Generalized Anxiety Disorder: Symptoms and DSM-5 Diagnosis

Generalized anxiety disorder (GAD) can be a challenge to diagnose. People consider panic attacks a hallmark of all anxiety disorders, but GAD is different in that there are generally no panic attacks associated with the condition.

As a result of this misconception, without the experience of panic attacks, a person may think they are "just worrying too much." Their struggles with constant worry may be minimized or dismissed and, in turn, not properly diagnosed or treated. 

Most of us experience worry and situations that can cause us to feel anxious, so what are professionals looking for to help determine if someone's worry and anxiety are related to GAD?

The first step is to evaluate symptom criteria, as outlined in "The Diagnostic and Statistical Manual of Mental Disorders," 5th Edition, Text Revision (also known as the DSM-5-TR). Mental health professionals look for factors like excessive, hindering worry paired with a variety of physical symptoms, then use proven diagnostic assessments to make a diagnosis and rule out other possibilities.

Symptoms of GAD

The DSM-5-TR outlines specific criteria to help professionals diagnose generalized anxiety disorder. Having a standard set of symptoms to reference when assessing clients helps them to more accurately diagnose mental health concerns and, in turn, create a more effective plan of care.

Excessive worry means worrying even when there is no specific threat present or in a manner that is disproportionate to the actual risk. Someone struggling with GAD experiences a high percentage of their waking hours worrying about something. The worry may be accompanied by reassurance-seeking from others.

In adults, the worry can be about job responsibilities or performance, one’s own health or the health of family members, financial matters, and other everyday, typical life circumstances. In children, the worry is more likely to be about their abilities or the quality of their performance (for example, in school). Many people with GAD also experience symptoms such as sweating, nausea, or diarrhea.

The anxiety, worry, and other associated symptoms make it hard to carry out day-to-day activities and responsibilities. They may cause problems in relationships, at work, or in other important areas of life.

In order to give a diagnosis of GAD, these symptoms also must be unrelated to any other medical conditions and cannot be explained by a different mental disorder or by the effect of substance use, including prescription medication, alcohol, or recreational drugs.

Clinical Assessment

During an assessment, your clinician will use the diagnostic criteria, standardized assessments, and their clinical judgment to make a diagnosis.

Generally, they will ask about your symptoms in an open-ended way, but you may also be asked to complete self-report questionnaires. These typically brief measures can help determine the diagnosis (as the Generalized Anxiety Disorder Scale-7 does) or severity of symptoms.

In specialized care settings, like an anxiety disorders clinic, standardized assessment tools are sometimes used to evaluate symptoms. In this case, your clinician conducts a semi-structured interview. The interview is likely to include a standardized set of questions, and your answers will help your clinician to make an accurate diagnosis.

Commonly used and well-validated diagnostic interviews for adults include the Structured Clinical Interview for DSM Disorders (SCID) and the Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5). There is a child version of the ADIS, in which both the parent and the child are asked about the child’s symptoms. These interviews also evaluate the presence of other associated conditions such as depression.

Generalized Anxiety Disorder Discussion Guide

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Your Visit

Remember to be honest with your provider at the first visit—both when filling out forms and discussing your symptoms face-to-face. Being upfront and honest can help determine what is happening and put together a plan of care specifically tailored to your needs.

Self-Assessment

If you are wondering whether you or your child might have GAD, you can consider completing a brief online self-screening tool for adults or for children provided by the Anxiety and Depression Association of America (ADAA). If you do this, you should still speak with a mental health professional or your physician for a proper diagnosis and treatment.

When to Seek Help 

Many people who struggle with GAD experience symptoms for a long time before seeking help. Reaching out for a diagnosis can feel challenging, especially when anxiety feels so constant and widespread.

Only around 20% of people who have symptoms of anxiety seek treatment. In 2020, a national coalition of women's health professionals recommended that all women aged 13 and older should be screened for anxiety. The lifetime prevalence of anxiety disorders is approximately two times higher in women than in men, so preventative screenings may be helpful in ensuring that women and girls receive appropriate interventions to improve health and well-being.

Contacting a mental health or other clinical provider is a courageous step that can help clarify what is happening and, in turn, lead to creating a plan of care that can help you find relief and regain a sense of well-being.

When deciding to seek help, something to consider is how difficult it is to feel any sense of calm, comfort, and reassurance around your worry.

Also, know that not experiencing panic attacks is another primary reason people don't seek help for their anxiety. Their worry may be chronic and concerning but, because there are no periods of acute panic attacks, they simply chalk the challenges up to being a "worrywart."

They may even be told this by others when seeking reassurance or trying to find comfort. Remember, however, that GAD is different in that panic attacks aren't typically present, so don't let this factor stop you from seeking help.

Additionally, take note of the physical symptoms that are accompanying your worry. As the anxiety continues, you may find more and more challenges with things like headaches, digestion, restlessness, and fatigue. Should you find that your worry feels excessive and begins leading to other physical symptoms, you may benefit from talking with a mental health or other care providers.

Finding a Clinician

Take time to research and seek out providers who specialize in the treatment of anxiety. Because anxiety is present in so many mental health conditions, you will want to talk with someone who understands the specific criteria required so you can be accurately diagnosed and treated.

Primary care physicians can often provide referrals to trusted and specialized mental health providers. Otherwise, to find a psychotherapist in your area, consult referral resources such as:

• Anxiety and Depression Association of America
• Association for Behavioral and Cognitive Therapies
• Association for Contextual Behavioral Science

The American Psychiatric Association (APA) is a national organization of psychiatrists that can also provide recommendations for local providers who are able to provide psychiatric evaluation and prescribe medications.

Another option is to try an online therapy program.

Differential Diagnosis

Anxiety symptoms can be found in many categories of mental health conditions listed in the DSM-5-TR, such as mood disorders, eating disorders, and cognitive disorders. Within the category of anxiety disorders, there are many symptoms that will overlap and anxiety conditions can sometimes be confused with one another.

The U.S. Preventative Services Task Force recommends that all adults under the age of 65 get screened for anxiety symptoms during routine doctor visits. While sitting with a mental health provider, they will be seeking information that will help them to best diagnose your condition. To give a differential diagnosis means to distinguish one condition from another when there are symptoms that overlap.

Some conditions that may need to be ruled out include:

• Obsessive-compulsive disorder (OCD)
• Panic disorder
• Social anxiety disorder

Although some of these conditions are discussed more casually by the general public, there are specific criteria that would need to be met in order for one of these (or other conditions) to be properly diagnosed.

There can be other behaviors and symptoms that can be present with anxiety. For example, when someone engages in self-sabotaging behavior, such as procrastination, they can be perceived as struggling with self-regulation and behavioral conditions. Overlooking elements of anxiety related to this behavior can end up creating an obstacle for someone to receive effective treatment.

Keep in Mind

Remember: GAD is a treatable condition. There is no need for you (or your child) to worry in silence. Treatment, particularly psychotherapy, self-help approaches, or other therapies, will teach you a variety of ways to cope with your anxiety. There are also medications that can help.