From the Guidelines
The gold standard for diagnosing anxiety is a comprehensive clinical assessment conducted by a qualified mental health professional, typically a psychiatrist or psychologist, using a structured clinical interview that evaluates symptoms against established diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) 1.
Key Components of the Assessment
- The assessment involves evaluating the nature, severity, and duration of symptoms, their impact on daily functioning, and ruling out other potential causes such as medical conditions or substance use.
- Standardized assessment tools like the Hamilton Anxiety Rating Scale (HAM-A), Generalized Anxiety Disorder 7-item scale (GAD-7), or Beck Anxiety Inventory (BAI) may be used to supplement the clinical interview and quantify symptom severity, but these are not diagnostic on their own.
- The diagnosis relies heavily on the clinician's expertise in recognizing the characteristic patterns of excessive worry, fear, and related physical symptoms that persist over time and cause significant distress or impairment.
Importance of Clinical Judgment
- Anxiety is fundamentally a clinical diagnosis based on symptom patterns and their impact rather than any objective biological marker.
- The use of valid and reliable screening tools, such as the GAD-7 scale, is recommended to identify patients with anxiety disorders, particularly generalized anxiety disorder (GAD) 1.
- Clinicians should consider special circumstances in screening and assessment of anxiety, including using culturally sensitive assessments and treatments, and tailoring assessment or treatment for those with learning disabilities or cognitive impairments.
From the Research
Diagnosis of Anxiety
- The diagnosis of anxiety disorders, including generalized anxiety disorder (GAD), requires a comprehensive differential diagnostic evaluation to identify confounding variables and comorbid conditions 2.
- Screening and monitoring tools, such as the GAD-7, can be used to help make the diagnosis and monitor response to therapy 2.
- A broad differential diagnosis is essential, as anxiety can be a principal manifestation of other types of mental or somatic illness 3.
Diagnostic Tools
- The GAD-7 is a free diagnostic tool that can be used to screen for GAD 2.
- The Severity Measure for Panic Disorder is another diagnostic tool that can be used to assess the severity of panic disorder 2.
- The Hamilton Anxiety Scale is a commonly used scale to assess the severity of anxiety symptoms 4.
Gold Standard for Diagnosing Anxiety
- There is no single gold standard for diagnosing anxiety, but a comprehensive diagnostic evaluation that includes a thorough medical and psychological history, physical examination, and use of diagnostic tools such as the GAD-7 and Hamilton Anxiety Scale is recommended 2, 3, 4.
- A diagnosis of anxiety disorder should be made based on a comprehensive evaluation of the patient's symptoms, medical history, and psychological history, rather than relying on a single diagnostic tool or test 2, 3.