Last reviewed: March 2019
Last updated: September  2018



History and exam

Key diagnostic factors

  • excessive worry for at least 6 months
  • anxiety not confined to another mental disorder
  • anxiety not due to medication or substance
  • muscle tension
  • sleep disturbance
  • fatigue
  • restlessness
  • irritability
  • poor concentration

Other diagnostic factors

  • headache
  • sweating
  • dizziness
  • gastrointestinal symptoms
  • muscle aches
  • increased heart rate
  • shortness of breath
  • trembling
  • exaggerated startle response
  • chest pain

Risk factors

  • family history of anxiety
  • physical or emotional stress
  • history of physical or emotional trauma
  • other anxiety disorder
  • female sex
  • diabetes
  • adolescence or early adulthood

Diagnostic investigations

Investigations to consider

  • thyroid function tests
  • urine drug screen
  • 24-hour urine for vanillylmandelic and metanephrines
  • pulmonary function tests
  • ECG
  • echocardiogram
  • electroencephalogram (EEG)
Full details

Treatment algorithm


Authors VIEW ALL

Emeritus Professor Medical Director

Anxiety Treatment and Research Centre

McMaster University and St Joseph’s Hospital




RPS has personally received royalties for articles published in UpToDate (Wolters Kluwer) and the Compendium of Therapeutic Choices, 2nd edition (Canadian Pharmacists Association).

Dr Richard P. Swinson would like to gratefully acknowledge Dr Elizabeth Hoge and Dr Phebe Tucker, previous contributors to this monograph. EH is an author of a number of references cited in this monograph. PT has done research for the companies GlaxoSmithKline, Bristol-Myers Squibb, Wyeth Pharmaceuticals, Astra-Zeneca, Cephalon, Inc., and Ortho-McNeil. She has also done consultancies for Forest Pharmaceuticals and received honoraria from Pfizer, Inc. and Forest Pharmaceuticals.

Peer reviewers VIEW ALL

Research Director

University of Alabama

School of Medicine Tuscaloosa Campus

College of Community Health Sciences




LD declares that she has no competing interests.

Research Director

Consultant Psychiatrist

Southern District Health Board

Senior Lecturer

Department of Psychological Medicine

Dunedin School of Medicine

Otago University


New Zealand


CG declares that he is a contributor to the American College of Physicians Physician Information and Educational Resource (PIER); has been on the speaking bureau for Jannsen Cilag, Astra Zeneca, and Lilly Pharmaceticals; and has attended conferences paid for by Lilly Pharmaceuticals.

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