GAD: Over-reactive and unstable mood

Abstract

• Generalized Anxiety Disorder (GAD) consists of an over-reactive and/or unstable mood that could be mistaken with mood swings and affective instability of bipolar disorder and borderline personality disorder. • Recognition of the over-reactive and/or unstable mood in GAD has significant clinical implication not to be misdiagnosed as bipolar disorder or borderline personality disorder that occurred in our research sample. • Inclusion of over-reactive and/or unstable mood in the next DSM edition as cardinal diagnostic criteria symptoms is a step towards a more comprehensive understanding of this very common psychiatric condition. We sought to clarify if over-reactive mood in Generalized Anxiety Disorder (GAD) could be misdiagnosed as mood swings of Bipolar Disorder, or with affective instability in Borderline Personality Disorder. We re-assessed 32 subjects who were referred to our clinic in 2020 and had been previously diagnosed with Bipolar and Borderline Personality Disorders, as they seem to fit more the diagnostic criteria of Generalized Anxiety Disorder (GAD), based on the structured clinical interview for DSM5 (SCID-DSM5) and our previously published general definition of this disorder. All the subjects met the DSM5 criteria of GAD and presented with excessive anxiety and worry lasting more than 6 months in different situations or spontaneous with no triggers, leading to dysfunctions in social, occupational, or any other important areas of the individual's life. The subjects also met our general definition of GAD and met the DSM5 diagnostic criteria for Social Anxiety Disorder, Panic Disorder and Major Depressive Disorder. Moreover some of these subjects had an over-reactive mood that was subjectively labeled by themselves as “mood swings”, but without any discreet hypomanic or manic episodes. Some of the subjects also described their mood as "unstable" that had led their previous clinicians with mislableing them with "affective instability" leading to the misdiagnosis of Borderline Personality Disorder. The result of the study showed that the over-reactive mood in GAD could simply by the patients be interpreted as mood swings and when reported to the physicians, diagnosed as Bipolar Disorder. In the same token the unstable mood in GAD could be taken as affective instability by the patients and the physicians, leading to the misdiagnosis of Borderline Personality Disorder. Other than mood over-reactivity and unstable mood in this sample that led their previous misdiagnoses with Bipolar and Borderline Personality Disorders, they were all presented with the symptoms of GAD like others without over-reactive and unstable mood. The findings of our present adds a new symptom of over-reactive mood in GAD that could be easily misinterpreted as mood swings and affective instability and misdiagnosed as Bipolar and Borderline Personality Disorders.