Last reviewed:December 2019
Last updated:May  2019



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


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).

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. 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.

Peer reviewersVIEW ALL

Research Director

University of Alabama

School of Medicine Tuscaloosa Campus

College of Community Health Sciences




LD declares that she has no competing interests.

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