• anxiety disorder;
  • hypochondriasis;
  • comorbidity;
  • follow-up

Objective:  There is insufficient knowledge of the long-term course of generalized anxiety disorder (GAD). We studied the course of this disorder in patients who were followed up for 40 years.

Method:  Patients admitted with the diagnosis of anxiety states (‘anxious thymopathy’ ) to the Lopez Ibor Neuropsychiatric Research Institute between 1950 and 1961 were examined between 1984 and 1988 (n = 65). The retrospective diagnosis of GAD was made according to DSM-III-R criteria during 1984–1988 (first examination). A re-examination was performed by the same psychiatrist in the period 1997–2001 (n = 59; second examination).

Results:  At first and second examinations 20% and 17% of subjects were diagnosed as GAD. Improvement was observed in 83%. GAD tended to disappear around age 50, but was replaced by somatization disorders. Lack of regular treatment compliance, female sex, and onset of GAD before age 25 were variables associated with a worse outcome. Undifferentiated somatization disorder was the most prevalent clinical status at follow-up.

Conclusion:  After several decades, participants improve with regard to GAD, although most continue to present somatizations.