اختلال اضطراب فراگیر: ارتباط با ضمیمه خود گزارش شده

Even though generalized anxiety disorder (GAD) is one of the most common of the anxiety disorders, relatively little is known about its precursors. Bowlby's attachment theory provides a framework within which these precursors can be considered. According to Bowlby, adult anxiety may be rooted in childhood experiences that leave a child uncertain of the availability of a protective figure in times of trouble. Furthermore, adult “current state of mind with respect to attachment” is thought to relate to adult anxiety. Both attachment-related components were assessed with 8 subscales of the Perceptions of Adult Attachment Questionnaire (PAAQ). Clinically severe GAD clients who were about to begin therapy reported experiencing less maternal love in childhood, greater maternal rejection/neglect, and more maternal role-reversal/enmeshment than did control participants. In keeping with a cumulative risk model, risk for GAD increased as indices of poor childhood attachment experience increased. GAD clients, in contrast to controls, also reported greater current vulnerability in relation to their mothers as well as more difficulty accessing childhood memories. Logistic regression analyses revealed that elevations on PAAQ subscales could significantly predict GAD vs. non-GAD status. Results and the implications for advancing the theory and treatment of GAD are discussed.

Generalized anxiety disorder (GAD) is one of the least studied of the anxiety disorders, despite the fact that epidemiological studies reveal that it is one of the most common (Dugas, 2000, Flannery-Schroeder, 2004, Kessler et al., 2001 and Rapee, 1991). GAD is also a frequent additional diagnosis to several other anxiety disorders (Brown and Barlow, 1992 and Curry et al., 2004) and contains a central feature (chronic worry) pervasive throughout the anxiety disorders (Barlow, 1988 and Mennin et al., 2004). According to DSM-III-R and DSM-IV criteria ( American Psychiatric Association, 1987 and American Psychiatric Association, 1994), GAD is characterized by the experience of chronic excessive worry over multiple life circumstances. Borkovec and colleagues (Borkovec, Alcaine, & Behar, 2004) have theorized about the function of pervasive worry in GAD. They have suggested that individuals with GAD avoid experiencing distressing negative emotions (and concurrent autonomic arousal) in the short run through engagement in the abstract, verbal-linguistic process of worry. In essence, individuals with GAD distance themselves from negative feelings by shifting their attention from negative emotions towards abstracted, conceptual thoughts (i.e., worry). There is a growing body of empirical support for the avoidance model of GAD (see Borkovec et al., 2004, for a review).