Excessive Worry is the Characteristic Symptom of Generalized Anxiety Disorder
The correct answer is "excessive worry" – this is the cardinal and defining symptom of GAD, characterized by persistent and excessive anxiety and worry about various domains that is difficult to control. 1
Core Diagnostic Features of GAD
The defining symptom constellation of GAD centers on excessive, uncontrollable worry that persists for at least 6 months and is difficult to control. 1, 2 This worry is:
- Excessive and disproportionate to actual circumstances or risks 3
- Difficult or impossible to control – patients describe the worry as "uncontrollable" 4, 1
- Focused on multiple life domains (health, family, work, finances) rather than a single concern 1, 2
- Persistent for at least 6 months according to DSM criteria 2, 5
Associated Physical and Psychological Symptoms
Beyond excessive worry, GAD presents with a cluster of accompanying symptoms that help distinguish it from normal anxiety: 3
- Restlessness or feeling keyed up or on edge 3, 5
- Fatigue or being easily fatigued 3, 5
- Difficulty concentrating or mind going blank 3, 5
- Irritability 3, 5
- Muscle tension 3, 5
- Sleep disturbance 3, 5
Why the Other Options Are Incorrect
Feeling of hopelessness is characteristic of major depressive disorder, not GAD, though depression commonly co-occurs with GAD in approximately 31% of cases. 3, 6
Decreased need for sleep is a symptom of mania or hypomania in bipolar disorder, not anxiety disorders. 1 GAD patients experience sleep disturbance (difficulty falling or staying asleep), not decreased need for sleep. 3
Inflated self-esteem is another manic symptom seen in bipolar disorder, completely unrelated to GAD presentation. 1
Clinical Pitfall to Avoid
The most common diagnostic error is missing comorbid depression when evaluating GAD patients. 6 Always screen with PHQ-9 alongside GAD-7, as depression co-occurs frequently and requires concurrent treatment. 6 The presence of hopelessness should prompt evaluation for major depressive disorder as a comorbid or alternative diagnosis. 1