title: The infrequency of "pure culture" diagnoses among the anxiety disorders.
abstract: BACKGROUND
  Anxiety disorders are known to commonly coexist in individuals, both with other anxiety disorders and with mental disorders from other groupings, such as affective disorders. We questioned how frequently anxiety disorders actually occur in isolation, as "pure cultures."
  
  
  METHODS
  We examined diagnostic patterns among the 711 subjects entered into a large, multicenter study of anxiety disorders, the Harvard/ Brown Anxiety Disorders Research Program (HARP), which focused on panic, agoraphobia, generalized anxiety disorder, and social phobias as "index disorders" required for intake.
  
  
  RESULTS
  We used various definitions for "pure culture." By all definitions, subjects with "pure culture" represented a minority, especially in cases of generalized anxiety disorder and social phobia, where comorbidity was virtually ubiquitous. "Pure culture" status was associated with later onset of illness and less chronicity.
  
  
  CONCLUSIONS
  Future studies of anxiety disorder should aim to document the extensive comorbidity, rather than eliminate it by restrictive diagnostic exclusion criteria, lest they yield atypical or even misrepresented groups of patients. Clinicians should not stop at identifying only the "main" diagnosis but look for other, comorbid diagnoses that are often present.
authors.affiliation: Brown University School of Medicine, Department of Psychiatry and Behavioral Sciences, Providence, RI, USA.
authors.forename: I M
authors.initials: IM
authors.lastname: Goldenberg
authors.forename: K
authors.initials: K
authors.lastname: White
authors.forename: K
authors.initials: K
authors.lastname: Yonkers
authors.forename: J
authors.initials: J
authors.lastname: Reich
authors.forename: M G
authors.initials: MG
authors.lastname: Warshaw
authors.forename: R M
authors.initials: RM
authors.lastname: Goisman
authors.forename: M B
authors.initials: MB
authors.lastname: Keller
mesh_terms: D000328:Adult; D000379:Agoraphobia / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology; D001008:Anxiety Disorders / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology; D016584:Panic Disorder / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology; D010698:Phobic Disorders / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology; D011446:Prospective Studies