Last reviewed: 27 Sep 2021
Last updated: 14 May 2021



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

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, sexual, or emotional trauma
  • other anxiety disorder
  • chronic physical health condition
  • female sex

Diagnostic investigations

Investigations to consider

  • thyroid function tests
  • urine drug screen
  • 24-hour urine for vanillylmandelic and metanephrines
  • pulmonary function tests
  • ECG

Treatment algorithm



Christopher Gale, BHB, MPH, MBChB, FRANZCP

Research Director

Consultant Psychiatrist

Southern District Health Board

Senior Lecturer

Department of Psychological Medicine

Dunedin School of Medicine

Otago University


New Zealand


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.


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.

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.

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