Anxiety and Related Disorders Interview Schedule for DSM-5® (ADIS-5) - Adult and Lifetime Version: Clinician Manual

30 Pages·2014·0.49 MB·English

by  Timothy A. Brown

Anxiety and Related Disorders
Interview Schedule
for DSM-5® (ADIS-5)
Adult and Lifetime Version
Clinician Manual
Timothy A. Brown
David H. Barlow
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Library of Congress Cataloging-in-Publication Data
Brown, Timothy A., 1960– author.
Anxiety and related disorders interview schedule for DSM-5, adult and lifetime version :
clinician manual / Timothy A. Brown, David H. Barlow.
pages cm
ISBN 978–0–19–932474–3 (acid-free paper) 1. Anxiety—Diagnosis—Handbooks, manuals, etc.
2. Mental illness—Classification—Handbooks, manuals, etc. 3. Interviewing in psychiatry.
4. Diagnostic and statistical manual of mental disorders. I. Barlow, David H., author. II. Title.
RC531.B76 2014
616.85′22—dc23
2013033944
9 8 7 6 5 4 3 2 1
Printed in the United States of America
on acid-free paper
ABOUT THE AUTHORS
Timothy A. Brown received his PsyD from the Virginia Consortium for Professional
Psychology in 1988. He has published numerous scientific articles and chapters in the area of anxiety
and mood disorders, and quantitative research methods. Presently, he is Professor in the Psychology
Department at Boston University, and Director of Research and Research Administration of the Center
for Anxiety and Related Disorders at Boston University. In addition to his own funded research on
the classification and psychopathology of emotional disorders, he has been a statistical investigator/
consultant on numerous federally funded research grants. He was a member of the DSM-5 Research
Planning Committee and was an Advisor to the DSM-5 Anxiety Disorders Workgroup. Currently,
his research has focused on dimensional approaches to emotional disorder classification, the role of
temperament in the psychopathology and longitudinal course of emotional disorders, and diathesis-
stress models of emotional disorders (e.g., interaction of novel candidate genes and life stress on the
temporal course of emotional disorders).
David H. Barlow received his PhD from the University of Vermont in 1969 and has
published over 500 articles and chapters as well as over 60 books and clinical manuals, mostly in
the area of emotional disorders and clinical research methodology. The book and manuals have been
translated into over 20 languages, including Arabic, Chinese, Hindi, and Russian. He was formerly
Professor of Psychiatry at the University of Mississippi Medical Center and Professor of Psychiatry
and Psychology at Brown University and founded clinical psychology internships in both settings.
He was also Distinguished Professor in the Department of Psychology at the University at Albany,
State University of New York. Currently, he is Professor of Psychology and Psychiatry, and Founder
and Director Emeritus, of the Center for Anxiety and Related Disorders at Boston University. Dr.
Barlow is the recipient of the 2000 American Psychological Association (APA) Distinguished
Scientific Award for the Applications of Psychology, and the James McKeen Cattell Fellow Award
from the Association for Psychological Science, honoring individuals for their lifetime of significant
intellectual achievements in applied psychological research. He is also the recipient of the 2008
Career/Lifetime Achievement Award, Association for Behavioral and Cognitive Therapies (ABCT);
and recipient of the 2000 Distinguished Scientific Contribution Award from the Society of Clinical
Psychology of the APA. He also received an award in appreciation of outstanding achievements
from the General Hospital of the Chinese People’s Liberation Army, Beijing, with an appointment
as Honorary Visiting Professor of Clinical Psychology. During the 1997–1998 academic year, he
was Fritz Redlich Fellow at the Center for Advanced Study in Behavioral Sciences, in Palo Alto,
California. Other awards include Career Contribution Awards from the Massachusetts, California,
and Connecticut Psychological Associations; the 2004 C. Charles Burlingame Award from the
Institute of Living in Hartford, Connecticut; the First Graduate Alumni Scholar Award from the
Graduate College, University of Vermont; the Masters and Johnson Award, from the Society for
Sex Therapy and Research; a certificate of appreciation for contributions to women in clinical
psychology from the Society of Clinical Psychology, Section IV: the Clinical Psychology of Women;
and a MERIT award from the National Institute of Mental Health for long-term contributions to
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the clinical research effort. His research has been continually funded by the National Institutes of
Health for over 40 years. In 2004 he received an Honorary Doctorate in Humane Letters from the
Massachusetts School of Professional Psychology, and in 2006, the American Board of Professional
Psychology’s Distinguished Service Award to the Profession of Psychology. He is Past-President
of the Society of Clinical Psychology of the APA and the ABCT, Past-Editor of several journals
including Clinical Psychology: Science and Practice and Behavior Therapy, and currently Editor-
in-Chief of the “Treatments That Work” series for Oxford University Press. He was a member of the
DSM-IV Task Force of the American Psychiatric Association, and a Co-Chair of the Work Group for
revising the anxiety disorder categories. He is a Diplomate in Clinical Psychology of the American
Board of Professional Psychology and maintains a private practice.
