aration anxiety disorder or obsessive-compulsive disorder.
Risk and Prognostic Factors
Temperamental. Behavioral inhibition, negative affectivity (neuroticism), and harm
avoidance have been associated wi th generalized anxiety disorder.
Environmental. Although childhood adversities and parental overprotection have been
associated with generalized anxiety disorder, no environmental factors have been identi-
fied as specific to generalized anxiety disorder or necessary or sufficient for making the di-
agnosis.
Genetic and physiological. One-third of the risk of expe riencing generalized anxiety
disorder is genetic, and these genetic factors overlap with the risk of neuroticism and are
shared with other anxiety and mood disorder s, particularly major depressive disorder.
Culture-Related Diagnostic Issues
There is considerable cultural variation in th e expression of generalized anxiety disorder.
For example, in some cultures, somatic symptoms predominat e in the expression of the
disorder, whereas in other cult ures cognitive symptoms tend to predominate. This differ-
ence may be more evident on initial presentation than su bsequently, as more symptoms
are reported over time. There is no information as to whether the propensity for excessive
worrying is related to culture, although the topic being worried about can be culture spe-
cific. It is important to consider the social and cultural context when evaluating whether
worries about certain situations are excessive.
Gender-Related Diagnostic Issues
In clinical settings, generalized anxiety diso rder is diagnosed somewhat more frequently
in females than in males (about 55%–60% of  those presenting wi th the disorder are
female). In epidemiological studies, approx imately two-thirds are female. Females and
males who experience generalized anxiety diso rder appear to have similar symptoms but