Generalized anxiety disorder with early and late onset of anxiety symptoms

Some generalized anxiety disorder (GAD) patients experience subclinical or clinical levels of anxiety before adulthood, whereas others have a later onset. To determine whether patients who experienced subclinical or clinical anxiety in the first two decades of life differed from those with a later onset, we reviewed the history, ratings on various scales, and psychophysiological recordings obtained from 103 GAD patients. Early-onset patients were younger and more likely to develop GAD without a precipitating stressful event. With the exception of depression in the early-onset group, present-state measures did not differentiate the two groups. During childhood, patients in the early-onset group were exposed to more domestic disturbances, experienced more childhood fears, and were more inhibited and socially maladjusted. As adults, they scored higher on trait anxiety and neuroticism, tended to have obsessional traits, were more sensitive in interpersonal relationships, and experienced more marital difficulties. These findings may be explained by (1) constitutional traits that make early-onset GAD patients more vulnerable to stressors; (2) a more disturbed environment during childhood that adversely affects personality development; or (3) a more severe disorder with an early subclinical onset that also affects personality development.