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Factors influencing the course of anxiety disorders are very complex and often not well studied. Risk factors for the development and course of anxiety disorders could be divided into predisposing factors, enabling factors and maintaining factors. For example, some research has shown that females are at increased risk for developing anxiety disorders. However, some studies have shown that, for example, women with lifetime panic disorder are more likely to develop other anxiety disorders (Ben-Porath, & Telch, 1999), whereas other studies have shown that men with GAD are more likely to suffer from panic disorder than women (Solomon & Marks, 2002). The reasons for the different findings may be that the researchers in these studies used different definitions of comorbidity and used different diagnostic procedures to assess the course of anxiety disorders. They may also have used different scales to measure anxiety. However, these different findings might also be explained by the fact that the distinction between risk and vulnerability factors is not as clear-cut as one might think. Moreover, researchers have often used depression as a comorbidity variable that influenced the course of anxiety disorders. Although depression and anxiety often co-occur, this is not always the case. In some cases, anxiety disorders may precede depression (Schmitt, Czaja, & Weisse, 2007), whereas in other cases depression may precede anxiety (Schore, 2003).
To summarize, it is important to keep the distinction between the course of the disorder and the course of individual symptoms in mind when conducting studies to assess course. This important distinction is not always clearly made in many (if not most) publications on course studies. Moreover, diagnostic criteria and symptom thresholds are not always clearly specified. For example, the DSM-IV criterion for panic disorder (lifetime prevalence) was always met in 30% of panic sufferers in a community study. (Segerstrom & Schatzberg, 2003) In this case, the disorder may not be chronic, but it may be very severe in nature. Another example is the relatively low prevalence of GAD in self-referred patients seeking treatment for GAD. These patients almost always met the DSM-IV GAD criterion, which may lead to a chronic course. In order to fully understand the course of anxiety disorders, not only diagnostic criteria but also symptom threshold values should be taken into account.
The available longitudinal data on the course of anxiety disorders are summarized in the current review. Because of the nature of the data, most studies could only show the average course and not the course for a specific group of patients. As the course is often the focus of particular interest in clinical practice, we also report on this issue. One in three individuals with a lifetime diagnosis of an anxiety disorder reports symptoms within the past month. Although anxiety disorders are often regarded as chronic conditions, several studies report symptom-free intervals ranging from 4 to 14 years. The overall stability of current diagnoses and the frequency of change from current to past diagnostic level is highest for panic disorder and generalized anxiety disorder (GAD), followed by social anxiety disorder, and lowest for specific phobias. Anxiety disorders are stable in about 80% of the individuals with current diagnoses. The frequency of diagnostic change is comparable to the stability and the course of panic disorder and GAD, but it is higher for specific phobias, which are more likely to be reported as chronic disorders. In accordance with other studies, we observed a higher age at onset of GAD and Social Phobia than for Panic Disorder and Generalized Anxiety Disorder. 827ec27edc