Generalized Anxiety Disorder (GAD) is characterized by excessive anxiety and worry occurring more days than not for at least six months, about a number of events or activities. The individual finds it difficult to control the worry. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past six months):
- Restlessness or feeling keyed up or on edge
- Being easily fatigued
- Difficulty concentrating or mind going blank
- Irritability
- Muscle tension
- Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep)
Additional diagnostic considerations
- The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).
- The disturbance is not better explained by another mental disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa).
Guideline-based assessment
- In terms of diagnostic investigations for GAD, the NICE 2020 guidelines recommend a comprehensive assessment in patients with suspected GAD, not solely relying on the number, severity, and duration of symptoms but also considering the degree of distress and functional impairment . The guidelines also recommend assessing how the following factors might have affected the development, course, and severity of the GAD: comorbid depressive disorder or other anxiety disorder, comorbid substance misuse, comorbid medical condition, history of mental health disorders, and past experience of, and response to, treatments
- Furthermore, the BAP 2014 guidelines recommend assessing for the presence of coexisting depressive symptoms and comorbid depression, treating depression if symptoms are more than mild in intensity. It is important to recognize that coexisting depressive symptoms in patients with anxiety disorders are associated with greater functional impairment and a longer duration of illness . The guidelines also recommend assessing for other potential comorbid disorders, physical illnesses, and excess alcohol consumption
In conclusion, the diagnosis of GAD is based on the presence of excessive anxiety and worry about a number of events or activities, associated with at least three of six specific symptoms, causing significant distress or impairment, and not better explained by another mental disorder or the physiological effects of a substance or medical condition. The assessment should be comprehensive, considering not only the symptoms but also the degree of distress, functional impairment, and the impact of various factors such as comorbid disorders and past treatment experiences.