How is anxiety diagnosed?

How to Diagnose Anxiety

Anxiety should be diagnosed using standardized screening tools like the GAD-7, followed by a comprehensive diagnostic assessment to evaluate symptom severity, functional impairment, and potential comorbidities. 1

Screening Process

• Initial screening should occur at diagnosis, during treatment, at follow-up intervals, and during times of personal transition or crisis 1
• The 7-item Generalized Anxiety Disorder scale (GAD-7) is the recommended screening tool for anxiety symptoms 1, 2
• GAD-7 scoring interpretation:
  • 0-4: None/minimal symptoms
  • 5-9: Mild symptoms
  • 10-14: Moderate symptoms
  • 15-21: Severe symptoms 1

Comprehensive Assessment

• Assessment should identify specific anxiety symptoms (e.g., worry, panic attacks, trembling, sweating, tachycardia, palpitations) 1

• Evaluate for risk factors and pertinent history:

  • Prior diagnosis of anxiety disorders with/without treatment
  • Family history of anxiety
  • Comorbid psychiatric disorders
  • History of substance use or abuse
  • Presence of other chronic illnesses 1

• Determine functional impairment across domains:

  • Home/family relationships
  • Social functioning
  • Occupational performance 1

• Rule out medical causes of anxiety symptoms:

  • Uncontrolled pain
  • Fatigue
  • Endocrine disorders
  • Medication side effects 1

Diagnostic Criteria Assessment

• For formal diagnosis, symptoms should be evaluated according to DSM-5 criteria 2
• For Generalized Anxiety Disorder, look for:
  • Excessive anxiety and worry occurring more days than not for at least 6 months
  • Difficulty controlling worry
  • Associated symptoms including restlessness, fatigue, concentration problems, irritability, muscle tension, and sleep disturbance 3

Special Considerations

• Emergency evaluation is required if there is risk of harm to self or others, severe agitation, psychosis, or confusion (delirium) 1
• Cultural factors may influence symptom presentation and should be considered during assessment 2
• Anxiety disorders are often comorbid with depression and other psychiatric conditions, requiring comprehensive evaluation 4
• Anxiety disorders are frequently underdiagnosed and undertreated in primary care settings, with less than 20% of patients receiving appropriate treatment 5

Assessment Algorithm

1. Screen with GAD-7 1
2. If score ≥10, proceed with comprehensive diagnostic assessment 1
3. Evaluate symptom severity, functional impairment, and risk factors 1
4. Rule out medical causes of anxiety 1
5. Assess for comorbid conditions 4
6. Determine appropriate treatment pathway based on severity:
   • None/mild (GAD-7: 0-9): Education and monitoring, self-help resources
   • Moderate (GAD-7: 10-14): Referral to psychological services, consider pharmacotherapy
   • Severe (GAD-7: 15-21): Referral to psychiatry/psychology for specialized treatment 1

Follow-up Assessment

• Regular reassessment is essential, particularly for patients with anxiety who may avoid follow-up due to avoidance behaviors 1
• Monthly follow-up until symptoms subside is recommended to:
  • Assess treatment compliance
  • Evaluate symptom improvement
  • Address barriers to treatment
  • Adjust treatment plan if needed 1