International Journal of Methods in Psychiatric Research

Int. J. Methods Psychiatr. Res. 25(3): 232–239 (2016)

Published online 5 July 2016 in Wiley Online Library
(wileyonlinelibrary.com) DOI: 10.1002/mpr.1515

The DSM-5 Dimensional Anxiety Scales

in a Dutch non-clinical sample:
psychometric properties including the
adult separation anxiety disorder scale
ELINE L. MÖLLER1,2 & SUSAN M. BÖGELS1,2

1 Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
2 Research Priority Area Yield, University of Amsterdam, Amsterdam, The Netherlands

Key words Abstract

anxiety, dimensional assessment,
With DSM-5, the American Psychiatric Association encourages complementing
DSM-5, psychometrics
categorical diagnoses with dimensional severity ratings. We therefore examined
the psychometric properties of the DSM-5 Dimensional Anxiety Scales, a set of
Correspondence
brief dimensional scales that are consistent in content and structure and assess
Dr. Eline L. Möller, Research
DSM-5-based core features of anxiety disorders. Participants (285 males, 255 fe-
Institute of Child Development
males) completed the DSM-5 Dimensional Anxiety Scales for social anxiety dis-
and Education, University of
order, generalized anxiety disorder, specific phobia, agoraphobia, and panic
Amsterdam, Nieuwe Achtergracht
disorder that were included in previous studies on the scales, and also for sepa-
127, 1018 WS Amsterdam, The
ration anxiety disorder, which is included in the DSM-5 chapter on anxiety dis-
Netherlands. Telephone (+31) 20
orders. Moreover, they completed the Screen for Child Anxiety Related
525 1259
Emotional Disorders Adult version (SCARED-A). The DSM-5 Dimensional
Email: [email protected]
Anxiety Scales demonstrated high internal consistency, and the scales correlated
significantly and substantially with corresponding SCARED-A subscales,
This article was generated as part
supporting convergent validity. Separation anxiety appeared present among
of the DSM-5 Work Group
adults, supporting the DSM-5 recognition of separation anxiety as an anxiety
activities. Copyright © 2016
disorder across the life span. To conclude, the DSM-5 Dimensional Anxiety
American Psychiatric Association
Scales are a valuable tool to screen for specific adult anxiety disorders, including
separation anxiety. Research in more diverse and clinical samples with anxiety
Received 30 December 2015;
disorders is needed. © 2016 The Authors International Journal of Methods in
revised 24 March 2016;
Psychiatric Research Published by John Wiley & Sons Ltd.
accepted 17 May 2016

Introduction Psychiatric Association (APA) strongly encourages re-

searchers and clinicians to supplement the traditional bi-
With the fifth edition of the Diagnostic and Statistical nary diagnosis of disorders with dimensional measures.
Manual of Mental Disorders (DSM-5), the American Dimensional assessment of psychopathology has several

232 © 2016 The Authors International Journal of Methods in Psychiatric Research Published by John Wiley & Sons Ltd.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which per-
mits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications
or adaptations are made.
Möller and Bögels Dimensional assessment of adult anxiety disorders

