Generalized Anxiety Disorder 397
rates are found in primary care settings. Although GAD is most prevalent in young to mid-
dle age adults, GAD and worry are common in older persons who may show less response to
cognitive- behavioral interventions.Course and Impairment
GAD tends to be chronic and unremitting. In the Harvard–Brown Anxiety Research
Program (HARP) which followed 558 patients over 8 years, only 46% of women and
56% of men experienced full remission of their GAD, while over the same period 36%
of women and 43% of men relapsed (Yonkers et al., 2003). Further analysis of the
HARP data set revealed that worsening impairment and presence of comorbid panic
disorder significantly increased risk for recurrence of GAD (Rodriguez et al., 2005). In
addition early age of onset and presence of a comorbid Axis II disorder are predictive of
chronicity and relapse (Massion et al., 2002; Yonkers, Dyck, Warshaw, & Keller, 2000).
Individuals with GAD are more likely to seek treatment and have a shorter delay in help
seeking than those with social phobia (Wagner et al., 2006). In the NCS-R, GAD was
associated with an 86.1% cumulative lifetime probability of treatment contact and a
median treatment- seeking delay of 9 years (Wang, Berglund, et al., 2005). In general,
individuals with GAD have treatment- seeking rates that are generally similar to the
other anxiety disorders (e.g., Wang, Lane, et al., 2005).
GAD is associated with significant impairment in social and occupational func-
tioning as well as quality of life. Various studies have found that individuals with GAD
experience significant decrements in work and social relationships as well as quality of
life that is even greater in comorbid conditions (e.g., Henning, Turk, Mennin, Fresco,
& Heimberg, 2007; Massion et al., 1993; see Hoffman, Dukes, & Wittchen, 2008).
Moreover, the impairment due to GAD is equivalent in magnitude to that seen in major
depression and is associated with a significant economic burden that may actually be
higher than that of the other anxiety disorders (Wittchen, 2002). In their meta- analysis
of quality of life studies, Olatunji et al. (2007) concluded that GAD had similar decre-
ments in quality of life to the other anxiety disorders except PTSD. Thus the disorder
represents a significant cost to society in terms of diminished work productivity, high
primary health care utilization, and substantial economic burden (Wittchen, 2002).
Treatment of GAD is costly relative to panic disorder and increases markedly when a
comorbid depression is present (Marciniak et al., 2005).
Clinician Guideline 10.6
GAD tends to take a chronic and unremitting course that causes significant social and occu-
pational impairment, leads to a decrement in life satisfaction, and places a significant eco-
nomic burden on society.Comorbidity
Like other anxiety disorders GAD is associated with a very high rate of Axis I and
Axis II comorbidity, which leads to greater functional impairment and poorer out-