Influence of Psychiatric Comorbidity on Recovery and Recurrence in Generalized Anxiety Disorder, Social Phobia, and Panic Disorder: A 12-Year Prospective Study

Abstract

Objective-The authors sought to observe the long-term clinical course of anxiety disorders over 12 years and to examine the influence of comorbid psychiatric disorders on recovery from or recurrence of panic disorder, generalized anxiety disorder, and social phobia.Method-Data were drawn from the Harvard/Brown Anxiety Disorders Research Program, a prospective, naturalistic, longitudinal, multicenter study of adults with a current or past history of anxiety disorders. Probabilities of recovery and recurrence were calculated by using standard survival analysis methods. Proportional hazards regression analyses with time-varying covariates were conducted to determine risk ratios for possible comorbid psychiatric predictors of recovery and recurrence.Results-Survival analyses revealed an overall chronic course for the majority of the anxiety disorders. Social phobia had the smallest probability of recovery after 12 years of follow-up. Moreover, patients who had prospectively observed recovery from their intake anxiety disorder had a high probability of recurrence over the follow-up period. The overall clinical course was worsened by several comorbid psychiatric conditions, including major depression and alcohol and other substance use disorders, and by comorbidity of generalized anxiety disorder and panic disorder with agoraphobia.Conclusions-These data depict the anxiety disorders as insidious, with a chronic clinical course, low rates of recovery, and relatively high probabilities of recurrence. The presence of particular comorbid psychiatric disorders significantly lowered the likelihood of recovery from anxiety disorders and increased the likelihood of their recurrence. The findings add to the understanding of the nosology and treatment of these disorders.Anxiety disorders are more common than any other major group of diagnoses, with the exception of substance use disorders. According to the National Comorbidity Survey, the overall lifetime prevalence of anxiety disorders is 24.9%, including rates of 3.5%, 13.3%, 5.1%, for panic disorder with or without agoraphobia, social phobia, and generalized anxiety disorder, respectively (1). The effects of these disorders on both physical health and occupational functioning have been well documented (2-6). In the WHO Collaborative Study on Psychological Problems in General Health Care, more than one-half of the patients with panic disorder without or with agoraphobia reported moderate to severe occupational Address correspondence and reprint requests to Dr. Bruce, Department of Psychiatry and Human Behavior, Brown University, Box G-BH, Providence, RI 02906; Steven_Bruce_PhD@Brown.edu (e-mail). NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript dysfunction and physical disability (3). The severity of disability reported was similar to that reported for depressive episodes and higher than that for alcohol dependence.Despite the high prevalence of anxiety disorders and the morbidity associated with these disorders, much is yet...

Fibroblast Growth Factor-2 Enhances Extinction and Reduces Renewal of Conditioned Fear

“…Renewal is a robust effect both in the laboratory and in clinical settings (Mineka et al, 1999;Mystkowski et al, 2002). Furthermore, in a longitudinal study of the clinical course of anxiety disorders over 12 years, it was demonstrated that anxiety disorders have a largely chronic course with low recovery rates and high relapse rates (Bruce et al, 2005). This illustrates the need to target relapse rates in treatment; thus, the findings that FGF2 renders rats less susceptible to relapse are potentially clinically relevant.…”

Cephalalgiaphobia: a possible specific phobia of illness

“…In Burlington, Vermont, some degree of illness fear was found in 18.2% of the population [19]. Phobic disorders are comorbid with other psychiatric conditions, particularly anxiety disorders [20]. There is also an increasing risk of the patient developing depression and substance abuse disorder [21].…”

Emotional disorders: Cluster 4 of the proposed meta-structure for DSM-V and ICD-11

“…In the 12-year follow-up in the Harvard/Brown Anxiety Disorders Research Program (HARP), only panic disorder had a favourable course, with 82 % achieving recovery, compared with 58 % for GAD, 48 % recovery for panic with agoraphobia and only 37 % for social phobia patients. The equivalent figures for recurrences during the follow-up period are 45 %, 58 % and 39 % respectively (Bruce et al 2005). Major depression is not included in the HARP data set.…”