benefits over the traditional categorical diagnosis, such as Scales in adults (i.e. Beesdo-Baum et al., 2012; LeBeau
providing information about disorder severity, subclinical et al., 2012; Knappe et al., 2013, 2014), participants com-
presentations of disorders, and change in symptoms over pleted the scales for fixe anxiety disorders (social anxiety
time (by repeated assessment) (e.g. Helzer et al., 2006; Hudziak disorder [SAD], generalized anxiety disorder [GAD], spe-
et al., 2007). Moreover, dimensional assessment may clarify cific phobia [SP], agoraphobia [AG], and panic disorder
the problem of diagnostic comorbidity (Krueger et al., 2005; [PD]). In the present study, a dimensional scale was also
Kraemer, 2007) and may enhance the communication administered for separation anxiety disorder (SepAD). A
between mental-health professionals (LeBeau et al., 2015). literature review by Bögels et al. (2013) showed that
In the domain of the anxiety disorders, these benefits of SepAD is a prevalent, often comorbid, and debilitating dis-
dimensional assessments are widely recognized, which is order in adulthood. There is evidence that a considerable
reflected by the measures clinicians and researchers use amount of adults report the first onset of the disorder in
to assess anxiety. That is, nearly all of the measures to as- adulthood. For that reason, in DSM-5 (APA, 2013) SepAD
sess anxiety symptoms are of a dimensional nature. How- is classified under the anxiety disorders instead of under
ever, many scales lack a theoretical basis, have the section “Disorders Usually First Diagnosed in Infancy,
unsatisfactory psychometric properties (Balon, 2005), lack Childhood, or Adolescence” as it was in the DSM-IV
homogeneity in format and content, and are quite lengthy (APA, 2000). Therefore, we were specifically interested in
(LeBeau et al., 2012). For that reason, the Anxiety Disor- adults’ responses on the DSM-5 Dimensional Anxiety
der Subgroup of the DSM-5 Anxiety, Obsessive- Scales for SepAD.
Compulsive Spectrum, Post-traumatic, and Dissociative In the present study, we again investigated the psycho-
Disorders Work Group developed a set of dimensional metric properties of the DSM-5 Dimensional Anxiety
measures for the anxiety disorders, the so called DSM-5 Scales, but now in a Dutch adult population. In contrast
Dimensional Anxiety Scales. The DSM-5 Dimensional to the four previous studies on adults in which the mean
Anxiety Scales are based on Lang’s (1971) tripartite model, age of the participants ranged from 20 to 35 years, our
in which anxiety is understood as consisting of three dif- sample was relatively older (mean age 44 years). The ob-
ferent and relatively independent components: behavior, jective of this paper was to examine the reliability, validity,
cognition, and physiology. The DSM-5 Dimensional Anx- and clinical sensitivity of the DSM-5 Dimensional Anxiety
iety Scales use a common template to assess the core fea- Scales in a non-clinical Dutch sample of adults, including
tures of fear and anxiety that are shared among the a scale for SepAD (as this disorder was overlooked as an
anxiety disorders, such as cognitive and physiological adult anxiety disorder in DSM-IV and was not part of pre-
symptoms, and avoidance and escape behaviors. More- vious DSM-5 dimensional assessment of anxiety disorders
over, the scales are concise, which facilitates their adminis- research). As anxiety disorders are more common in
tration, especially in clinical practice settings. women than men (Craske, 2003; McLean and Anderson,
Four studies have already tested the psychometric 2009), and as anxiety symptoms differ in type and severity
properties of the adult-version of the DSM-5 Dimensional between men and women (Bekker and Van Mens-
Anxiety Scales in both German and American samples Verhulst, 2007), psychometric properties of the DSM-5
(Beesdo-Baum et al., 2012; LeBeau et al., 2012; Knappe Dimensional Anxiety Scales were investigated for males
et al., 2013, 2014). In addition, one study tested the psy- and females separately.
chometric properties of the child and parent-version of
the DSM-5 Dimensional Anxiety Scales in a Dutch sample Methods
(Möller et al., 2014a). These series of investigations have
Participants
demonstrated strong psychometric properties of the scales
in clinical and non-clinical samples. To sum up, high reli- Participants consisted of parents of 8 to 13 year old chil-
ability, convergent and discriminant validity, test–retest dren, recruited from eight elementary schools in both ru-
reliability, sensitivity to clinical severity, and sensitivity to ral and urban areas of the Netherlands. The recruited
change were found. Of note, the psychometric properties children and parents also participated in a study on the
of the scales were substantially weaker for specific phobia, psychometric properties of the DSM-5 Dimensional Anx-
which may be due to the heterogeneity of the disorder (i.e. iety Scales in children (Möller et al., 2014a) and in a study
the different specific phobias are distinct in nature). This on the influence of fathers’ versus mothers’ anxious or
scale is therefore in need of more evaluation. confident social referencing signals in ambiguous situa-
Moreover, in the four studies examining the psycho- tions (Möller et al., 2014b). Of the 898 children invited
metric properties of the DSM-5 Dimensional Anxiety to participate 394 children (44%) agreed. Twelve children

