II. Definitions
- Generalized Anxiety Disorder
- Persistent and Excessive Worry, fear, uneasiness, restlessness, irritability, Muscle tension on >50% of days, lasting at least 6 months
III. Epidemiology
- Most common Anxiety Disorder
- Adult Prevalence
- Annual: 2 to 3% per year
- Lifetime: 7-8% in women, 4-5% in men
- Onset peaks in ages 20 to 40 years (least common over age 60 years)
- Women are more than twice as likely to be diagnosed with anxiety over lifetime
IV. Pathophysiology
- Dysregulation of worry
V. Symptoms: Topics of Excessive Worry
- Children
- School performance
- Sports performance
- Catastrophic events (e.g. earthquake, nuclear war)
- College students
- Academic performance
- Relationships
- Adults
- Children's well-being
- Illness or injury
- Family and other relationships
- Occupational and financial concerns
- Elderly
- Health
- Social relationships
- Finances
VI. Symptoms: Physical
- See Anxiety Symptoms
- Excessive, overwhelming and uncontrolled worry
VII. Symptoms: Avoidance behaviors
- Avoidance of activities may be subtle
- Limited interpersonal relationships
- Procrastination
- Non-assertive in new situations
VIII. Diagnosis: Diagnostic Criteria (DSM 5, 300.02, F41.1)
- Excessive anxiety and worry for at least 6 months on most days (more than 50%)
- Involves two or more life circumstances (e.g. home, work, school)
- Anxiety or worry is difficult to control
- Associated symptoms (3 present in adult, 1 in child), with some symptoms present on more than half of the days
- Impaired social or occupational functioning or distress
- No Anxiety Secondary Cause
- Not primarily to other psychiatric illness
- See Differential Diagnosis below
- Not primarily due to underlying medical condition (e.g. Hyperthyroidism)
- Not primarily due to Substance Abuse
- Not primarily to other psychiatric illness
IX. Diagnosis: Scales
- Generalized Anxiety Disorder Scale (GAD-7)
- PROMIS Emotional Distress-Anxiety Short Form for adults
- Severity Measure for Generalized Anxiety Disorder - Adults
- Hamilton Anxiety Scale (HAM-A)
- Zung Self Rating Scale for Anxiety
- Beck Anxiety Scale
X. Differential Diagnosis
- See Anxiety Secondary Causes
- Other Anxiety Disorders
- Other psychiatric conditions
- Major Depression
- Personality Disorder (Anxiety Cluster)
- Eating Disorder (e.g. Anorexia Nervosa)
- Body Dysmorphic Disorder
- Delusional disorder (e.g. Schizophrenia)
- Substances
- Stimulants (e.g. Cocaine, Amphetamines, excessive Caffeine)
- Depressant Substance Withdrawal (e.g. Alcohol, Benzodiazepines, Opioids)
- Medical Conditions
- Hyperthyroidism
- Cardiopulmonary Disease (e.g. Asthma, Congestive Heart Failure, Atrial Fibrillation)
XI. Management
XII. Prognosis: Predictors of better outcomes
- Lower anxiety level
- Lower demoralization level
- Higher level of Major Depression at presentation
XIII. References
- APA (1994) DSM IV, APA, p. 432-6
- Derogatis (1989) Anxiety and Depressive Disorders, p.42
- Kowalchuk (2022) Am Fam Physician 106(6): 657-64 [PubMed]
- Kroenke (2007) Ann Intern Med 146(5): 317-25 [PubMed]
- Locke (2015) Am Fam Physician 91(9): 617-24 [PubMed]
- Wittchen (2002) J Clin Psychiatry 63:24-34 [PubMed]
- Zal (1995) Fam Prac Recert 17(10): 17-32 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Definition (NCI_NCI-GLOSS) | A condition marked by excessive worry and feelings of fear, dread, and uneasiness that last six months or longer. Other symptoms of GAD include being restless, being tired or irritable, muscle tension, not being able to concentrate or sleep well, shortness of breath, fast heartbeat, sweating, and dizziness. |
| Definition (NCI) | An anxiety disorder characterized by excessive and difficult-to-control worry about a number of life situations. The worry is accompanied by restlessness, fatigue, inability to concentrate, irritability, muscle tension, and/or sleep disturbance and lasts for at least 6 months. |
| Definition (PSY) | An anxiety disorder characterized by free-floating, persistent, and excessive worry for at least six months. |
| Concepts | Mental or Behavioral Dysfunction (T048) |
| ICD9 | 300.02 |
| ICD10 | F41.1 |
| SnomedCT | 191706008, 192401002, 21897009 |
| DSM4 | 300.02 |
| English | Generalized Anxiety Disorder, GAD - General anxiety disorder, generalized anxiety disorder, generalized anxiety disorder (diagnosis), Generalized anxiety dis, anxiety disorder generalize, anxiety disorder generalized, generalised anxiety disorder, generalized anxiety disorders, gad, anxiety disorders generalized, gads, Generalised anxiety disorder (disorder), GAD, Generalized anxiety disorder, GAD - Generalised anxiety disorder, GAD - Generalized anxiety disorder, Generalised anxiety disorder, Generalized anxiety disorder (disorder), generalized; anxiety disorder, anxiety disorder; generalized, Generalised anxiety disorder [Ambiguous] |
| Italian | Disturbo ansioso generalizzato, Glutammico-decarbossilasi |
| Dutch | gegeneraliseerde angststoornis, angststoornis; gegeneraliseerd, gegeneraliseerd; angststoornis, Gegeneraliseerde angststoornis, generaliseerde angststoornis |
| French | Trouble de l'anxiété généralisée, Anxiété généralisée |
| German | GAD, Generalisierte Angststoerung, generalisierte Angststoerung |
| Spanish | TAG, trastorno de ansiedad generalizada (trastorno), trastorno de ansiedad generalizada, Trastorno de ansiedad generalizada |
| Japanese | 全般性不安障害, ｾﾞﾝﾊﾟﾝｾｲﾌｱﾝｼｮｳｶﾞｲ |
| Czech | Generalizovaná úzkostná porucha |
| Korean | 전신 불안장애 |
| Hungarian | Generalizált szorongás zavar, GAD, Generalizált szorongásos zavar |
| Portuguese | Perturbação de ansiedade generalizada |
