Diagnostic Features

Diagnostically, GAD, PTSD, and OCD share a number of common features with depression. Repetitive, negative thinking is common to both depression and GAD. The repetitive thinking in GAD is in the form of worry, the content of which typically regards possible negative outcomes for future events (Dozois, Dobson, & Westra, 2004). In depression, the repetitive thinking is in the form of "rumination" which has been defined as behaviors and thoughts that focus the individual's attention on his/her depressive symptoms, and the implications and consequences of these symptoms (Nolen-Hoeksema, 1991). Individuals tend to negatively appraise themselves, their feelings, behaviors, situations, life stresses, and ability to cope. Depression and OCD also share the common feature of negative repetitive thinking. However, the main distinction is that the obsessions are "ego-dystonic" in OCD, which means that the thoughts are mood-incongruent and cause the individual distress, whereas the negative thinking is generally mood-congruent in depression. PTSD and MDD also have a common feature, in that exposure to a traumatic event or significant stressor is associated with the onset of both disorders (Shalev et al., 1998). The central feature of PTSD is that the symptomatology develops following an acute, extreme traumatic event. Similarly, in depression, negative life events have been implicated in the onset of depressive episodes; however, the accumulative effect of several negative life events or of chronic stress has also been associated with depression onset (Rowa, Beiling, & Segal, 2005).

One important issue concerns whether comorbidity among depressive and anxiety disorders should be diagnosed as distinct entities or as a mixed anxiety-depressive disorder (Zinbarg & Barlow, 1991). At present, there is a paucity of research to support mixed anxiety-depression as a distinct diagnostic category that would better account for the symptom picture, although it currently exists in the section on criteria sets and axes for further study in the text revision of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; American Psychiatric Association, 2000). In addition, there is literature to suggest that the anxiety and mood disorders share common features, as well as features that are unique from one another (cf. Brown, Chorpita, & Barlow, 1998; Dozois et al., 2004). Specific diagnostic issues are beyond the scope of this chapter, but we note that diagnostic overlap continues to be debated. However, for treatment, there are a number of advantages for conceptualizing these disorders as separate entities. A DSM-IV diagnosis can not only aid in the communication with other professionals but also assist in the identification of the appropriate scientific base regarding the disorder and its treatment options.

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