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May 1994

DSM-III-R Generalized Anxiety Disorder in the National Comorbidity Survey

Author Affiliations

From the Max-Planck-Institut fur Psychiatrie Clinical Institute, Munich, Germany (Dr Wittchen); the Institute for Social Research (Drs Zhao and Kessler) and the Department of Sociology (Dr Kessler), the University of Michigan, Ann Arbor; and the Department of Mental Hygiene, The Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md (Dr Eaton).

Arch Gen Psychiatry. 1994;51(5):355-364. doi:10.1001/archpsyc.1994.03950050015002

Background:  Nationally representative general population data are presented on the current, 12-month, and lifetime prevalence of DSM-III-R generalized anxiety disorder (GAD) as well as on risk factors, comorbidity, and related impairments.

Methods:  The data are from the National Comorbidity Survey, a large general population survey of persons aged 15 to 54 years in the noninstitutionalized civilian population of the United States. DSM-III-R GAD was assessed by lay interviewers using a revised version of the Composite International Diagnostic Interview.

Results:  Generalized anxiety disorder was found to be a relatively rare current disorder with a current prevalence of 1.6% but was found to be a more frequent lifetime disorder affecting 5.1% of the US population aged 15 to 45 years. Generalized anxiety disorder was twice as common among women as among men. Multivariate logistic regression analysis showed that being older than 24 years, separated, widowed, divorced, unemployed, and a homemaker are significant correlates of GAD. Consistent with studies in treatment samples, we found that GAD was frequently associated with a wide spectrum of other mental disorders, with a lifetime comorbidity among 90.4% of the people who had a history of GAD.

Conclusion:  Contrary to the traditional view that GAD is a mild disorder, we found that the majority of people with GAD, whether they were comorbid or not, reported substantial interference with their life, a high degree of professional help seeking, and a high use of medication because of their GAD symptoms. Although lifetime GAD is highly comorbid, the proportion of current GAD that is not accompanied by any other current diagnosis is high enough to indicate that GAD should be considered an independent disorder rather than exclusively a residual or prodrome of other disorders.