7-10 Ormel and associates 7 found that the mean numbers of disability days in the past month were much higher among primary care patients with pure GAD than among patients with none of the psychiatric disorders assessed in their survey. Three primary care studies found that pure GAD, defined as a current episode of GAD in the absence of any other mood, anxiety, or substance use disorder, was associated with meaningful levels of impairment in several life domains. The ancillary condition is major depressive disorder (MDD) in 48% of patients. 4,5 More than 90% of patients with GAD present with an additional psychiatric diagnosis. It is the robust association of GAD with psychological and physical comorbidities that potentially contributes to the complexity of the illness as well as the limited treatment success. Epidemiological studies, however, suggest a lifetime GAD prevalence of 4% to 7%, a 1-year prevalence of 3% to 5%, and a current prevalence of 1.5% to 3%.4 Discrepancies between the incidence of anxiety-related symptoms and potential subsequent underestimation of GAD prevalence may be attributed to DSM-IV diagnostic criterion of 6 months duration of worry. 3 GAD typically presents in an episodic pattern of moderate improvement or remission and relapse characterized by a chronic and complicated clinical course.Ĭhronic worry, a core component of GAD, is consistently found in 10% of the population, and this subset reports a level of anxiety and tension so significant that it markedly impairs daily function.
2 A diagnosis of GAD currently implies chronic, excessive worry lasting at least 6 months and 3 of the possible 6 somatic or psychological symptoms (restlessness, fatigue, muscle tension, irritability, difficulty concentrating, and sleep disturbance). 1 An ongoing evolution of the definition of GAD has resulted in a bifurcation of the historical anxiety neurosis designation. Generalized anxiety disorder (GAD) is a prevalent, chronic, debilitating mental illness associated with marked impairment in daily functioning.
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