Common condition defined as chronic, excessive worry for at least 6 months that causes distress or impairment.
At least three key symptoms out of a possible six are required to make a diagnosis according to the Diagnostic and statistical manual of mental disorders, fifth edition, (DSM-5) criteria. These include restlessness or nervousness, being easily fatigued, poor concentration, irritability, muscle tension, and/or sleep disturbance.
It is in part a diagnosis of exclusion: physical health conditions, other mental health disorders, and medications or other substances should be ruled out as a primary cause.
Physical examination and laboratory studies are generally normal if no co-existing physical or mental health conditions or substance abuse issues exist.
Treatment is primarily with cognitive therapy, serotonergic antidepressants, psychotherapy, or a combination of these approaches.
Generalised anxiety disorder (GAD) is defined as at least 6 months of excessive worry about everyday issues that is disproportionate to any inherent risk, causing distress or impairment. The worry is not confined to features of another mental health disorder, a result of substance abuse, or relating only to a physical health condition.
At least three of the following symptoms are present most of the time: restlessness or nervousness, being easily fatigued, poor concentration, irritability, muscle tension, or sleep disturbance. Other common complaints are autonomic in nature, such as sweating, lightheadedness, palpitations, dizziness, and epigastric discomfort. Anxiety may be 'free-floating' (i.e., not restricted to, or even strongly predominating in, any particular environmental circumstances). Examples of worries include fears that the patient or a relative will shortly become ill or have an accident.
History and exam
Southern District Health Board
Department of Psychological Medicine
Dunedin School of Medicine
CG is an author of the Royal Australian and New Zealand College of Psychiatrists clinical practice guideline on social phobia, panic disorder, and generalised anxiety disorder. He is a contributor to the Cochrane Common Mental Disorders group, writing on generalised anxiety disorder, and has authored papers relating to heterogeneity of the database separately to Cochrane work. Otago University has commercial and research relationships with multiple pharmaceutical companies. He is an author of a number of references cited in this topic.
Dr Christopher Gale would like to gratefully acknowledge Dr Richard P. Swinson, Dr Elizabeth Hoge, and Dr Phebe Tucker, previous contributors to this topic.
RPS has personally received royalties for articles published in UpToDate (Wolters Kluwer) and the Compendium of Therapeutic Choices, 2nd edition (Canadian Pharmacists Association). EH is an author of a number of references cited in this topic. PT has done research for GlaxoSmithKline, Bristol-Myers Squibb, Wyeth Pharmaceuticals, Astra-Zeneca, Cephalon, Inc., and Ortho-McNeil. She has also consulted for Forest Pharmaceuticals and received honoraria from Pfizer, Inc. and Forest Pharmaceuticals.
University of Alabama
School of Medicine Tuscaloosa Campus
College of Community Health Sciences
LD declares that she has no competing interests.
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