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The criteria for Generalized Anxiety Disorder (GAD) according to the DSM-5-TR include excessive anxiety and worry about various events or activities, occurring more days than not for at least 6 months, difficulty controlling the worry, and the presence of additional symptoms such as restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbance.[1]
The anxiety and worry must be associated with three or more of the following symptoms (only one required in children): restlessness, being easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbances.
These symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).
The disturbance is not better explained by another mental disorder (e.g., panic disorder, social anxiety disorder, obsessive-compulsive disorder).
Diagnosis should be confirmed through a comprehensive clinical interview, and tools like the GAD-7 scale can be used to assess symptom severity over the past 2 weeks.[1]
Additional info
In diagnosing GAD, it's crucial to differentiate it from other anxiety disorders and conditions that might present with similar symptoms. For instance, panic disorder involves unexpected panic attacks, while obsessive-compulsive disorder is characterized by repetitive rituals aimed at reducing anxiety.[1] Additionally, conditions such as depression and PTSD can also manifest with significant anxiety, complicating the diagnostic process.[1-2] The use of structured diagnostic tools like the GAD-7 scale helps in quantifying the severity of anxiety and can guide treatment decisions, although it assesses symptoms over a shorter period (2 weeks) compared to the DSM-5-TR criteria (6 months).[1] It's important to rule out substance-induced anxiety and anxiety due to a general medical condition through patient history, physical examination, and appropriate laboratory tests as indicated.[1]
References
Reference 1
1.
Elsevier ClinicalKey Clinical Overview
Diagnosis
Diagnosis is based on patient history and physical examination findings; DSM-5-TR criteria must be met for a diagnosis of generalized anxiety disorder
Excessive use of alcohol, caffeine, or other stimulants must be ruled out as a cause of symptoms
GAD-7 scale Beck Anxiety Inventory
GAD-7 assesses symptoms over the past 2 weeks instead of 6 months ( per DSM-5-TR
Beck Anxiety Inventory contains 21 items comprising somatic, affective, and cognitive symptoms related specifically to anxiety disorders
Comprehensive clinical interview is used to assess for the following DSM-5-TR criteria:
Excessive anxiety and worry (apprehensive expectation) about various events or activities (eg, work or school performance), occurring more days than not, lasting 6 months or longer
Patient has difficulty controlling this worry
Anxiety and worry occur in conjunction with at least 3 (only 1 required in children) of the following symptoms, with at least some symptoms having been present for more days than not for the past 6 months:
Restlessness
Fatigability
Compromised ability to concentrate
Crankiness/irritability
Increased muscle tension
Poor sleep quality, including trouble falling asleep, difficulty staying asleep, or restlessness
Patient's symptoms lead to clinical distress and engender negative effects on work, school, or everyday life
Another medical condition or substance use disorder is not the cause
Different mental disorder has not given rise to the patient's symptoms
Maintain a high index of suspicion for medical conditions that could cause the symptoms; laboratory testing is generally deferred, but CBC, thyroid function tests, basic chemistry panel, urine drug screening, and ECG should be obtained as indicated by the clinical presentation and medical history
Diagnosis
Depressed mood for most days over 2 weeks along with at least 2 characteristic symptoms
Anhedonia
Change in weight or appetite
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue
Feelings of worthlessness or inappropriate guilt
Diminished ability to concentrate or indecisiveness
Suicidal ideation or attempt
Obsessive-compulsive disorder
Characterized by continually recurring thoughts or images (obsessions) that increase anxiety and repetitive or ritualistic actions (compulsions) performed to alleviate that anxiety
Excessive worrying and some symptoms of anxiety can be present
Differentiated by repetitive rituals and behaviors (eg, hand-washing, mental acts of ordering or checking) performed to alleviate anxiety
Anxiety relates more to imagined or fantastic events
Diagnosis can be confirmed by DSM-5-TR criteria:
Obsessive thoughts and compulsive behaviors take up at least 1 hour of the day
Patient suffers from clinically significant impairment in an occupational or social setting
Posttraumatic stress disorder
Psychological disturbance or anhedonic/dysphoric mental state caused by experiencing a serious traumatic event
Heightened anxiety is typically present, along with its mental and physical symptoms
Main distinguishing criterion is the association of anxiety with a specific event, not with normal daily functioning, and the presence of flashbacks, dreams, and dissociative states relating to that event
Diagnosis can be confirmed by DSM-5-TR criteria:
Adults and children older than 6 years
Traumatic experience (eg, grave injury, sexual violence, threat of death) or such an event affecting a close friend or relative
Repeated exposure to circumstances surrounding such events, as with first responders or emergency department personnel
Psychological disturbance lasting longer than 1 month, including invasive memories, dreams, flashbacks, avoidance of stimuli associated with such events, irritability, anxiety, and insomnia
Patient suffers from clinically significant impairment in an occupational or social setting
Children younger than 6 years, specific criteria include:
Witnessing traumatic events, especially those affecting a primary caregiver
Reference 2
2.
Lyness, Jeffrey M., Lee, Hochang B. (2024). In Goldman-Cecil Medicine (pp. 2336). DOI: 10.1016/B978-0-323-93038-3.00362-2
This more heterogeneous condition is defined by the presence of clinically significant anxiety and associated somatic symptoms for 6 or more months. For some patients, the symptoms are episodic but are not the full-fledged panic attacks seen in panic disorder, whereas for others the symptoms may be omnipresent, albeit often with waxing and waning intensity. Generalized anxiety disorder is often overridden in the diagnostic hierarchy by other conditions that produce anxiety.
