General Anxiety Disorder (GAD)

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Diagnosis

The American Psychiatric Association (APA) provides the criteria for diagnosis of general anxiety disorder.

Diagnostic Criteria for Generalized Anxiety Disorder

1. Excessive anxiety and worry (apprehensive expectation), occuring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).
2. The person finds it difficult to control the worry.
3. 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 6 months). Note: Only one item is required in children.
• 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)
4. The focus of anxiety and worry is not confined to features of an Axis I disorder, e.g., the anxiety or worry is not about having a panic attack (as in panic disorder), being embarrassed in public (as in social phobia), being contaminated (as in obsessive-compulsive disorder), being away from home or close relatives (as in separation anxiety disorder), gaining weight (as in anorexia nervosa), having multiple physical complaints (as in somatization disorder), or having a serious illness (as in hypochondriasis), and the anxiety and worry do no occur exclusively during posttraumatic stress disorder.
5. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
6. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism) and does not occur exclusively during a mood disorder, a psychotic disorder, or a pervasive developmental disorder.

APA. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. 1994. Washington, DC: American Psychiatric Association (APA).

Differential Diagnosis
GAD must be differentiated from the following:

• Anxiety as a result of an organic cause
• Anxiety triggered by a specific situation
• Normal anxiety in response to stress

Because brief anxiety is a normal reaction common in specific situations, it is different than generalized, chronic anxiety. GAD must also be distinguished from other psychiatric disorders, medical conditions, and drug-related conditions.

Psychiatric disorders that may cause symptoms similar to GAD include the following:

• Major depressive disorder
• Other anxiety disorders
• Obsessive compulsive disorder (OCD)
• Panic disorder
• Phobias
• Posttraumatic stress disorder (PTSD)
• Schizophrenia

Depression and anxiety often occur simultaneously, and each must be evaluated to make an appropriate treatment plan. When the anxiety is focused on certain situations, as in OCD or PTSD, and when it is expressed as panic, it is diagnosed and treated as such.

Anxiety also is associated with drug and alcohol abuse. It is a symptom of withdrawal from alcohol, benzodiazapines, cocaine, marijuana, and SSRIs. Certain stimulants (e.g., amphetamines, asthma medication, caffeine) can produce anxiety in the user.

Organic causes of anxiety include the following medical and substance-related conditions.

Medical conditions

• Cardiac disease
• Hyperthyroidism (sweating, irritability)
• Hypoglycemia (low blood sugar)
• Heart attack
• Pulmonary embolus (blood clot in pulmonary artery)
• Tachycardia (increased heart rate)
• Temporal lobe epilepsy (TLE)

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