Generalised anxiety disorder is a persistent and common disorder, in which the patient has unfocused worry and anxiety that is not connected to recent stressful events, although it can be aggravated by certain situations. This disorder is twice as common in women than it is in men. Generalised anxiety disorder is characterised by feelings of threat, restlessness, irritability, sleep disturbance, and tension, and symptoms such as palpitations, dry mouth, and sweating. These symptoms are recognised as part of the anxiety syndrome rather than independent complaints. The symptoms overlap greatly with those of other common mental disorders and we could regard the disorder as part of a spectrum of mood and related disorders rather than an independent disorder. Generalised anxiety disorder has a relapsing course, and intervention rarely results in complete resolution of symptoms, but in the short term and medium term, effective treatments include psychological therapies, such as cognitive behavioural therapy; self-help approaches based on cognitive behavioural therapy principles; and pharmacological treatments, mainly selective serotonin reuptake inhibitors.
History
Generalised anxiety disorder is a relatively recent diagnosis. Before 1980 it was subsumed under the label of anxiety neurosis, a disorder first delineated by Freud in 1894 1 and characterised by persistent feelings of unattached fearfulness described as free-floating anxiety. 1 However, the disorder described by Freud also included the symptom of panic, and when panic disorder was subsequently identified as a separate illness by Klein, 2 the part of anxiety neurosis that did not include panic became known as generalised anxiety disorder. This classification was unsatisfactory because there were no features that defined generalised anxiety disorder; it became a residual diagnosis for anxiety disorders that had no other diagnosis; and it had substantial overlap with other disorders, known contentiously as comorbidity. 3–5 However, the diagnosis of generalised anxiety disorder is now embraced by epidemiologists and clinical psychopharmacologists, although other clinicians, especially those working in primary care, are less enthusiastic. The comorbidity seen in generalised anxiety disorder accounts for a substantial amount of morbidity and disability. 6,7
Some clinicians argue that generalised anxiety disorder remains an ill-defined diagnosis, which supports the notion that it was constructed to support the validity of other diagnoses in the anxiety group rather than being a useful homogeneous clinical entity. 8 Generalised anxiety disorder was almost excluded from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) 9 classification in 1994, on the grounds that its diagnostic status could be faulted on the grounds of poor reliability. Supporters of this diagnosis argue that, despite its overlap with other disorders, a diagnosis of generalised anxiety disorder is an advance on previous categorisations, and that the criterion that it has a 6-month duration has created a more homogenous disorder. Additionally, the associated social, occupational, and economic burden is similar to that of major depression, and the increasing prevalence of generalised anxiety disorder with advanced age distinguishes it from other anxiety disorders, which suggests that this diagnosis will not be abandoned.
