Signs and Symptoms of Generalized Anxiety Disorder
Generalized Anxiety Disorder (GAD) is characterized by excessive, uncontrollable worry about multiple topics that persists for at least 6 months, accompanied by at least three of six physical or cognitive symptoms including restlessness, fatigue, concentration problems, irritability, muscle tension, and sleep disturbance. 1
Core Diagnostic Features
According to the DSM-5 criteria, GAD presents with the following key features:
Psychological Symptoms
- Excessive anxiety and worry (apprehensive expectation) about various events or activities 1
- Difficulty controlling the worry 1, 2
- Disproportionate worry relative to actual risk (especially in cancer patients who may have excessive fear of recurrence) 1
- Worry about multiple areas of life (health, finances, family, work issues) 3
Physical and Cognitive Symptoms
GAD must be associated with at least three of the following six symptoms:
- Restlessness or feeling keyed up or on edge 1, 2
- Being easily fatigued 1, 2
- Difficulty concentrating or mind going blank 1, 2
- Irritability 1, 2
- Muscle tension 1, 2
- Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep) 1, 2
Severity Assessment
The GAD-7 scale is a validated screening tool that measures symptom severity over the past two weeks 1:
| Severity | GAD-7 Score |
|---|---|
| None/Minimal | 0-4 points |
| Mild | 5-9 points |
| Moderate | 10-14 points |
| Severe | 15-21 points |
Clinical Presentation Patterns
GAD may present differently depending on the patient:
- Somatic complaints: Patients often present with physical symptoms rather than explicitly reporting anxiety 1
- Functional impairment: Symptoms interfere with daily activities, work performance, and social relationships 1
- Chronic course: GAD typically has a waxing and waning pattern with few complete remissions 4
- High healthcare utilization: GAD patients are frequent users of primary care resources 4
Common Comorbidities
GAD frequently co-occurs with:
- Major depression (particularly important as comorbidity significantly increases disability) 4
- Other anxiety disorders (social anxiety, panic disorder) 1
- Substance use disorders 1
Special Considerations
Age-Related Differences
- Children and adolescents: May present with more somatic complaints and require age-appropriate assessment 1
- Older adults: May present with more physical symptoms and less obvious worry 1
Cultural Considerations
Assessment should be culturally sensitive, as expression of anxiety symptoms may vary across different cultural backgrounds 1
Diagnostic Pitfalls to Avoid
Failing to distinguish from normal worry: GAD worry is excessive, difficult to control, and causes significant distress or impairment 1
Missing medical causes: Always consider medical conditions (e.g., endocrine disorders) or medication effects that can mimic anxiety symptoms 5
Overlooking GAD in patients with somatic complaints: Patients may focus on physical symptoms rather than psychological distress 1
Inadequate assessment of functional impairment: GAD significantly impacts quality of life and functioning, similar to major depression 4
Not using standardized screening tools: The GAD-7 or GAD-2 provide objective measurement of symptoms and severity 1
The proper identification of GAD symptoms is essential for early intervention and appropriate treatment, which can significantly improve patient outcomes and quality of life.