Everyone experiences being anxious or feeling depressed at some point during their lives. That's normal. But you might be thinking, “At what point do my anxiety . Learn more about mental and mood disorders such as depression, anxiety, bipolar etc. by visiting Mental Health America. Anxiety is a natural response to a stressful or dangerous situation. The body reacts to a situation with a racing heart, sweaty palms and shortness of breath.
and Disorders Anxiety Mood
First, GAD has established reliability and validity in its own right, and specific features e. Second, examination of the nature of the overlap of GAD and MDD with each other and with other disorders suggests a more complex pattern of differences between these conditions than has been suggested e.
Third, although findings suggest that GAD and MDD may have overlapping heritable characteristics, other evidence suggests that the two disorders may be distinguished by both environmental factors and temporal presentations. Finally, although overlap between GAD and MDD is reflected in their relationships to negative affectivity, temporal relationships between these disorders may be demonstrated by functional changes in emotional responsivity. The past two decades have seen considerable advances in understanding and treating anxiety and mood disorders.
However, despite the delineation of specific mechanisms e. Further, when multiple disorders are present, reliable diagnosis can be difficult. Particularly characteristic of this difficulty is generalized anxiety disorder GAD , the nosological integrity of which has been criticized [for a review, see Mennin et al. Although the reliability and validity of GAD have improved considerably because worry was established as its central feature, GAD exhibits high rates of comorbidity with unipolar mood disorders [see Brown et al.
Watson [ , ] criticized the rationally derived diagnostic classification system in Diagnostic and Statistical Manual of Mental Disorders DSM-IV [ American Psychiatric Association, ] for categorizing disorders on the basis of shared phenomenological features rather than empirical data. He explained that this system assumes weak relationships across diagnostic categories e.
Citing findings from epidemiological samples, he explained that the overlap between GAD and MDD is substantial [tetrachoric correlations between disorders range from. Further, he reviewed structural modeling studies that examined either symptom patterns or diagnoses [e.
Watson reviewed genotypic data [e. Finally, Watson also noted that both conditions respond to treatment with serotonin and norepinephrine reuptake inhibitors, further suggesting a shared relationship between GAD and MDD.
Although GAD and the unipolar mood disorders are significantly related, removing GAD from the anxiety disorders may be premature for two main reasons. First, this decision may not fully reflect the complex relationship that GAD shares with both mood and anxiety disorders. Second, the decision to remove GAD from the anxiety disorders arises without fully accounting for the relationship between mood disorders and anxiety disorders other than GAD.
In the remainder of this paper, we consider six issues that challenge the arguments and suggestions of Watson [e. Many investigators cite the history of poor reliability of GAD as evidence for the need to reclassify. Other common criticisms of GAD are that it is not associated with independent contributions to impairment or distress and that it lacks clear and specific mechanisms that could differentiate it from other conditions. Although early versions of GAD suffered considerably from low reliability and poor validity, GAD as defined in the DSM-IV has, to the contrary, achieved diagnostic reliability on par with other anxiety and mood disorders and demonstrated unique mechanisms and patterns of impairment.
Early investigations into the reliability of GAD provided little support for the diagnosis. Reasons for low reliability may have included the lack of a clear marker for the condition and the inclusion of many nonspecific physical symptoms. DSM-IV further clarified the diagnosis by focusing physical symptoms around chronic levels of tension and removing symptoms that more likely to reflect acute autonomic arousal.
This change reduced rates of comorbidity with other anxiety disorders, increased the specificity of these physical symptoms [e. Numerous studies demonstrate that GAD with or without comorbid MDD is associated with significant impairment and distress. Primary-care patients with noncomorbid GAD reported more disability days in a 1-month period and poorer social functioning than other primary-care patients [e.
Lifetime GAD was independently associated with an increased likelihood of dissatisfaction with the respondent's main activity and an increased likelihood of dissatisfaction with family life. Both past-year and lifetime GAD were significantly associated with an increased likelihood of low overall perceived well-being. Taken together, these investigations suggest that both GAD and MDD demonstrate significant, yet distinguishable, associations with impairment.