Int. J. Methods Psychiatr. Res. 25(3): 232–239 (2016). DOI: 10.1002/mpr

© 2016 The Authors International Journal of Methods in Psychiatric Research Published by John Wiley & Sons Ltd. 233
Dimensional assessment of adult anxiety disorders Möller and Bögels

were excluded from the study as they were absent on the timeframe. Items are rated on a five point Likert scale
day of testing or due to missing data. The sample of parents ranging from 0 (never) to 4 (all of the time). A total score
that participated consisted of 285 females and 255 males. can be created for each dimensional scale by summing the
Table 1 shows the characteristics of the participants. scores on the 10 items (possible scores ranging from 0 to
40). In addition, a total score across all six dimensional
scales can be created by summing the total scores for each
Assessments dimensional scale (possible scores ranging from 0 to 240).
To translate the DSM-5 Dimensional Anxiety Scales from
DSM-5 Dimensional Anxiety Scales English into Dutch, the first author translated the scales
into Dutch and a native English speaker who was not fa-
The Anxiety Disorder Subgroup of the DSM-5 Anxiety,
miliar with the questionnaire translated them back into
Obsessive-Compulsive Spectrum, Post-traumatic, and
English.
Dissociative Disorders Work Group developed the initial
version of the DSM-5 Dimensional Anxiety Scales and
Screen for Child Anxiety Related Emotional Disorders
the scales were revised by LeBeau et al. (2012). Originally,
Adult version
the DSM-5 Dimensional Anxiety Scales assess five anxiety
disorders: SAD, GAD, SP, AG, and PD. In the current Participants completed the Screen for Child Anxiety Re-
study, we also used a dimensional scale for SepAD. All lated Emotional Disorders Adult version (SCARED-A;
six scales share a common template that assesses the fre- Bögels and Van Melick, 2004; Van Steensel and Bögels,
quency of cognitive and physical symptoms and the fre- 2014), a screening tool for identifying anxiety disorders in
quency of escape and avoidance behaviors that are adults. The SCARED-A assesses a range of DSM-IV based
present across all anxiety disorders. To create disorder- anxiety symptoms that can be divided into symptoms of
specific dimensional scales, the scales are adapted for each PD (13 items), GAD (9 items), SAD (9 items), SepAD (12
disorder through the use of different introductory state- items), SP (15 items), obsessive-compulsive disorder (9
ments and different reference points throughout the items. items), and post-traumatic stress disorder (4 items). Items
Each dimensional scale consists of 10 items, with the first on obsessive-compulsive disorder and post-traumatic
five items assessing the frequency of cognitive and physical stress disorder were omitted because they are no longer
symptoms related to the experience of fear and anxiety part of the anxiety disorders in DSM-5 (APA, 2013). Par-
(e.g. “I had thoughts of bad things happening”, “I felt ticipants rated how frequently they experienced each of
tense muscles, on edge or restless, or had trouble relaxing the remaining 58 anxiety symptoms on a three-point Likert
in these situations”) and the second set of five items scale (almost never = 0; sometimes = 1; often = 2). The in-
assessing the frequency of escape and avoidance behaviors ternal consistency of the SCARED-A total score is excellent
(e.g. “I moved away from these situations or left them (Cronbach’s alpha > 0.90), the internal consistencies of the
early”, “I have distracted myself to avoid thinking about SCARED-A subscales are moderate to high, with
these situations”). In contrast to the version of the Cronbach’s alpha values > 0.70, and the SCARED-A dis-
DSM-5 Dimensional Anxiety Scales that the APA pub- criminates between adults with and without anxiety disor-
lished online which uses a seven-day timeframe, in our ders (Van Steensel and Bögels, 2014). In our sample,
study items were assessed in regard to the past four weeks Cronbach’s alpha’s ranged from 0.67 to 0.93, indicating a
to facilitate the comparison with the results of the previous moderate-to-high level of internal consistency (see
studies on the scales, which all used a four-week Table 2).

