From the Guidelines
No, a diagnosis of Generalized Anxiety Disorder (GAD) does not necessarily include panic attacks as a required feature, though individuals with GAD may experience them. GAD is primarily characterized by persistent, excessive worry about various aspects of life that is difficult to control, lasting for at least six months 1. While panic attacks are more commonly associated with Panic Disorder, many individuals with GAD may experience panic attacks as part of their anxiety symptoms. The difference is that in GAD, panic attacks are not the central feature and tend to be less frequent or intense than in Panic Disorder.
Key Features of GAD
- Persistent, excessive worry about various aspects of life
- Difficulty controlling worry
- Symptoms lasting for at least six months
- Associated symptoms may include restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbances GAD symptoms typically include these features, and treatment for GAD often involves a combination of cognitive-behavioral therapy (CBT), medications such as SSRIs (like sertraline or escitalopram), SNRIs (like venlafaxine or duloxetine), or occasionally benzodiazepines for short-term use. If panic attacks are present in GAD, they would be addressed as part of the overall treatment plan, with specific techniques to manage acute episodes of panic alongside strategies to address the broader, persistent worry characteristic of GAD, as assessed by tools like the Generalized Anxiety Disorder scale (GAD-7) 1.
From the Research
Generalized Anxiety Disorder (GAD) Diagnosis
- GAD is characterized by excessive worry and anxiety that occur on most days for at least 6 months, affecting daily functioning 2
- The diagnosis of GAD is complex and can be difficult, requiring careful attention to several key symptomatic presentations 3
Panic Attacks in GAD Diagnosis
- Originally, GAD was created as a residual category within the anxiety disorders as a rubric for patients with serious anxiety problems but without panic attacks 3
- GAD is differentiated from panic disorder largely on the basis of the chronicity of GAD and the episodic, abrupt nature of panic attacks 4
- However, a study found that GAD can encompass social anxiety as well as performance anxiety and its extension to panic disorder (PD) and major depressive disorder (MDD), and did not exclude patients if the anxiety led to panic attacks 5
Key Considerations
- Anxiety disorders, including GAD, are associated with physical symptoms, such as palpitations, shortness of breath, and dizziness 6
- Brief screening measures, such as the Generalized Anxiety Disorder-7, can aid in diagnosis of anxiety disorders 6
- First-line treatments for GAD include pharmacotherapy, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), and psychotherapy, such as cognitive behavioral therapy 6