The Natural History of Generalized Anxiety Disorder: A Review

Catherine L. Woodman, MD

Disclosures

Medscape Psychiatry & Mental Health eJournal. 1997;2(3) 

In This Article

Outcome

There are limited data related to the predictors of outcome for anxiety disorders, and GAD is no exception. Furthermore, the prognostic factors identified for anxiety disorders may not apply to GAD. However, the general rule that the future course of the illness is best predicted by the past course almost certainly applies to GAD. This has been confirmed in at least 2 studies (Noyes and associates[32]; Woodman and coworkers[43]). Angst and Vollrath[48] found that no demographic factor was of significant prognostic value for anxiety disorders, although occupational status, social class, and marital status were suggested to have some value.

While the significance of comorbidity continues to be controversial as it pertains to the validity of the diagnosis of GAD, the presence of comorbid disorders does appear to have a significant effect on prognosis.[48] Mancuso and associates[40] noted that GAD patients with personality disorders, dysthymia, and social phobia had a worse prognosis than patients without these disorders. Woodman and colleagues[43] found that patients with comorbid MDD had a poorer outcome than those without major depression. Noyes and coworkers[11] noted that individuals with chronic physical disorders had more severe GAD.

Life events also may have an effect on the course of GAD. Some studies have found that stressors and life changes have an unfavorable impact on the prognosis of GAD, but others have found that they have no impact.[48,49,50] Kendler and associates[28,29] noted that more life events were associated with the expression of GAD in a general-population study of female-female twin pairs. This area of research appears fruitful and should be explored further.

There is limited information about the predictors of outcome in individuals with GAD, but the factors identified are similar to those found to predict outcome in other anxiety disorders and depressive disorders. Earlier age of onset, more severe symptoms at the time of diagnosis, and prior treatment are associated with a poorer prognosis. The presence of GAD may predict a worse outcome for subjects with another psychiatric diagnosis; this has been the most important finding related to comorbidity and GAD. The research in the area of outcomes and GAD needs further exploration.

Unfortunately, most GAD patients may never receive treatment. Data from one survey indicated that only about 25% of individuals with GAD ever receive treatment.[51]

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