Accuracy of Anxiety Disorder Not Otherwise Specified Diagnosis in Older Veterans

J Psychiatr Pract. 2019 Sep;25(5):358-364. doi: 10.1097/PRA.0000000000000408.


We examined the accuracy of the anxiety not otherwise specified (anxiety NOS) diagnosis in 61 patients, using data from older Veterans screened for a large trial of cognitive behavioral therapy for late-life generalized anxiety disorder. We compared the anxiety NOS diagnoses based on the electronic medical record to diagnoses obtained via a gold standard structured diagnostic interview conducted for this trial. We found concordance of the anxiety NOS diagnosis in only 2 participants (3%). Most patients (77%) met diagnostic criteria for a specific Diagnostic & Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) anxiety disorder, including generalized anxiety disorder, posttraumatic stress disorder, panic disorder, and/or social anxiety disorder, on the basis of a structured diagnostic interview. The erroneous diagnosis of anxiety NOS is a barrier to patients receiving appropriate evidence-based care for specific anxiety-related and trauma-related disorders. Undertreated anxiety can result in poorer health outcomes, overutilization of medical services, and increased health care costs. Accurate diagnosis of anxiety disorders is foundational to evidence-based treatment; thus, it is imperative that patients presenting with anxiety symptoms receive proper diagnostic assessment to facilitate access to the appropriate evidence-based mental health services.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Anxiety Disorders* / classification
  • Anxiety Disorders* / diagnosis
  • Anxiety Disorders* / psychology
  • Anxiety Disorders* / therapy
  • Cognitive Behavioral Therapy / methods
  • Diagnosis, Differential
  • Diagnostic Errors* / prevention & control
  • Diagnostic Errors* / statistics & numerical data
  • Diagnostic and Statistical Manual of Mental Disorders
  • Evidence-Based Practice / standards
  • Female
  • Humans
  • Interview, Psychological
  • Male
  • Mental Health Services / standards
  • Patient Selection
  • Psychiatric Status Rating Scales
  • Psychotropic Drugs / therapeutic use*
  • Veterans* / psychology
  • Veterans* / statistics & numerical data


  • Psychotropic Drugs