Increases in reliability and delineation of the essential criteria for a diagnosis of GAD have led to the delineation of pathological mechanisms with greater specificity [see Borkovec et al. Worry is more elevated in GAD than other anxiety and mood disorders [e. Recently, other constructs have demonstrated patterns of specificity with GAD.
Intolerance of uncertainty, which refers to one's characteristic difficulty with ambiguous and uncertain possibilities, has been found to be elevated in individuals with GAD compared to those with other anxiety and mood disorders, including MDD [see Dugas et al.
In contrast, individuals with MDD, but not GAD, appear to have a greater certainty that negative events will occur [e. In particular, GAD was uniquely related to greater emotional reactivity and dysregulation, when variance associated with MDD was constrained. In contrast, MDD had a specific relationship with poor ability to understand emotional information and negative beliefs about the consequences of experiencing emotions, when variance associated with GAD was constrained.
Finally, although some biological mechanisms appear to be nonspecific e. However, a stronger test of the overlap between GAD and MDD comes from the examination of symptom sets rather than diagnoses, given that diagnoses are confounded by the categorization system from which they are derived [ Brown and Barlow, ].
In studies examining symptom-level items related to anxiety and mood pathology [e. Symptoms reflective of general anxiety and depressive symptoms both most strongly mapped onto negative emotionality, as in the diagnostic structural models, but only depressive symptoms mapped onto positive emotionality and only anxious symptoms mapped onto the autonomic arousal factor. One drawback to these symptom-level studies was the reliance on nonclinical samples.
In contrast, Brown et al. These findings not only support the relationship between GAD and MDD but also demonstrate important areas of divergence that should give us pause before making classification decisions based on structural overlap.
First, the specificity of the relationship between GAD and MDD appears to be affected by the nature of inputs to the structural models, which reflect a tautology given the considerable symptomatic overlap in the DSM-IV criteria for these disorders.
In addition, the findings from Brown et al. These points are expanded on herein. Although the diagnostic structural analyses [Krueger et al. One explanation for these heterogeneous results is the nature of the inputs submitted for modeling. However, such inputs to the model are highly related by design i.
Similarly, other analyses examining the overlap between mood and anxiety symptoms have shown greater distinctiveness in the conditions when anxious apprehension, assessed with the Penn State Worry Questionnaire, was included [e. Although the diagnostic criteria for GAD in the DSM-IV reduced rates of comorbidity with other anxiety disorders and increased the specificity of its physical symptoms [e.
However, defining GAD and MDD using highly overlapping symptoms may obscure important distinctions between these disorders as well. A quick look at the diagnostic criteria for GAD reveals that four out of the six associated physical symptoms i. In addition, four of the symptoms required for MDD i. Similarly, three of the symptoms of dysthymia i.
Given that three of these symptoms are required for GAD, five for MDD, and two for dysthymia, there is a high likelihood that individuals could meet criteria for GAD or a mood disorder with symptoms fully reflective of GAD and vice versa. Thus, it remains a question as to whether individuals who meet criteria for these diagnoses with overlapping symptoms are best described as having GAD, MDD, or both.
Although the majority of current symptoms of GAD were not well differentiated from depression, muscle tension appeared to be uniquely related to worry and difficulty concentrating appeared to have a particularly strong relationship with depression. Indeed, muscle tension was negatively related to depression in this study. These findings of the specificity of muscle tension to GAD are noteworthy given that physiological studies have also found differences between GAD and healthy controls [e.
One might question whether muscle tension was emphasized and difficulty concentrating de-emphasized, whether the patterns of co-occurrence between GAD and MDD might be altered.
Intolerance of uncertainty [ Dugas et al. Preliminary findings suggest that the inclusion of one item inquiring about intensity of emotional responses increases distinctiveness of GAD in relation to MDD. Another possibility for increasing distinctiveness of GAD is to alter what might be overly restrictive criteria in the current symptom set.
Further, Kessler et al. One possibility that has been offered by Kessler et al. It may be that decreasing arbitrarily restrictive criteria increases prevalence rates as both of these criteria changes did and, subsequently, decreases the effect of comorbidity.
Interestingly, bipolar II comorbidity did not decrease as a result of the duration change in the Kessler et al. These results suggest that classification of GAD and the mood disorders should reflect relationships with bipolar as well as unipolar mood disorders.
