The Epidemiology of Generalized Anxiety Disorder - 17/08/11
Résumé |
The American Psychiatric Association first introduced the diagnosis of generalized anxiety disorder (GAD) 2 decades ago in the DSM-III.4 Before that time, GAD was conceptualized as one of the two core components of anxiety neurosis, the other being panic.3 A recognition that GAD and panic, although often occurring together, are sufficiently distinct to be considered independent disorders led to their separation in the DSM-III.
The DSM-III definition of GAD required uncontrollable and diffuse (i.e., not focused on a single major life problem) anxiety or worry that is excessive or unrealistic in relation to objective life circumstances and that persists for 1 month or longer. Several related psychophysiologic symptoms also were required to occur with the anxiety or worry for a diagnosis of GAD. Early clinical studies evaluating DSM-III according to this definition in clinical samples found that the disorder seldom occurred in the absence of some other comorbid anxiety or mood disorder. Comorbidity of GAD and major depression was especially strong16, 17 and led some commentators to suggest that GAD might better be conceptualized as a prodrome, residual, or severity marker than as an independent disorder.19, 22, 46 The rate of comorbidity of GAD with other disorders decreases as the duration of GAD increases.18 Based on this finding, the DSM-III-R committee on GAD recommended that the duration requirement for the disorder be increased to 6 months. This change was implemented in the final version of the DSM-III-R.5 Additional changes in the definition of excessive worry and the required number of associated psychophysiologic symptoms were made in the DSM-IV.6
These changes in diagnostic criteria led to delays in cumulating data on the epidemiology of GAD. Nonetheless, such data became available over the past decade. As described in more detail later, these new data challenge the view that GAD should be conceptualized as a prodrome, residual, or severity marker of other disorders. Instead, the data suggest that GAD is a common disorder that, although often comorbid with other mental disorders, does not have a rate of comorbidity that is higher than those found in most other anxiety or mood disorders. The new data also challenge the validity of the threshold decisions embodied in the DSM-IV.6 This article begins by reviewing results from these studies on the prevalence, course, and symptom specificity of GAD. The authors then consider the important issues of comorbidity and impairment. The final section of the article discusses epidemiologic evidence on patterns of help seeking for GAD.
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| Address reprint requests to Ronald C. Kessler, PhD Department of Health Care Policy Harvard Medical School 180 Longwood Avenue Boston, MA 02115 This work was supported by Grants R01 MH46376, R01 DA1121, MH58261, and K05 MH00507 from the U.S. Public Health Service and by an unrestricted educational grant from Wyeth-Ayerst Pharmaceuticals. Portions of this article are from Kessler RC: The epidemiology of pure and comorbid generalized anxiety disorder: A review and evaluation of recent research. Acta Psychiatr Scand 102(suppl):7–13, 2000; with permission. |
Vol 24 - N° 1
P. 19-39 - mars 2001 Retour au numéro
Article précédent
- Overview and Clinical Presentation of Generalized Anxiety Disorder
- Karl Rickels, Moira Rynn
- Comorbidity in Generalized Anxiety Disorder
- Russell Noyes
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