The primary symptom of Generalized Anxiety Disorder (GAD) is excessive worry about many different things, which is present most of the time and whose focus may shift from moment to moment. As described by the Diagnostic and Statistical Manual of Mental Disorders IV-TR, individuals who endorse generalized anxiety disorder symptoms, do not need to recognize the worry as “excessive” in order to meet criteria, as long as the other symptoms are present. People with GAD find that they have great difficulty controlling their worry and often experience some or all of the following symptoms1:
- poor concentration
- muscle tension
Common areas of worry for individuals with GAD are2:
- social or interpersonal relationships
- occupation or school
- community or world events
- personal health
- the health of people close to them
GAD is diagnosed only when symptoms are not part of another psychiatric disorder, the person worries more often than not for at least 6 months, and the anxiety or worry interferes significantly with the person’s day-to-day tasks and responsibilities or causes significant distress1. Providers can diagnose GAD by conducting a clinical interview. They can monitor GAD symptoms by administering self-report questionnaires or self-monitoring forms, and, of course, by asking questions regarding symptom severity and frequency.
Generalized anxiety disorder is more common in women than in men, and its age of onset varies from childhood to older adulthood1. GAD runs in families, which suggests an interaction of both genetic and environmental influences. Often it is diagnosed in individuals with a mood disorder, such as major depressive disorder, another anxiety disorder, such as panic disorder, or in those with substance use disorders, such as alcohol or stimulant abuse or dependence1. Some GAD symptoms overlap with those of other psychiatric disorders; therefore it is important that a diagnosis of GAD be made only by a trained mental health care professional.
GAD in children: GAD often presents differently in children than in adults. Children don’t necessarily talk about difficulty controlling their worry and they often don’t report the symptom of muscle tension3. Whereas younger children are more likely to worry excessively about their physical well-being, older children tend to worry more about their competence, psychological well-being, and social evaluation4. According to the DSM IV-TR (the manual used to diagnose psychiatric disorders), children need to report only one of the associated symptoms in order to meet the diagnostic criteria for generalized anxiety disorder3. It is often helpful to gather symptom information from several sources (that is, the child, parents, and teachers) as appropriate for a more accurate assessment and better treatment planning.
GAD in older adults: Unlike other anxiety disorders that typically develop in early adulthood, GAD can develop later in life and its symptoms can be long-lasting. However, older adults are less likely to report anxiety symptoms5, which might make it more difficult to diagnose especially given the challenge of distinguishing GAD from depression. About a quarter of older adults with depression also have GAD, which may also increase their level of suicidality6. Therefore, in order to provide the appropriate treatment, it is important to conduct a thorough assessment for symptoms of anxiety, depression, and suicidal thoughts.
1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4thed., text revision). Washington, DC: Author.
2. Brown, T. A., Di Nardo, P. A., & Barlow, D. H. (1994). Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV). San Antonio, TX: Psychological Corporation/Graywing Publications Incorporated.
3. Tracey, S. A., Chorpita, B. F., Douban, J., & Barlow, D. H. (1997). Empirical evaluation of DSM-IV generalized anxiety disorder criteria in children and adolescents. Journal of Clinical Child Psychology, 26,404-414.
4. Vasey, M. W., Crnic, K. A., & Carter, W. G. (1994). Worry in childhood: Developmental perspective. Cognitive Therapy and Research, 18, 529-549.
5. Levy, B. R., Conway, K. P., Brommelhoff, J., & Merikangas, K. R. (2003). Intergenerational differences in the reporting of elder’s anxiety. Journal of Mental Health and Aging, 9, 233-241.
6. Lenze, E. J., Mulsant, B. H., Shear, M. K., Schulberg, H. C., Dew, M. A., Begley, A. E., Pollock, B. G., & Reynolds, C. F. (2000). Comorbid anxiety disorders in depressed elderly patients. American Journal of Psychiatry, 157, 722-728.