Revised diagnostic criteria and a new structured interview for diagnosing anxiety disorders

In recent years there has been a growing interest in the diagnosis and treatment of Anxiety Disorders. A fundamental assumption of the newer treatments is the identification of specific subtypes of Anxiety Disorders. Although the DSM-III classification of Anxiety Disorders is widely accepted, research experience since its publication in 1980 has identified many problems with the classification and diagnostic criteria for the individual Anxiety Disorders. This paper discusses these problems and solutions proposed by an advisory committee to the American Psychiatric Association Work Group to Revise DSM-III. This paper also describes a new structured diagnostic interview that can be used to make the DSM-III-R Anxiety Disorders diagnoses in adults: the Structured Clinical Interview for DSM-III-R (SCID). The revised DSM-III-R criteria are embedded in this interview, which is modelled on the clinical diagnostic interview. Amongst the problems found in the DSM-III is that of multiple diagnoses and hierarchies. Although multiple diagnoses are encouraged where appropriate, the classification is organized hierarchically so that more pervasive disorders exclude the additional diagnosis of syndromes considered symptomatic of the more pervasive disorder. The exclusion criteria for the various disorders, which operationalize this hierarchical structure, have been criticized on various grounds, and research data on the concurrence of different syndromes suggest that the revision of DSM-III might do well to eliminate some of the diagnostic hierarchies that prevent the joint diagnosis of different syndromes. Revisions that address these concerns are proposed in the exclusion criteria for most of the Anxiety Disorders. Revisions are also proposed in the inclusion criteria for several of the Anxiety Disorders, based upon clinical and research experience with the DSM-III criteria since its publication.