Generalized Anxiety Disorder: Symptoms and Diagnosis

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Generalized anxiety disorder (GAD) can be a challenge to diagnose. People consider panic attacks a hallmark of all anxiety disorders, and GAD is different in that there are generally no panic attacks associated with it. Without panic attacks present, we may think we are "just worrying too much." Our struggles of constant worry may be minimized or dismissed and, in turn, not properly diagnosed or treated. 

Most of us feel worried at some point in our lives and experience situations that can cause us to feel anxious, so what are professionals looking for to help determine if someone struggles with GAD? An evaluation of symptom criteria, as outlined in The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (also known as the DSM-5), is the first step—they look for factors like excessive, hindering worry paired with a variety of physical symptoms, then use proven diagnostic assessments to make a diagnosis and rule out other possibilities.

Symptoms

The DSM-5 outlines specific criteria to help professionals diagnose generalized anxiety disorder. Having a standard set of symptoms to reference when assessing clients helps them to more accurately diagnose mental health concerns and, in turn, create a more effective plan of care.

When assessing for GAD, clinical professionals are looking for the following:

  1. The presence of excessive anxiety and worry about a variety of topics, events, or activities. Worry occurs more often than not for at least 6 months and is clearly excessive. Excessive worry means worrying even when there is no specific threat present or in a manner that is disproportionate to the actual risk. Someone struggling with GAD experiences a high percentage of their waking hours worrying about something. The worry may be accompanied by reassurance-seeking from others. In adults, the worry can be about job responsibilities or performance, one’s own health or the health of family members, financial matters, and other everyday, typical life circumstances. In children, the worry is more likely to be about their abilities or the quality of their performance (for example, in school).
  2. The worry is experienced as very challenging to control. The worry in both adults and children may easily shift from one topic to another.
  3. The anxiety and worry are accompanied with at least three of the following physical or cognitive symptoms (In children, only one symptom is necessary for a diagnosis of GAD):
    • Edginess or restlessness
    • Tiring easily; more fatigued than usual
    • Impaired concentration or feeling as though the mind goes blank
    • Irritability (which may or may not be observable to others)
    • Increased muscle aches or soreness
    • Difficulty sleeping (due to trouble falling asleep or staying asleep, restlessness at night, or unsatisfying sleep)

    Many individuals with GAD also experience symptoms such as sweating, nausea, or diarrhea.

    • The anxiety, worry, or associated symptoms make it hard to carry out day-to-day activities and responsibilities. They may cause problems in relationships, at work, or in other important areas.
    • These symptoms are unrelated to any other medical conditions and cannot be explained by the effect of substances including a prescription medication, alcohol, or recreational drugs.
    • These symptoms are not better explained by a different mental disorder.

    Assessment

    During an assessment, your clinician will use the diagnostic criteria, standardized assessments, and their clinical judgment to make a diagnosis.

    Generally, they will ask about your symptoms in an open-ended way, but you may also be asked to complete self-report questionnaires. These typically brief measures can help determine the diagnosis (as the Generalized Anxiety Disorder Scale-7 does) or severity of symptoms.

    In specialized care settings, like an anxiety disorders clinic, standardized assessment tools are sometimes used to evaluate symptoms. In this case, your clinician gives you a semi-structured interview. The interview is likely to include a standardized set of questions, and your answers will help your clinician to make an accurate diagnosis.

    Commonly used and well-validated diagnostic interviews for adults include the Structured Clinical Interview for DSM Disorders (SCID) and the Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5). There is a child version of the ADIS, in which both parent and child are asked about the child’s symptoms. These interviews also evaluate the presence of other associated conditions such as depression.

    Your Visit

    Remember to be honest with your provider at the first visit—both when filling out forms and discussing your symptoms face-to-face. Being upfront and honest can help determine what is happening and put together a plan of care specifically tailored to your needs.

    Self-Assessment

    If you are wondering whether you or your child might suffer from GAD, you can consider completing a brief online self-screening tool for adults or for children provided by the Anxiety and Depression Association of America (ADAA). If you do this, you should still speak with a mental health professional or your physician for a proper diagnosis and treatment.

