Diagnosing generalised anxiety disorder

Generalised anxiety disorder is characterised by unrelenting excessive worry or anxiety over everyday matters. The person’s worry can be over things in or out of their control and is relentless, resulting in the person being constantly ‘on edge’. Generalised anxiety disorder has a fluctuating course but tends to be a long-term disorder and affects up to 6% of the Australian population. Females are 2 to 3 times more likely to develop generalised anxiety disorder.

The diagnostic criteria for generalised anxiety disorder described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are:

  • excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance)
  • the individual finds it difficult to control the worry
  • the anxiety and worry are associated with 3 or more of the following 6 symptoms (with at least some symptoms being present for more days than not for the past 6 months)
  • restlessness or feeling ‘keyed up’ or ‘on edge’
  • being easily fatigued
  • difficulty concentrating or mind ‘going blank’
  • irritability
  • muscle tension
  • sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)
  • the anxiety, worry or physical symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning
  • the symptoms are not attributable to the physiological effects of a substance (eg caffeine intoxication, stimulant use, alcohol or drug discontinuation) or another medical condition (eg hyperthyroidism)
  • the symptoms are not better explained by another psychiatric disorder (eg adjustment disorder with anxious mood).

Anxiety in children can manifest as tantrums, crying, clinging or freezing.

Patients with generalised anxiety disorder may present during an acute crisis when anxiety is severe and disabling, or causing the patient unacceptable distress.

There is significant overlap between generalised anxiety disorder and other anxiety disorders—see Overview of anxiety and associated disorders for information on diagnosing and differentiating anxiety disorders. Generalised anxiety disorder is often comorbid with and may mask: