Generalized anxiety disorder

Generalized 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 coexisting physical or mental health conditions or substance misuse issues exist.

Treatment is primarily with psychotherapy (usually cognitive behavioral therapy), serotonergic antidepressants, or a combination of these approaches.

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 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.