DSM-IV and beyond: what is generalized anxiety disorder?

With the advent of DSM-III in the USA (1), a new disorder termed generalized anxiety disorder (GAD) was established separately from panic disorder. Because GAD was relegated to a residual category, it soon became a confusing diagnosis. Although revisions in DSM-III-R (2) removed GAD as a residual category, they also complicated the clinical examination necessary to arrive at a GAD diagnosis. With the publication of DSM-IV (3), GAD has been further refined in an attempt to improve the reliability and discriminability of the disorder. However, it continues to be controversial, and a number of issues remain unresolved.