Two-year course of anxiety disorders: different across disorders or dimensions?

Acta Psychiatr Scand. 2013 Sep;128(3):212-21. doi: 10.1111/acps.12024. Epub 2012 Oct 26.


Objective: This study compares diagnostic and symptom course trajectories across different anxiety disorders, and examines the role of anxiety arousal vs. avoidance behaviour symptoms in course prediction.

Method: Data were from 834 subjects with a current anxiety disorder from the Netherlands Study of Depression and Anxiety (NESDA) who were re-interviewed after 2 years. DSM-IV-based diagnostic interviews and Life Chart Interviews (LCI) were used to assess the diagnostic and symptom course trajectory over 2 years. Anxiety arousal and avoidance behaviour symptoms were measured with LCI, Beck Anxiety Inventory and Fear Questionnaire.

Results: Prognosis varied across disorders, with favourable remittance rates of 72.5% for panic disorder without agoraphobia and 69.7% for generalized anxiety disorder; gradually declining to 53.5% for social phobia and 52.7% for panic disorder with agoraphobia. Only 42.9% of those with multiple anxiety disorder remitted, and this group showed a more chronic course than pure anxiety disorders. Both baseline duration and severity were course predictors. Avoidance behaviour symptoms predicted the outcome better than anxiety arousal symptoms.

Conclusions: These data suggest that the specific anxiety disorders such as recognized by DSM-IV are useful in predicting the outcome and that this may be determined largely by the relative severity of avoidance behaviour that patients have developed.

Keywords: anxiety arousal; anxiety disorder; avoidance behaviour; course; generalized anxiety disorder; panic disorder; social phobia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age of Onset
  • Anxiety Disorders* / diagnosis
  • Anxiety Disorders* / epidemiology
  • Anxiety Disorders* / physiopathology
  • Anxiety Disorders* / psychology
  • Arousal*
  • Behavioral Symptoms / diagnosis*
  • Comorbidity
  • Depressive Disorder / epidemiology
  • Diagnostic and Statistical Manual of Mental Disorders
  • Escape Reaction*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Netherlands
  • Outcome Assessment, Health Care
  • Psychiatric Status Rating Scales
  • Psychotherapy / methods*
  • Psychotropic Drugs / therapeutic use*
  • Socioeconomic Factors
  • Surveys and Questionnaires


  • Psychotropic Drugs