Table 1. Characteristics of the participants

Males (n = 255) Females (n = 285)

Age (mean [M], standard deviation [SD]) 45.30 (5.55) 43.09 (4.56)
Born in the Netherlands (n, %) 227 (89%) 255 (89%)
Working fulltime (n, %) 210 (82%) 31 (11%)
Number of children (M, SD) 2.66 (1.54) 2.59 (1.54)
Educational level (M, SD)1 5.91 (1.91) 5.60 (1.96)

1
On a scale from 0 (primary education) to 8 (university).

Int. J. Methods Psychiatr. Res. 25(3): 232–239 (2016). DOI: 10.1002/mpr

234 © 2016 The Authors International Journal of Methods in Psychiatric Research Published by John Wiley & Sons Ltd.
Möller and Bögels Dimensional assessment of adult anxiety disorders

Table 2. Cronbach’s alphas (α) for the SCARED-A total Table 3. Descriptive statistics for the DSM-5 Dimensional
score and subscales Anxiety Scales and the SCARED-A

Males Females Mean total

score
SCARED-A scale α n α n (standard Possible
N deviation) Range range
SAD 0.84 247 0.85 279
GAD 0.81 251 0.84 279 Males
SP 0.71 241 0.79 277
Dimensional scales
PD 0.68 246 0.80 277
SAD 254 2.54 (3.65) 0–17 0–40
SepAD 0.67 246 0.71 268
GAD 248 3.73 (4.43) 0–21 0–40
Total score 0.87 227 0.93 254
SP 248 2.82 (5.09) 0–40 0–40
AG 252 1.04 (2.90) 0–20 0–40
Note: SAD, social anxiety disorder; GAD, generalized anxi-
PD 254 1.08 (3.59) 0–33 0–40
ety disorder; SP, specific phobia; PD, panic disorder;
SepAD 253 1.32 (3.24) 0–31 0–40
SepAD, separation anxiety disorder.
SCARED-A subscales
Procedure SAD 247 2.31 (2.67) 0–13 0–18
The ethical committee of the University of Amsterdam GAD 251 2.96 (2.79) 0–14 0–18
SP 241 3.68 (3.16) 0–16 0–30
approved the study and participants signed informed
PD 246 1.19 (1.60) 0–11 0–26
consent before taking part in the study. After children
SepAD 246 2.73 (2.28) 0–10 0–24
had completed the questionnaires at school, they received
the questionnaires for their parents, including a post-free Females
return envelope. Fathers and mothers completed the ques-
Dimensional scales
tionnaires at home and mailed them back to the univer- SAD 283 3.95 (5.23) 0–25 0–40
sity. Completing the questionnaires lasted approximately GAD 282 5.79 (5.80) 0–29 0–40
60 minutes. Parents received a compensation of 10 euro, SP 276 5.40 (7.26) 0–38 0–40
schools a compensation of 100 euro per 60 participating AG 280 1.94 (4.31) 0–34 0–40
children, and children received a small gift. PD 280 1.63 (4.56) 0–40 0–40
SepAD 283 3.07 (5.47) 0–33 0–40
Results
SCARED-A subscales
Descriptive statistics SAD 279 3.66 (3.24) 0–13 0–18
GAD 279 3.94 (3.30) 0–14 0–18
Non-parametric tests were used, as data were not nor-
SP 277 5.59 (4.30) 0–20 0–30
mally distributed. The means, standard deviations, and PD 277 2.14 (2.51) 0–19 0–26
ranges of responses to the DSM-5 Dimensional Anxiety SepAD 268 3.56 (2.81) 0–15 0–24
Scales and SCARED-A are depicted in Table 3.
Wilcoxon’s signed rank test showed that females scored Note: SAD, social anxiety disorder; GAD, generalized anxi-
higher than males on all DSM-5 Dimensional Anxiety ety disorder; SP, specific phobia; AG, agoraphobia; PD,
Scales, all p values < 0.001. Inspecting the relative pres- panic disorder; SepAD, separation anxiety disorder.
ence of each disorder (each DSM-5 Dimensional Anxiety
Scale score divided by the total score on all DSM-5 Di- alphas were high for both males (range = 0.86–0.94) and
mensional Anxiety Scales), Wilcoxon’s signed rank test females (range = 0.89–0.95), indicating a high level of ho-
showed no differences between males and females, all p mogeneity, also for the SP scale.
values > 0.05, indicating that the relative presence of each
of the anxiety disorders symptoms (including SepAD
symptoms) did not differ for men and women. Convergent and discriminant validity
To investigate the validity of the DSM-5 Dimensional
Internal consistency
Anxiety Scales, Spearman’s correlations were calculated
Cronbach’s alpha coefficients were calculated for each between each DSM-5 Dimensional Anxiety Scale and each
DSM-5 Dimensional Anxiety Scale (Table 4). Cronbach’s subscale of the SCARED-A. These correlations for

