Generalised Anxiety Disorder (GAD)
General Psychiatry Article Disclaimer
- DSM-5 criteria or ICD-11 diagnostic requirements are used to structure the Clinical Features and Diagnosis section. The classification system used is selected according to its clarity and suitability for non-specialist learning.
- The criteria are summarised and simplified rather than reproduced in full, while preserving their original diagnostic meaning.
- Where appropriate, a student-friendly pattern-recognition summary is provided to highlight the most clinically and exam-relevant features.
Exam tip (re-psychiatry questions)
- Do not attempt to memorise every DSM-5 or ICD-11 criterion word-for-word. However, it is important to read through the criteria and become familiar with the key symptom clusters, duration thresholds, exclusions, and distinguishing features highlighted in this article.
- Exam questions may not provide every feature required to meet the full diagnostic criteria. Familiarity with the criteria can help one recognise the most likely diagnosis, exclude important alternatives, and narrow the differential diagnosis.
Clinical Features and Diagnosis
High-yield pattern recognition for GAD:
- Chronic, persistent anxiety or worrying on most days for at least 6 months
- Worry involves several domains (e.g. work, health, family, finances)
- Patient finds the worry difficult to control
- Causes clinically significant distress or functional impairment
NICE recommends using the GAD-2 tool to screen for GAD.
DSM-5 criteria for GAD, ALL must be met: [Ref]
- Excessive anxiety and worry about a number of events or activities (e.g. work or school performance)
- The anxiety and worry are associated with at least 3 of the following
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Restlessness or feeling keyed up or on edge
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Being easily fatigued
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Difficulty concentrating or mind going blank
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Irritability
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Muscle tension
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Sleep disturbance (e.g. difficulty falling or staying asleep, restless unsatisfying sleep)
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- Occurring on most days for at least 6 months
- The disturbance is NOT better explained by or attributable to:
- Medical condition (e.g. hyperthyroidism)
- Physiological effect of a substance (e.g. drug abuse, beta-2 agonist)
- Another mental disorder
- Anxiety or worry about having panic attacks in panic disorder
- Negative evaluation in social anxiety disorder (social phobia)
- Contamination or other obsessions in OCD
- Separation from attachment figures in separation anxiety disorder
- Reminders of traumatic events in PTSD
- Gaining weight in anorexia nervosa
- Physical complaints in somatic symptom disorder
- Perceived appearance flaws in body dysmorphic disorder
- Having a serious illness in illness anxiety disorder
- Content of delusional beliefs in schizophrenia or delusional disorder
Generalised Anxiety Disorder vs Panic Disorder
| Feature | Generalised anxiety disorder (GAD) | Panic disorder |
|---|---|---|
| Core problem | Persistent, excessive worry about multiple areas of life | Recurrent unexpected panic attacks |
| Course | Persistent anxiety or worry | Discrete panic attacks, with possible anticipatory anxiety between attacks |
| Typical symptoms | Restlessness, fatigue, poor concentration, irritability, muscle tension, sleep disturbance | Palpitations, sweating, trembling, dyspnoea, chest discomfort, dizziness, fear of dying or losing control |
Management
Offer self-care advice to all patients (in addition to those below):
- Sleep hygiene
- Regular exercise
If the patient presents with GAD and a comorbid condition (e.g. depression, other anxiety disorders) → treat the primary disorder first (one that is more severe and is more likely to improve overall functioning if treated)
NICE recommends a stepped approach, step up accordingly if ineffective:
| Step | Management |
|---|---|
| 1 |
|
| 2 | Offer low-intensity psychological interventions (guided by the patient’s preference):
|
| 3 (consider starting here from the start if there is marked functional impairment) | Offer either of the following (guided by the patient’s preference):
If the patient is pregnant, high-intensity psychological intervention is preferred. Do not routinely offer benzodiazepines for GAD in primary / secondary care, except as a short-term measure during crises. |
| 4 | Offer referral for specialist assessment of needs and risks
Combination treatment is usually needed |