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Introduction
The Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5; Brown &
Barlow, 2014a) is a structured interview designed to diagnose current anxiety, mood, obsessive-
compulsive, trauma, and related disorders (e.g., somatic symptom, substance use) and to permit
differential diagnosis among these disorders according to DSM-5 criteria (American Psychiatric
Association, 2013). In most diagnostic sections, the ADIS-5 also provides (a) dimensional assessment
of the key and associated features of disorders and (b) inquiry to foster the functional analysis of the
various disorders (e.g., nature of situations avoided, content of fear cognitions). Diagnostic sections
in addition to anxiety and mood disorders are included because of their high comorbidity rate with
these conditions and because the presenting symptoms of these other disorders are often quite similar
to those of the anxiety and mood disorders (e.g., illness anxiety disorder and generalized anxiety
disorder). The ADIS-5 contains screening questions for a variety of other conditions including
hoarding disorder, impulse control disorders, eating disorders, attention deficit disorder, dissociative
disorders, and psychotic disorders. Other sections of the ADIS-5 include the assessment of episodic
and ongoing life stress, medical and psychiatric treatment history, and familial psychiatric history.
The Anxiety and Related Disorders Interview Schedule for DSM-5: Lifetime Version
(ADIS-5L; Brown & Barlow, 2014b) contains all of the sections included in the ADIS-5. However,
unlike the ADIS-5, the ADIS-5L is designed to establish past (lifetime) diagnoses as well. The
ADIS-5L also contains a Diagnostic Timeline to assist in the determination of the onset, remission,
and temporal sequence of disorders. This manual has been developed to accompany both the ADIS-5
and ADIS-5L. Because the ADIS-5 and the ADIS-5L differ only in that the latter contains sections to
assess past diagnoses, the abbreviation “ADIS-5” will be used throughout the manual in discussing
information germane to both schedules. When discussing issues specific to the ADIS-5L, the
abbreviation “ADIS-5L” will be used.
Because the ADIS-5 is designed for the detailed examination of the emotional disorders and
related problems, it will be of most value for research and clinical applications directly related to these
problem areas. More comprehensive structured interviews may be better suited for general outpatient
clinics or more broad-based research efforts that aim to evaluate all the DSM-5 disorders. For these
purposes, we recommend the Structured Clinical Interview for DSM-5. However, such interviews
provide a considerably less detailed evaluation of the emotional disorders than does the ADIS-5.
The ADIS-5 and its predecessors (the ADIS, ADIS-R, and ADIS-IV for DSM-III, DSM-III-R,
and DSM-IV, respectively) were developed over the years at the Center for Anxiety and Related
Disorders at Boston University (and previously, the Center for Stress and Anxiety Disorders at the
University of Albany, New York), supported in part by funds from the National Institute of Mental
Health. The content and wording of questions, as well as the general organization of the interview,
are based on several years of experience in interviewing and diagnosing patients with emotional
disorders. Previous editions of the ADIS have demonstrated good reliability for the majority of
disorders covered (e.g., Di Nardo, Moras, Barlow, Rapee, & Brown, 1993). Our most recent study
entailing two independent administrations of the ADIS-IV (Brown, Di Nardo, Lehman, & Campbell,
2001) indicated good-to-excellent interrater agreement for current DSM-IV disorders (range of
κs = .67 to .86), except dysthymia (κ = .31).