Int. J. Methods Psychiatr. Res. 25(3): 232–239 (2016). DOI: 10.1002/mpr

© 2016 The Authors International Journal of Methods in Psychiatric Research Published by John Wiley & Sons Ltd. 235
Dimensional assessment of adult anxiety disorders Möller and Bögels

Table 4. Cronbach’s alphas (α) for the six DSM-5 values < 0.01), indicating some convergent validity. Dis-
Dimensional Anxiety Scales criminant validity was only demonstrated for GAD (for
both males and females), and not for SAD, SP, PD, and
Males Females SepAD. Validity could not be calculated for AG, as the
Dimensional current version of the SCARED-A does not measure AG.
scale α n α n

SAD 0.86 254 0.91 283

Clinical sensitivity
GAD 0.88 248 0.90 282
SP 0.93 248 0.93 276 To assess clinical sensitivity of the DSM-5 Dimensional
AG 0.91 252 0.94 280 Anxiety Scales, Mann-Whitney U tests were used to in-
PD 0.94 254 0.96 280 vestigate whether participants who exceeded the cutoff
SepAD 0.90 253 0.94 283 on the SCARED-A scored significantly higher on the
DSM-5 Dimensional Anxiety Scales than those who
Note: SAD, social anxiety disorder; GAD, generalized anxi-
scored below the cutoff. The following cutoff scores
ety disorder; SP, specific phobia; AG, agoraphobia; PD,
were used: for males, SCARED-A total score ≥ 20, for
panic disorder; SepAD, separation anxiety disorder.
females, SCARED-A ≥ 30 (Van Steensel and Bögels,
2014). Males who exceeded the SCARED-A cutoff
conceptually similar and distinct measures were then sta- scored higher (mean rank = 179.61, n = 37) on the
tistically compared with a Fisher r-to-z test. Spearman’s DSM-5 Dimensional Anxiety Scales than males who
correlations between the total score of each DSM-5 Di- did not (mean rank = 101.22, n = 190), U = 1087.50,
mensional Anxiety Scale and the total score of each p < 0.001. In addition, females who exceeded the
SCARED-A subscale are shown in Table 5. For both males SCARED-A cutoff scored higher (mean rank = 206.76,
and females, moderate to high correlations appeared be- n = 40) on the DSM-5 Dimensional Anxiety Scales than
tween each DSM-5 Dimensional Anxiety Scale and the females who did not (mean rank = 112.68, n = 214),
corresponding subscale of the SCARED-A (all p U = 1109.50, p < 0.001.

Table 5. Spearman’s correlations between the DSM-5 Dimensional Anxiety Scales and the SCARED-A for males and
females

Dimensional scales SCARED SAD SCARED GAD SCARED SP SCARED PD SCARED SepAD

Males (n = 250)
SAD 0.50 (ref) 0.50 0.25** 0.43 0.32*
GAD 0.32** 0.59 (ref) 0.23** 0.26** 0.37**
SP 0.13* 0.20 0.32 (ref) 0.20 0.18
AG 0.24 0.25 0.21 0.26 0.13
PD 0.29 0.28 0.20 0.33 (ref) 0.17†
SepAD 0.34 0.40 0.20** 0.22** 0.43 (ref)
Females (n = 278)
SAD 0.50 (ref) 0.51 0.26** 0.35* 0.28**
GAD 0.42** 0.62 (ref) 0.31** 0.47* 0.46**
SP 0.35 0.40 0.37 (ref) 0.39 0.36
AG 0.39 0.51 0.32 0.42 0.38
PD 0.20** 0.40 0.29 0.41 (ref) 0.40
SepAD 0.30** 0.52 0.31** 0.45 0.53 (ref)

Note: SAD, social anxiety disorder; GAD, generalized anxiety disorder; SP, specific phobia; AG, agoraphobia; PD,
panic disorder; SepAD, separation anxiety disorder; ref, reference correlation for test of correlated coefficients. AG is
not measured in the current version of the SCARED-A, therefore convergent and discriminant validity could not be
calculated for AG.
**p < 0.01;*p < 0.05;†p < 0.10.

