Is the Generalized Anxiety Disorder Symptom of Worry Just Another Form of Neuroticism? A 5-Year Longitudinal Study of Adolescents From the General Population

Objective: Generalized anxiety disorder (GAD) is a commonly occurring anxiety disorder that many times is characterized by an onset in adolescence and symptoms that increase in severity into adulthood. Due to the persistent nature of the disorder’s primary symptom of worry, which appears more related to a personality trait than an anxiety state, the current DSM-IV nosology of GAD has been debated. Recently, evidence is accumulating that suggests that the GAD symptom of worry is strongly related to the personality trait of neuroticism. This study investigates whether the GAD symptom of worry and neuroticism are best explained as 1 general factor or as 2 distinct entities in adolescents. Additionally, the interrelation over time between the GAD symptom of worry and neuroticism in adolescents is examined.

Method: Dutch secondary school adolescents from the general community were prospectively studied annually for 5 years. The adolescent population consisted of 923 early adolescents (49% girls) and 390 middle adolescents (57% girls), with mean ages of 12 and 16 years, respectively, on the first measurement wave. At all 5 waves, the adolescents completed self-rated measures of GAD and neurotic symptoms.

Results: Confirmatory factor analyses established that the GAD symptom of worry and neuroticism are 2 distinct entities, and structural equation modeling demonstrated very strong interrelated properties between these 2 entities. These findings did not differ between the adolescent sex and age groups.

Conclusions: The findings suggest that the GAD symptom of worry is more akin to a personality trait than an anxiety state in adolescents, which may hold implications for the current nosology and treatment of GAD.

J Clin Psychiatry 2010;71(7):942-948

Submitted: July 3, 2009; accepted September 10, 2009.

Online ahead of print: May 4, 2010 (doi:10.4088/JCP.09m05506blu).

Corresponding author: William W. Hale III, PhD, Utrecht University, Research Center Adolescent Development, PO Box 80.140, 3508 TC Utrecht, The Netherlands (b.hale@uu.nl).