Generalized anxiety disorder

Last reviewed: 2 Sep 2023
Last updated: 24 Aug 2023



History and exam

Key diagnostic factors

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

Other diagnostic factors

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

Risk factors

  • family history of anxiety
  • physical or emotional stress
  • history of physical, sexual, or emotional trauma
  • other anxiety disorder
  • chronic physical health condition
  • female sex
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

Investigations to consider

  • thyroid function tests
  • urine drug screen
  • 24-hour urine for catecholamines, metanephrines, normetanephrines, and creatinine
  • pulmonary function tests
  • ECG
More investigations to consider

Treatment algorithm


anxiety symptoms meeting DSM-5-TR criteria

anxiety symptoms not meeting DSM-5-TR criteria



Philip John Cowen, MD, FRCPsych, FMedSci

Professor of Psychopharmacology

Department of Psychiatry

University of Oxford




PJC has acted as an expert witness in medico-legal cases involving anxiety and depressive disorders and their treatment. He is a member of the British Association for Psychopharmacology.


Professor Philip John Cowen would like to gratefully acknowledge Dr Christopher Gale, Dr Richard P. Swinson, Dr Elizabeth Hoge, and Dr Phebe Tucker, previous contributors to this topic.


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. Otago University has commercial and research relationships with multiple pharmaceutical companies. He is an author of a number of references cited in 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 conducted 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.

Peer reviewers

Lori Davis, MD

Research Director

University of Alabama

School of Medicine Tuscaloosa Campus

College of Community Health Sciences




LD declares that she has no competing interests.

Arianna Di Florio, MD, PhD

Senior Clinical Lecturer

Division of Psychological Medicine and Clinical Neurosciences

Cardiff University

United Kingdom


ADF declares that she has no competing interests.

Elaine Lockhart, MB, BCH, BAO

Consultant in Paediatric Liaison Psychiatry

Royal Hospital for Children


United Kingdom


EL declares that she has no competing interests.

  • Differentials

    • Panic disorder
    • Social anxiety disorder
    • Obsessive-compulsive disorder
    More Differentials
  • Guidelines

    • Screening and diagnosis of mental health conditions during pregnancy and postpartum
    • Treatment and management of mental health conditions during pregnancy and postpartum
    More Guidelines
  • Patient leaflets

    Anxiety: what is it?

    Anxiety: what treatments work?

    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer