.

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1M7lz/R(B?0物质/药物所致的焦虑障碍:将物质+药物所致的焦虑障碍与广泛性焦虑障碍相鉴别,可通过判定一种物质或药物(例如,滥用的药物、接触毒素)是否与焦虑在病因学上相关。例如,只在饮用大量咖啡后才产生的严重焦虑将被诊断为咖啡因所致的焦虑障碍。心理学空间#lo-k8F{XR8v#z

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社交焦虑障碍:有社交焦虑障碍的个体通常有预期焦虑,集中于即将到来的社交情境,那时他们必须表演或被他人评判,然而,无论是否被评判,有广泛性焦虑障碍的个体都会担忧。心理学空间 t qpF)j U,o~ zW

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Obsessive-compulsive disorder.Several features distinguish the excessive worry of generalized anxiety disorder from the obsessional thoughts of obsessive-compulsive disorder. In generalized anxiety disorder the focus of the worry is about forthcoming problems, and it is the excessiveness of the worry about future events that is abnormal. In obsessive-compulsive disorder, the obsessions are inappropriate ideas that take the form of intrusive and unwanted thoughts, urges, or images.心理学空间v"\4}7X!{

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强迫障碍:有几个特征可以将广泛性焦虑障碍的个体的过度焦虑与强迫症的强迫性思维相区分:在广泛性焦虑障碍中,焦虑的焦点是即将来临的问题,是对未来事件的非正常的过度担忧。而在强迫症中,强迫思维是不恰当的观念,体现为侵入性或不想要的想法、冲动或画面。

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-v#Gi&Sxr0Posttraumatic stress disorder and adjustment disorders.Anxiety is invariably present in posttraumatic stress disorder. Generalized anxiety disorder is not diagnosed if the anxiety and worry are better explained by symptoms of posttraumatic stress disorder. Anxiety may also be present in adjustment disorder, but this residual category should be used only when the criteria are not met for any other disorder (including generalized anxiety disorder). Moreover, in adjustment disorders, the anxiety occurs in response to an identifiable stressor within 3 months of the onset of the stressor and does not persist for more than 6 months after the termination of the stressor or its consequences.

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创伤后应激障碍和适应障碍:焦虑在创伤后应激障碍中不同程度地存在。如果焦虑与担忧可以被创伤后应激障碍的症状更好地解释,就不能诊断为广泛性焦虑障碍。适应障碍中也可能存在焦虑,但只有当不符合任何其他障碍(包括广泛性焦虑障碍)的诊断标准时,才能使用这个诊断。而且,在适应障碍中,焦虑的产生是对能确认的应激源的反应,在应激源产生后的3个月内起病,在应激源或其后果终结后,持续不超过6个月。心理学空间Y;`e5z/Bc'Eb?/k

o[y-]:{,H\-U_'e0Depressive, bipolar, and psychotic disorders.Generalized anxiety/worry is a common associated feature of depressive, bipolar, and psychotic disorders and should not be diagnosed separately if the excessive worry has occurred only during the course of these conditions.

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5_cb,PffO"k0抑郁、双相与精神病性障碍:广泛性焦虑/担忧是抑郁、双相和精神病性障碍常见的相关特征,如果过度的担忧只发生于这些疾病的病程中,那就不能独立诊断为广泛性焦虑障碍。

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'U+i&hSm} Ur0Comorbidity 共病心理学空间4bm`+P8L:k6^G.Zw

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Individuals whose presentation meets criteria for generalized anxiety disorder are likely to have met, or currently meet, criteria for other anxiety and unipolar depressive disorders. The neuroticism or emotional liability that underpins this pattern of comorbidity is associated with temperamental antecedents and genetic and environmental risk factors shared between these disorders, although independent pathways are also possible. Comorbidity with substance use, conduct, psychotic, neurodevelopmental, and neurocognitive disorders is less common.

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{Q#\?f d,Hy0那些表现符合广泛性焦虑障碍的个体也可能符合或同时符合其他焦虑和单相抑郁障碍的诊断标准。与这些共病模式有关的神经质或情绪的易变性,和这些障碍共享气质和遗传以及环境风险因素,尽管也有可能独立存在。与物质使用、品行、精神病性、神经发育和神经认知障碍的共病较少见。

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TAG: DSM DSM5 广泛性焦虑 焦虑
«交往焦虑量表(Interaction Anxiousness Scale, IAS) 焦虑障碍 Anxiety
《焦虑障碍 Anxiety》
DSM5 社交焦虑障碍(社交恐惧症)Social Anxiety Disorder (Social Phobia)»
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