From the Guidelines
The DSM-5 criteria for Generalized Anxiety Disorder (GAD) include excessive anxiety and worry occurring more days than not for at least 6 months about multiple events or activities, accompanied by at least three of six physical or cognitive symptoms, including restlessness, impaired concentration, and difficulty sleeping, as outlined in the Journal of Clinical Oncology study 1. The anxiety and worry are associated with at least three of the following six symptoms:
- 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 causes clinically significant distress or impairment in social, occupational, or other important areas of functioning, and must not be attributable to the physiological effects of a substance or another medical condition, and must not be better explained by another mental disorder, as indicated in the study 1. For diagnosis, these symptoms should be assessed through clinical interviews, and severity can range from mild to severe based on the level of distress and functional impairment, according to the guidelines outlined in the Journal of Clinical Oncology study 1. GAD often requires treatment with psychotherapy (particularly cognitive-behavioral therapy) and sometimes medication, with the goal of reducing symptoms and improving quality of life, as suggested by the study 1.
From the FDA Drug Label
Generalized Anxiety Disorder (300. 02) is described in the American Psychiatric Association's Diagnostic and Statistical Manual, III1 as follows: Generalized, persistent anxiety (of at least 1 month continual duration), manifested by symptoms from three of the four following categories: Motor tension: shakiness, jitteriness, jumpiness, trembling, tension, muscle aches, fatigability, inability to relax, eyelid twitch, furrowed brow, strained face, fidgeting, restlessness, easy startle. Autonomic hyperactivity: sweating, heart pounding or racing, cold, clammy hands, dry mouth, dizziness, lightheadedness, paresthesias (tingling in hands or feet), upset stomach, hot or cold spells, frequent urination, diarrhea, discomfort in the pit of the stomach, lump in the throat, flushing, pallor, high resting pulse and respiration rate Apprehensive expectation: anxiety, worry, fear, rumination, and anticipation of misfortune to self or others. Vigilance and scanning: hyperattentiveness resulting in distractibility, difficulty in concentrating, insomnia, feeling "on edge," irritability, impatience.
The GAD DSM-5 Criteria are not directly mentioned in the provided drug label, however the label does reference the Diagnostic and Statistical Manual, III1. The criteria mentioned are for Generalized Anxiety Disorder (300.02) and include symptoms from three of the four categories: Motor tension, Autonomic hyperactivity, Apprehensive expectation, and Vigilance and scanning 2.
From the Research
GAD DSM-5 Criteria
The DSM-5 criteria for Generalized Anxiety Disorder (GAD) are not explicitly stated in the provided studies. However, the characteristics of GAD are described in the studies as follows:
- GAD is chiefly characterized by a cognitive focus on threats and risks towards the individual and/or the immediate family, accompanied by a sense of tension, worry, muscle pain, disturbed sleep, and irritability 3.
- The condition impairs work capacity, relations, and leisure activities, and aggravates concurrent somatic diseases 3.
Symptoms and Treatment
The symptoms of GAD include:
- Excessive anxiety and worry about various things for at least 6 months 4
- Restlessness, feeling on edge, or irritability 4
- Difficulty concentrating or mind going blank 4
- Sleep disturbance 4
- Muscle tension 4
Treatment options for GAD include:
- Cognitive behavioral therapy (CBT) 3, 5, 6
- Selective serotonin reuptake inhibitors (SSRIs) 3, 4, 5, 7
- Serotonin and norepinephrine reuptake inhibitors (SNRIs) 3, 4, 5, 7
- Benzodiazepines (BZs) 4
- Pregabalin 3
Effectiveness of Treatment
The effectiveness of these treatments is supported by the following evidence:
- CBT, SSRIs, and SNRIs are effective in reducing anxiety symptoms in adults and children with GAD 4, 5, 7
- CBT augmentation of SSRI treatment reduces peak cortisol levels in older adults with GAD 6
- SSRIs and SNRIs are effective in reducing internalizing symptoms in patients with anxiety, obsessive-compulsive, and stress-related disorders 7