    When to Seek Help 

    Many people struggle with GAD experience symptoms for a long time before seeking help. Reaching out for a diagnosis can feel challenging, especially when anxiety feels so constant and widespread. Contacting a mental health or other clinical provider is a courageous step that can help clarify what is happening and, in turn, lead to creating a plan of care that can help you find relief and regain a sense of well-being.

    When deciding to seek help, something to consider is how difficult it is to feel any sense of calm, comfort, and reassurance around your worry. If you find yourself constantly seeking reassurance from others, or repeatedly trying different methods of stress management and relaxation to no avail, it may be worth contacting a professional.

    Also, know that no experience of a panic attack is another primary reason people don't seek help. The worry is chronic and concerning but, because there are no periods of acute panic attacks, they simply chalk the challenges up to being a "worry wart." They may even be told this by others when seeking reassurance or trying to find comfort. Remember, GAD is different in that panic attacks aren't typically present, so don't let this factor stop you from reaching out.

    Additionally, take note of the physical symptoms that are accompanying your worry. As the anxiety continues, you may find more and more challenges with things like headaches, digestion, restlessness, and fatigue. When we feel this way we are not able to live our best life. Should you find that your worry feels excessive and begins leading to other physical symptoms, you may benefit from talking with a mental health or other care providers.

    Finding a Clinician

    Take time to research and seek out providers who specialize in the treatment of anxiety. Because anxiety is present in so many mental health conditions, you will want to talk with someone who understands the specific criteria required so you can be accurately diagnosed and treated.

    Primary care physicians can often provide referrals to trusted and specialized mental health providers. Otherwise, to find a psychotherapist in your area, consult referral resources such as:

    The American Psychiatric Association is a national organization of psychiatrists that can also provide recommendations for local providers who are able to provide psychiatric evaluation and prescribe medications.

    Differential Diagnosis

    Anxiety symptoms can be found in many categories of mental health conditions listed in the DSM-5, such as within mood disorders, eating disorders, and cognitive disorders. Within the category of anxiety disorders there are many symptoms that will overlap and anxiety conditions can sometimes be confused with one another.

    While sitting with a mental health provider, they will be seeking information that will help them to best diagnose your condition. A differential diagnosis means to distinguish one condition from another when there are symptoms that overlap.

    Some conditions that may need to be ruled out include:

    Although some of these conditions are discussed more casually by the general public, there are specific criteria that would need to be met in order for one of these (or other conditions) to be properly diagnosed. It is important for you to sit with a qualified professional to determine what is happening for you and to be offered a plan of care that can best help.

    Additionally, there can be other behaviors and symptoms that can be present with anxiety. When someone engages in self-sabotaging behavior, such as procrastination, they can be perceived as struggling with self-regulation and behavioral conditions. Overlooking elements of anxiety related to this behavior can end up creating an obstacle for someone to receive effective treatment.

    Sitting with a qualified professional to determine an accurate diagnosis is key. Having the willingness to reach out for help, being honest with your provider and participating actively in treatment can help you regain a sense of well-being.

    A Word From Verywell

    Remember, GAD is a treatable condition. There is no need for you (or your child) to worry in silence. Treatment, particularly psychotherapy, self-help approaches, or other therapies, will teach you a variety of ways to cope with your anxiety. There are also medications that can help.

    What Could Cause Generalized Anxiety Disorder?
    View Article Sources
    • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Washington, D.C.: American Psychiatric Association; 2013.
    • Brown, TA, Barlow DH. Treatments That Work: Anxiety and Related Disorders Interview Schedule for DSM-5. New York: Oxford University Press, 2014.
    • First MB, Williams JBW, Benjamin LS, Spitzer RL, First MB. SCID-5-PD: Structured Clinical Interview for DSM-5® Personality Disorders. Arlington, VA: American Psychiatric Association Publishing; 2016.