On the Diagnosis, Assessment, and Treatment of Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is increasingly recognized as a prevalent anxiety disorder with a chronic course and signifi cant impairment (APA, 2000; Ballenger et al., 2001; Weisberg, 2009). In the Netherlands, according to the second Netherlands Mental Health Survey and Incidence Study (NEMESIS-2; De Graaf, Ten Have, & Van Dorsselaar, 2010) GAD was found to have a 4.5% lifetime prevalence rate, and the 12-month prevalence rate was reported to be 1.7%. GAD is a long-term illness with a high likelihood of recurrence. For instance, during the 12 years of a large longitudinal study, the Harvard-Brown Anxiety Research Project (HARP; Bruce et al., 2005), the average amount of time that patients met diagnostic criteria of GAD was 74%. Further, GAD was found to have a probability of recovery of 0.58 in the 12 years the study lasted, and the probability of recurrence in patients who recovered was 0.45. GAD has been found to be associated with considerable impairment and severity. For instance, in one study GAD was the anxiety disorder with the highest rate of moderate to severe disability (Sanderson & Andrews, 2002). Further, lifetime and current GAD were found to be associated with decreased overall well-being (Stein & Heimberg, 2004) and with impairment that was equivalent in magnitude to the impairment caused by major depressive disorder (Kessler, Dupont, Berglund, & Wittchen, 1999).

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