Despite these encouraging possibilities for modifying GAD criteria, its important to also note that some changes might lead to increases in the overlap between GAD and MDD, such as lifting the hierarchical requirement between the conditions i.
With dysthymia, the correlations with GAD and other anxiety disorders are almost indistinguishable. Tetrachoric correlations with dysthymia were equivalent for GAD. Slade and Watson  analyzed epidemiological data from the Australian National Survey of Mental Health and Well-Being and found similar tetrachoric correlations between the mood disorders and other anxiety disorders correlations ranged from.
Analysis of data from the clinical sample of Brown et al. Another consideration in pondering the overlap of mood disorders with other anxiety disorders versus GAD is the role of positive affectivity in MDD and social anxiety disorder. A strong relationship has been found between MDD and reduced positive affectivity [e. Similarly, a diminished response to positive stimuli in MDD has also been demonstrated in experimental settings using subjective, expressive, and psychophysiological indices [e.
A recent meta-analysis [ Bylsma et al. However, low positive affectivity does not appear to be specific to MDD. Learn More About the Trauma Institute. Individuals or couples who want to transition into parenthood but are experiencing difficulties becoming pregnant may feel alone, frustrated, ashamed or experience symptoms of depression or anxiety. Pregnancy therapy may be a helpful outlet to help cope with these feelings and reduce stress. The Comprehensive Assessment can serve as a one-time consultation, second opinion, or serve as the initial step before the treatment phase.
If requested, The Center is pleased to be able to share its conclusions with your current mental health professional. When it comes to anxiety or mood disorders we specialize in treating the whole person, not just your symptoms.
In all of our programs your comfort, privacy and long-term success are paramount. Our practice has been helping people for over thirty years overcome their problems. The Center offers cutting edge therapy designed to get you on the road to a speedy recovery.
We offer cognitive behavior therapy, psychodynamic psychotherapy, mindfulness meditation, group therapy. For individuals around the country or those wanting help from the comfort of your own home, we offer therapy via Facetime, Skype or phone. We have professionals available 7 days a week. For those who prefer a more short-term approach we offer weekend sessions for individuals or groups. Perfect for those with a less flexible work schedule. Youth Services Children and adolescents experience normal problems of growing up due to pressures of social media, school, socializing, self esteem or family.
In all instances, the child's discomfort is excessive and disproportionate to the situation. Other related difficulties include Selective Mutism, and Disruptive and Oppositional behavior. Depressed children and teenagers experience a change in their enjoyment of life.
They may be irritable and moody, complain of feeling bored all of the time, and have less interest in activities that they used to enjoy, such as playing sports or spending time with friends. Dysthymia is a more chronic condition than Major Depression. Children and teens explain their sadness as less severe and will often describe feeling "blah" or "blue. During some periods of time, the child is depressed; during other periods, the child feels elated, over confident, impulsive, and easily frustrated.
A member of our specialty team will meet with your family to perform a comprehensive assessment, which includes an interview and the completion of questionnaires. Our goal is to help you understand your child's behavior and specific difficulties, including any relevant diagnoses, and to provide you with recommendations for the most appropriate treatment plan to meet your family's needs.
Our treatment services are based on scientific research that indicates which treatments are most effective for particular childhood difficulties. When devising a treatment plan, it is our goal to tailor the therapeutic approach to meet the specific needs of your child.
We aim to address emotional symptoms and behaviors, as well as any impairment in social, academic, or family functioning. To provide comprehensive care, our clinicians can consult with professionals outside of our center as well, such as teachers or speech and language therapists. Two specific modalities for the treatment of anxiety and mood disorders are Cognitive-Behavioral Therapy CBT and medication:. The following services are being offered currently:.
Depression, Anxiety, & Mood DIsorders
The past two decades have seen considerable advances in understanding and treating anxiety and mood disorders. However, despite the delineation of specific . But some people experience feelings of anxiety or depression or suffer mood swings that are so severe and overwhelming that they interfere with personal. Anxiety, stress and mood issues are very common around the world. Our goal is to help every person learn how to recognize and face their fears.