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Uses of the ADIS-5
Clinical applications. Diagnostic evaluation is crucial to treatment planning. Before
treatment planning can be initiated, it is important to obtain a comprehensive evaluation of the
presenting complaint and any co-occurring disorders, both psychological and medical. The ADIS-5
was developed to facilitate differential diagnosis among the emotional disorders and commonly co-
occurring disorders. This inquiry also enables the clinician to understand the functional relationships
among these disorders and their associated symptoms. In many diagnostic sections, the line of inquiry
goes beyond establishing DSM-5 diagnoses to focus on the functional relationships among specific
symptoms. For instance, there are many symptoms that are shared among the range of emotional
disorders (e.g., panic attacks, social anxiety, worry, and situational avoidance). Moreover, many
patients with emotional disorders present with more than one disorder, referred to as comorbidity
(cf. Brown, Campbell, Lehman, Grisham, & Mancill, 2001). DSM-5 allows for multiple diagnoses,
following certain exclusionary rules. For example, generalized anxiety disorder (GAD) can be
assigned in the presence of other disorders, provided that the focus of anxiety and worry is not
confined to features of another disorder, and the excessive worry does not occur exclusively during
the course of certain other conditions (e.g., mood and psychotic disorders). Thus, a potential issue for
differential diagnosis involving GAD is to determine if all of the symptoms reported by the patient
should be subsumed under a co-occurring disorder or whether the symptoms form an independent
disorder.
Even for purely clinical applications, we favor a structured interview format such as the
ADIS-5 for differential diagnosis because it ensures the systematic inquiry necessary to determine
the relationships among emotional disorder symptoms. In each diagnostic section of the ADIS-5,
there are questions designed to determine if the patient meets the diagnostic criteria for that disorder,
the exact focus of concern associated with each symptom, and the relationship of the symptom to
symptoms reported by the patient in other diagnostic sections. Systematic and detailed questioning
of this nature is necessary for reliable differential diagnosis.
Research applications. In clinical research, it is essential that the methods used to diagnose
patients for inclusion in a study have demonstrated reliability and validity. Therefore, a structured
interview is needed to reduce information variance and interviewer variance, and to ensure
replicability of diagnostic procedures. In addition to items assessing basic diagnostic criteria (and
differential diagnosis), the ADIS-5 includes a number of questions designed to provide a systematic
and quantifiable assessment of the various dimensional aspects of the disorder. In most diagnostic
sections, the initial screening questions are linked to the key features of the disorder, and have been
designed to be rated on a dichotomous basis (i.e., yes/no). After the initial screening items, the inquiry
proceeds to symptom ratings that are also linked to the key features of the disorder, but these ratings
are made dimensionally (i.e., 0–8 scales) rather than dichotomously. This assessment approach is
based on a vast literature attesting to the fact that the key and associated features of disorders operate
on a continuum rather than in a binary (presence/absence) fashion (e.g., symptoms of social anxiety
are not specific to social anxiety disorder but are found in varying degrees in other disorders and in
individuals without a DSM-5 disorder; cf. Brown & Barlow, 2005, 2009). Dimensional assessment
has many advantages over a purely binary (DSM-5 diagnosis) approach, including the ability to better
capture individual differences in disorder severity and to detect salient subclinical presentations
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(e.g., individuals who evidence several features of a disorder, but not to an extent that crosses the
DSM-5 threshold). In applied research, these dimensional ratings (e.g., composite of the fear ratings
for the 15 social situations in the Social Anxiety Disorder section) are often used as treatment outcome
variables (e.g., more sensitive to change than binary outcomes) as well as dimensional indicators of
disorder features in factor analytic, regression, and structural equation models (e.g., Brown, 2007;
Naragon-Gainey, Gallagher, & Brown, in press).
Changes Introduced in the ADIS-5
Although many of the revisions to the ADIS-5 and ADIS-5L are also discussed intermittently
in subsequent sections of this manual, this section provides a condensed, nonexhaustive overview of
the changes and new features of the interview, for individuals who have used previous versions of
the ADIS.
Name of interview. It would be appropriate to begin this section by acknowledging that although
the ADIS acronym has been retained, the actual name of the interview has been changed to “Anxiety
and Related Disorders Interview Schedule for DSM-5.” Given the breadth of diagnostic coverage
provided by the ADIS-5, it would be misleading and would sell the interview short to refer to it simply
as an anxiety disorders interview. In fact, especially after the reorganization of diagnoses in DSM-5,
anxiety disorders represent a small number of the diagnoses covered by full diagnostic sections in the
ADIS-5. Of the 16 full diagnostic sections in the ADIS-5, only 6 are anxiety disorders per the DSM-5
classification. The remaining 10 diagnostic sections, all of which corresponding to disorders that overlap
or co-occur with anxiety disorders (e.g., mood disorders, somatic symptom disorders), provide the same
high level of diagnostic assessment as the anxiety disorder diagnostic sections. Thus, the name of the
interview was revised to better reflect the range of diagnostic coverage offered by the ADIS-5.
