DSM-5 Diagnostic Criteria for Generalized Anxiety Disorder

What are the Symptoms? And How are They Assessed?

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In May 2013, the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders, or the DSM-5 for short, was released by the American Psychiatric Association. The DSM-5 serves as a reference for qualified mental health providers to make a diagnosis of Generalized Anxiety Disorder (GAD) and other psychiatric conditions.

What are the symptoms?

The DSM-5 criteria for GAD are as follows:

  • The presence of excessive anxiety and worry about a variety of topics, events, or activities. Worry occurs more often than not for at least 6 months and is clearly excessive.

    Excessive worry means worrying even when there is nothing wrong, or in a manner that is disproportionate to actual risk. This typically involves spending a high percentage of 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. Of note, in children, the worry is more likely to be about their abilities or the quality of their performance (for example, in school).

    • The worry is experienced as very challenging to control.

    Worry in both adults and children may shift from one topic to another.

    • The anxiety and worry is associated with at least 3 of the following physical or cognitive symptoms (In children, only 1 symptom is necessary for a diagnosis of GAD.):
    1. Edginess or restlessness.
    1. Tiring easily; more fatigued than usual.
    2. Impaired concentration or feeling as though the mind goes blank.
    3. Irritability (which may or may not be observable to others).
    4. Increased muscle aches or soreness.
    5. Difficulty sleeping (due to trouble falling asleep or staying asleep, restlessness at night, or unsatisfying sleep).

      Many individuals with GAD also experience symptoms such as sweating, nausea or diarrhea.

      • The anxiety, worry, or 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.
      • These symptoms are unrelated to any other medical conditions and cannot be explained by the effect of substances including a prescription medication, alcohol or recreational drugs.
      • These symptoms are not better explained by a different mental disorder.

      How are the symptoms assessed?

      If you are wondering if you or your child might suffer from GAD, consider completing a brief, self-screening tool and speaking with a mental health professional or your physician. Learn about the different ways that anxiety can manifest.

      A qualified professional who is knowledgeable about these symptoms and their typical presentations will often rely on clinical judgment to make a diagnosis. They will meet with you and ask about your symptoms in an open-ended way.

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

      In adults, commonly used, and well-validated diagnostic interviews include the Structured Clinical Interview for DSM Disorders (sometimes referred to as the SCID) and the Anxiety and Related Disorders Interview Schedule for DSM-5 (or, the ADIS-5). There is a child version of the ADIS, in which both parent and child are asked about the child’s symptoms. These interviews ask not just about anxiety symptoms, but will also evaluate the presence of other, sometimes associated conditions like depression.

      It is also possible that when initially assessing the nature and intensity of your anxiety, or while undergoing treatment, you will be asked to complete self-report questionnaires. These typically brief measures can help determine diagnosis (as the Generalized Anxiety Disorder Scale-7 does) or severity of symptoms.

      Remember, GAD is a treatable condition. There is no need for you (or your child) to worry in silence. Treatment, particularly psychotherapy or self-help approaches, will teach you a variety of ways to cope with your anxiety and how to change the way that you think about your worry. There are also medications that can help with persistent anxiety.

      References:

      American Psychiatric Association. Diagnostic and statistical manual of mental disorders (Fifth edition). Washington, D.C.: American Psychiatric Association; 2013.

      Brown, TA, Barlow DH. Treatments that Work: Anxiety and Related Disorders Interview Schedule for DSM-5. New York: Oxford University Press, 2014.

      First MB, Spitzer RL, Gibbon M, Williams JB. Structured Clinical Interview for DSM-IV (SCID). New York: Biometrics Research, New York State Psychiatric Institute; 1998. [DSM-5 version pending publication by the American Psychiatric Association: http://www.scid4.org/index.html]

      Silverman WK, Albano AM. Anxiety Disorders Interview Schedule for DSM-IV: Child Version, child and parent interview schedules. San Antonio, TX, Psychological Corporation, 1996.

      Spitzer RL, Kroenke K, Williams JBW, Lowe B. A brief measure for assessing generalized anxiety disorder. Arch Intern Med. 2006;166:1092-1097.

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