Common condition defined as chronic, excessive worry for at least 6 months that causes distress or impairment.
At least 3 key symptoms out of a possible 6 are required to make a diagnosis: restlessness or nervousness, easy fatigability, poor concentration, irritability, muscle tension, or sleep disturbance.
It is in part a diagnosis of exclusion: medical conditions, medications or substances, and other mental disorders should be ruled out as a primary cause.
Physical examination and laboratory studies are generally normal if no coexisting medical problems or substance abuse issues exist.
Treatment is with either pharmacotherapy, psychotherapy, or a combination.
Generalized 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 disorder, or as a result of substance abuse or a general medical condition. At least 3 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
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).
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 generalized anxiety disorder. He is a contributor to the Cochrane Common Mental Disorders group, writing on generalized 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.
Dr Richard P. Swinson and Dr Christopher Gale would like to gratefully acknowledge Dr Elizabeth Hoge and Dr Phebe Tucker, previous contributors to this topic.
University of Alabama
School of Medicine Tuscaloosa Campus
College of Community Health Sciences
LD declares that she has no competing interests.
Use of this content is subject to our disclaimer