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The Long-Term Clinical Course of Generalized Anxiety Disorder

Martin B. Keller, MD

Published: August 1, 2002

Article Abstract

Although generalized anxiety disorder (GAD) is a common disorder associated with significantlevels of morbidity, little is known of its long-term course and outcomes. During the first 5 years,GAD follows a chronic course with low rates of remission and moderate rates of relapse/recurrencefollowing remission. Retrospective studies suggest that this chronic pattern may last up to 20 years. Itis hoped that, as with depression, long-term prospective studies in GAD will provide insight into thecourse, nature, and outcomes of the disorder over time. The studies will also identify any changes inthe duration and severity of episodes of GAD over time, enabling treatments to effectively reflect thecourse of the disorder. Studies of other anxiety disorders and depression suggest that the course andoutcome of the disorder may be influenced by certain factors such as stressful life events, anxietysensitivity/negative affect, gender, subsyndromal symptoms, and comorbid disorders. Currently, studiesare underway to determine the effects of these factors on the risk of relapse/recurrence, maintenanceof full symptoms, and development of subsyndromal symptoms in GAD. GAD is currentlyunderrecognized and undertreated, but it is hoped that this will change with the ever-increasing awarenessof anxiety disorders. As treatment for GAD becomes more common, future prospective studieswill identify the effect of therapy on the course and nature of the disorder, leading to increasedunderstanding of GAD and the development of effective treatment strategies tailored for individualpatients.

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