Deleted sections. The ADIS-5 no longer includes the Hamilton Rating Scales for Anxiety
and Depression given the rather outdated nature and poor psychometric quality of these ratings. The
Mixed Anxiety Depression diagnostic section has been deleted given the elimination of this category
from DSM-5. In the ADIS-5, a separate section no longer exists for Acute Stress Disorder because all
of the information necessary for assigning this condition can be obtained in the Posttraumatic Stress
Disorder diagnostic section.
New diagnostic sections. Because separation anxiety disorder is now classified by DSM-5 as
an anxiety disorder that can be assigned to adults, the ADIS-5 contains a Separation Anxiety Disorder
section. The inclusion of this section in the ADIS-5L will also foster the evaluation of separation
anxiety disorder as a past (childhood) diagnosis, a common type of comorbidity that may have been
missed in earlier versions of the ADIS. In addition, the ADIS-5 includes a diagnostic section for body
dysmorphic disorder (now classified by DSM-5 as an “obsessive-compulsive and related disorder”),
a condition that may have considerable diagnostic and phenotypic overlap with other emotional
disorders such as obsessive-compulsive disorder and social anxiety disorder.
Organizational changes. As discussed in more detail later, the Medical/Treatment History
section has been moved to the front of the interview to assess such matters as the status and
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stabilization of medical and psychological treatments, and the existence of medical conditions that
may be germane to differential diagnosis and the overall clinical picture. In the Agoraphobia and
Major Depressive Disorder sections, dimensional ratings of these disorders are now made regardless
of the patient’s replies to questions in Initial Inquiry. It was deemed important to obtain dimensional
assessment of these conditions in all patients given (a) agoraphobia’s status as a stand-alone disorder
in DSM-5 and (b) the need to have a dimensional representation of depression in addition to the
anxiety disorders. Last, the interviewer can now skip out earlier in the Alcohol Use Disorder and
Substance Use Disorders sections if no evidence of excessive use is noted.
Expansions to diagnostic sections. In the Generalized Anxiety Disorder section, there is an
optional subsection for rating worry behaviors, based on a diagnostic criterion that was considered but
ultimately rejected for DSM-5. In Specific Phobia, the rating for animals has been expanded from a
single rating (in the ADIS-IV) to entail four common types of animal phobias (also with space to rate
an “other” animal phobia). The Posttraumatic Stress Disorder section has been revised substantially
to incorporate major revisions to this diagnosis, but also to provide a systematic evaluation of trauma
exposure history (which was an open-ended question in earlier versions of the ADIS). The Substance
Use Disorders section was expanded to foster the rating and diagnostic assessment of multiple current
and past substance use disorders. The Other Disorders Screening section has been expanded to screen
for additional disorders and symptoms including hoarding, eating disorders, and homicidal thought/
intent.
In the Major Depressive Disorder and Bipolar/Cyclothymia sections of the ADIS-5, the
PAST EPISODES subsection is included. Although the ADIS-5 is not designed to assess for all past
diagnoses, it was deemed important to assess past episodes of these conditions given the episodic
nature of these disorders and to promote accurate assignment of DSM-5 course specifiers (e.g., single
versus recurrent episode).
Clinical severity rating and dimensional ratings. For reasons discussed in the Assigning
Diagnoses section of this manual, it is no longer required that the principal diagnosis be assigned the
highest clinical severity rating (i.e., principal diagnosis is denoted by a label, not by a quantitative
rating). In addition, significant changes have been made with regard to the decision rules and order
in which dimensional ratings are assigned in the RATINGS subsection of the diagnostic sections.
The nature and reasons for these changes can be found in the “Organization of Diagnostic Sections”
portion of this manual.
Miscellaneous revisions. The Clinician’s Ratings and Diagnoses page has been revised
considerably, in part to be consistent with the fact that DSM-5 no longer uses a five-axis diagnostic
system (e.g., no differentiation is made between Axis I and Axis II disorders). In addition, many
more specific changes have been made throughout the interview protocol such as revising the
wording of items to improve the ease and clarity of administration, and reorganization and expansion
of symptom ratings in accord with DSM-5 changes and to improve coverage. For instance, the
SITUATION RATINGS subsection in Social Anxiety Disorder has been reorganized and expanded
to foster the assignment of the new diagnostic specifier, “Performance only.” The SITUATION
RATINGS subsection in Agoraphobia has been rearranged to assist with the evaluation of the new
DSM-5 requirement that the agoraphobic fear must apply to two of five types of situations (public
transportation, open spaces, enclosed places, crowds/lines, being outside of home alone).