Int. J. Methods Psychiatr. Res. 25(3): 232–239 (2016). DOI: 10.1002/mpr

236 © 2016 The Authors International Journal of Methods in Psychiatric Research Published by John Wiley & Sons Ltd.
Möller and Bögels Dimensional assessment of adult anxiety disorders

Discussion and not only in childhood (Bögels et al., 2013) and for
elimination of the requirement that the disorder needs to
In this study, we investigated the psychometric properties start in childhood in DSM-5 (APA, 2013).
of the DSM-5 Dimensional Anxiety Scales, a set of brief In previous studies the psychometric properties of the
self-report scales to assess six anxiety disorders (SAD, DSM-5 Dimensional Anxiety Scale for SP were unsatisfac-
GAD, SP, AG, PD, and SepAD), in a Dutch non-clinical tory. In our study, a Cronbach’s alpha of 0.93 was found
sample of adults. The internal consistency of the scales for both males’ and females’ SP, indicating excellent inter-
was excellent. Correlations between the DSM-5 Dimen- nal consistency. In addition, we found good convergent
sional Anxiety Scales and the corresponding SCARED-A validity of the DSM-5 Dimensional Anxiety Scale for SP.
subscales were medium-to-large (rs = 0.33–0.62), indicat- Therefore, our results do not support calls for further re-
ing good convergent validity. Moreover, participants who finement of the SP scale (e.g. LeBeau et al., 2012; Knappe
exceeded the SCARED-A cutoff scored higher on the et al., 2014).
DSM-5 Dimensional Anxiety Scales than those who scored A strength of this study is that we tested the DSM-5 Di-
below the cutoff, supporting the clinical sensitivity of the mensional Anxiety Scales including for the first time the
scales. Thus, our results using a Dutch sample replicate scale for adult SepAD. There is another adult separation
previous findings on the good psychometric properties of anxiety questionnaire, namely the Adult Separation Anxi-
the scales in Germany and the United States (Beesdo-Baum ety Questionnaire (ASA-27; Manicavasagar et al., 2003),
et al., 2012; LeBeau et al., 2012; Knappe et al., 2013, 2014). however this questionnaire is substantially longer (27
Discriminant validity (i.e. lack of convergence between items) and the attractiveness of the DSM-5 Dimensional
each DSM-5 Dimensional Anxiety Scale and non- Anxiety Scales is that each of the anxiety domains are
corresponding SCARED-A scales) was only demonstrated assessed in exactly the same way. The study findings
for GAD, and not for SAD, SP, PD and SepAD. This may should, however, be interpreted in the light of several lim-
be due to worry being the defining characteristic of GAD, itations. First, the use of a non-clinical sample may be
compared to all other anxiety disorders of which anxiety considered as a limitation, as the scales are primarily de-
is the core feature (Andrews et al., 2010). In this sense, veloped for use in clinical settings. Second, our sample
GAD may be more distinct from the other anxiety disor- was quite homogeneous with all participants having chil-
ders, than the other anxiety disorders from each other. An- dren and being of a somewhat limited age range. In addi-
other explanation for the low discriminant validity of the tion, almost all participants were married (whereas divorce
SAD, SP, PD and SepAD scales may be the high overlap rates are around 38% in the Netherlands; CBS Statline,
among anxiety disorders (e.g. Kroenke et al., 2007). This 2014) and most had a Caucasian background. This possi-
high overlap among anxiety disorders is exactly one of bly limits the generalizability of our findings. Third, we
the reasons why the dimensional approach of assessing did not measure the categorical presence of anxiety disor-
domains of anxiety has been included in DSM-5. An alter- ders using a clinical interview, and therefore could exam-
native explanation for the low discriminant validity may be ine clinical sensitivity only using the SCARED-A cutoff
that the SCARED-A and the DSM-5 Dimensional Anxiety scores. Fourth, as the SCARED-A does not include a sep-
Scales are conceptually too similar to validly assess discrim- arate subscale for AG, we were unable to assess the conver-
inant validity. To obtain formal tests of discriminant valid- gent and discriminant validity of the DSM-5 Dimensional
ity from other types of psychopathology (e.g. depression), Anxiety Scale of AG.
future studies should include measures assessing domains It should be noted that although the benefits of a di-
theoretically distinct from anxiety. mensional approach over a traditional categorical ap-
This was the first study including the DSM-5 Dimen- proach are widely acknowledged (Krueger et al., 2005;
sional Anxiety Scale to assess adult SepAD. Previous stud- Helzer et al., 2006; Hudziak et al., 2007; Kraemer, 2007),
ies assessing the scales in adults (Beesdo-Baum et al., 2012; several real and perceived obstacles have hindered the
LeBeau et al., 2012; Knappe et al., 2013, 2014) did not adoption of dimensional assessment measures in clinical
include adult SepAD. Our study showed that the SepAD practice (LeBeau et al., 2015). First, although the DSM-5
dimensional scale is just as reliable and valid as the other has been published for more than two years, there is still
scales. Moreover, it was shown that SepAD is also present limited awareness of the dimensional component in the
among adults (both men and women even scored higher DSM-5 and the dimensional measures that accompany it
on SepAD than on PD and AG; see Table 3), which (LeBeau et al., 2015). Second, many clinicians do not value
provides support for the recognition of SepAD as an the psychometric properties of dimensional assessment
anxiety disorder that is important across the life span, measures, do not see their benefit over clinical judgment

