Generalised anxiety disorder

Generalised anxiety disorder (GAD) is a common condition defined as chronic, excessive worry for at least 6 months that causes distress or impairment, and is hard to control.

At least three key symptoms out of a possible six are required to make a diagnosis of GAD in adults according to the Diagnostic and Statistical Manual of mental disorders, fifth edition, text revision (DSM-5-TR) criteria. These include restlessness or nervousness, being easily fatigued, poor concentration, irritability, muscle tension, and/or sleep disturbance. One key symptom is required to make the diagnosis in children.

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 misuse issues exist.

Treatment is primarily with psychotherapy (usually cognitive behavioural therapy), serotonergic antidepressants, 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 misuse, or relating only to a physical health condition. The worry is hard to control.

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.[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022. In children, at least one key symptom should be present most of the time.

Other common complaints are autonomic in nature, such as sweating, lightheadedness, palpitations, dizziness, and epigastric discomfort.[2]World Health Organization. International classification of diseases, eleventh revision. 6B00: generalised anxiety disorder. 2022 [internet publication]. https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1712535455 Anxiety may be 'free-floating' (i.e., not restricted to, or even strongly predominating in, any particular environmental circumstances).[2]World Health Organization. International classification of diseases, eleventh revision. 6B00: generalised anxiety disorder. 2022 [internet publication]. https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1712535455 Examples of worries include fears that the patient or a relative will shortly become ill or have an accident.