Phenomenology and Course of Generalised Anxiety Disorder

Yonkers, Kimberly A.; Warshaw, Meredith G.; Massion, Ann O.; Keller, Martin B.

doi:10.1192/bjp.168.3.308

Cited by 242Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Treatment and AccessChild and Adolescent Psychosocial and Emotional Development

Phenomenology and Course of Generalised Anxiety Disorder

Yonkers, Kimberly A., Warshaw, Meredith G., Massion, Ann O., Keller, Martin B.·1996·British Journal of Psychiatry

DOI 10.1192/bjp.168.3.308

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Abstract

Background The diagnostic category of generalised anxiety disorder (GAD) was originally intended to describe residual anxiety states. Over the years clinical criteria have been refined in an attempt to describe a unique diagnostic entity. Given these changes, little is known about the clinical course of this newly defined disorder. This study investigates the longitudinal course, including remission and relapse rates, for patients with DSM-III-R defined GAD. Method Analysis of the 164 patients with GAD participating in the Harvard Anxiety Research Program. Patients were assessed with a structured clinical interview at intake and re-examined at six month intervals for two years and then annually for one to two years. Psychiatric Status Ratings were assigned at each interview point. Kaplan-Meier curves were constructed to assess likelihood of remission. Results Comorbidity was high, with panic disorder and social phobia as the most frequently found comorbid disorders. The likelihood of remission was 0.15 after one year and 0.25 after two years. The probability of becoming asymptomatic from all psychiatric symptoms was only 0.08. Conclusions This prospective study confirms the chronicity associated with GAD and extends this finding to define the one and two year remission rates for the disorder. Likelihood of remission for GAD and any other comorbid condition after one year was half the annual remission rate for GAD alone.

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GAD is a chronic condition.
“Generalised anxiety disorder (GAD) is described as a chronic condition (Yonkers, Warshaw, Massion, & Keller, 1996)”
From A randomised controlled trial of acceptance and commitment therapy and cognitive-behaviour therapy for generalised anxiety disorder (2014) · cites this paper as Yonkers, Warshaw, Massion, & Keller, 1996

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“Other gender differences reported have included a somewhat higher Axis I comorbidity for women with GAD (Yonkers et al., 1996), and a correlation between psychosocial stressors and the onset of anxiety disorders for women (Brown et al., 1996).”
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“Clonazepam is a high-potency benzodiazepine effective in anxiety disorders and is the second most commonly used drug in GAD.(1) To the best of our knowledge, there are no studies reporting the use of clonazepam in GAD.”
Influential
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“Women with MDD (non-TRD) present comorbid anxiety disorders more frequently than men and are more likely to suffer from anxiety prior to the development of depression (Breslau et al. 1995; Yonkers et al. 1996; Howell et al. 2001; Marcus et al. 2005; Grigoriadis and Erlick Robinson 2007; Bukh et al. 2010).”
Affect-Focused Body Psychotherapy in Patients With Generalized Anxiety Disorder : Evaluation of an Integrative Method
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“The study of 135 patients with GAD with or without other anxiety and mood disorders found that when GAD was comorbid with any other disorder, the chance of remission was three times less than when GAD was absent.(72) Also, it has been reported that an independent association of comorbid anxiety with greater severity a…”
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“For example, although neurotic disorders are the UK’s most common psychiatric diagnoses, affecting 16% ofwomen and11% ofmen (ONS, 2003), high levels of co-morbidity (co-existence of more than onemental health problem) have been found between different anxiety disorders (e.g., Magee et al., 1996; Yonkers et al., 1996)…”
Background
Regulation of emotion in generalized anxiety disorder
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“Between 60% and 80% of patients have reported worrying for their entire life (Barlow, 1988; Rapee, 1991), and the rate of spontaneous remission over a 2-year period is low (Yonkers et al., 1996).”
Background

Authors: Yonkers, K. A., Warshaw, M. G., Massion, A. O., & Keller, M. B.
Affiliations: The University of Texas Southwestern Medical Center (US)
Brown University (US)
University of Massachusetts Chan Medical School (US)
Butler Hospital (US)
Corresponding author: Yonkers, Kimberly A.
ORCID: Yonkers, Kimberly A.
Keller, Martin B.
Venue: British Journal of Psychiatry
Publisher: Royal College of Psychiatrists
Published: 1996-03
Volume: 168
Issue: 3
Pages: 308-313
ISSN: 0007-1250 (ISSN-L)
1472-1465
DOI: 10.1192/bjp.168.3.308
OpenAlex: W1981272264
Cited by: 242
References: 24
Citations by year: 2026: 3 · 2025: 1 · 2024: 1 · 2023: 6 · 2022: 4 · 2021: 6 · 2020: 4 · 2019: 4 · 2018: 6 · 2017: 5 · 2016: 7 · 2015: 8 · 2014: 6 · 2013: 11 · 2012: 11
FWCI: 2.91
Type: journal article
Language: en
Open access: closed
Licence: www.cambridge.org/core/terms (unspecified, 7977 d)
Locations: The British Journal of Psychiatry (publishedVersion)
PubMed (publishedVersion)
Funders: National Institute of Mental Health (R01MH051415)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords: generalized anxiety disorder, clinical course, remission, relapse, chronicity, comorbidities, panic disorder, social anxiety disorder, DSM-III-R, longitudinal follow-up
MeSH terms: Adult, Aged, Anxiety Disorders, Depressive Disorder, Female, Humans, Longitudinal Studies, Male, Middle Aged, Prospective Studies, Psychiatric Status Rating Scales, Recurrence, Remission, Spontaneous, Sex Factors, Comorbidity

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Phenomenology and Course of Generalised Anxiety Disorder

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