Int. J. Methods Psychiatr. Res. 25(3): 232–239 (2016). DOI: 10.1002/mpr

© 2016 The Authors International Journal of Methods in Psychiatric Research Published by John Wiley & Sons Ltd. 237
Dimensional assessment of adult anxiety disorders Möller and Bögels

alone, and question the practicality of such measures comparison with SepAD as measured using a (semi)struc-
(Jensen-Doss and Hawley, 2010). Thus, both researchers tured clinical interview such as the Structured Clinical In-
and clinicians should become aware of the usefulness of terview for DSM-5 Disorders (First et al., 2015) is needed.
this dimensional approach for assessing anxiety problems Moreover, the use of the scales may bridge the gap be-
and the existence of the DSM-5 Dimensional Anxiety tween community and clinical studies, as data can be bet-
Scales. The scales can improve the current diagnostic sys- ter compared when this standardized dimensional
tem by their increased utility and benefits in terms of com- measure is used to assess participants’ anxiety disorder
munication between mental health professionals (LeBeau symptoms.
et al., 2015). With respect to their usefulness, the scales
have been published online (see http://www.psychiatry.
Acknowledgements
org/practice/dsm/dsm5/online-assessment-measures) and
can be downloaded for free, which makes them easily The authors wish to acknowledge the other members of the
available to both clinicians ánd patients. In addition, the Anxiety Disorders Sub-work Group of the DSM-5 Anxiety,
DSM-5 Dimensional Anxiety Scales are very brief and Obsessive-Compulsive Spectrum, Post-traumatic, and Disso-
can thus be completed quickly. Concerning communica- ciative Disorder Work Group (Michelle Craske, Gavin An-
drews, Katharine Phillips, Murray Stein, and Hans-Ulrich
tion, when researchers and clinicians use the same mea-
Wittchen) and the advisors to the Sub-work Group (Lynn Al-
sure to assess severity, scores can be more easily
den, David Barlow, Katja Beesdo-Baum, Richard Heimberg,
interpreted and compared than when different measures Devon Hinton, Stefan Hofmann, Donald Klein, Ronald
with different cutoff scores and symptom domains are Rapee, and Richard Zinbarg).
used (LeBeau et al., 2015). The contributions of Möller and Bögels were supported by
Taken together, the findings of our study support the an Innovation Research Vici NWO grant, number 453-09-
routine use of the DSM-5 Dimensional Anxiety Scales, al- 001, to Susan Bögels.
though more research on the DSM-5 Dimensional Anxiety
Scales is needed, in particular on their test–retest reliabil-
Declaration of interest statement
ity, discriminant validity, and (dis)agreement among clini-
cians and patients. Particularly for the SepAD scale The authors have no competing interests.

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