How Generalized Anxiety Disorder Is Diagnosed Using the DSM-5

Understanding GAD

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When does worry reach the point of being an anxiety disorder? Generalized anxiety disorder (GAD) is defined for mental health professionals in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition or the DSM-5 for short. This manual allows all behavioral and mental health providers to use the same criteria when they assess you and enables them to make a diagnosis of GAD or other psychiatric conditions.

Learn how your provider uses this manual and assessment tools to diagnose GAD.

Symptoms of Generalized Anxiety Disorder From the DSM-5

The DSM-5 criteria that are used to diagnose GAD are as follows:

1. 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 the 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).

2. The worry is experienced as very challenging to control. The worry in both adults and children may shift from one topic to another.

3. The anxiety and worry are associated with at least three of the following physical or cognitive symptoms (In children, only one symptom is necessary for a diagnosis of GAD):

  • Edginess or restlessness
  • Tiring easily; more fatigued than usual
  • Impaired concentration or feeling as though the mind goes blank
  • Irritability (which may or may not be observable to others)
  • Increased muscle aches or soreness
  • 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.

Assessing GAD Symptoms

If you are wondering whether you or your child might suffer from GAD, consider completing a brief online self-screening tool for adults or for children provided by the Anxiety and Depression Association of America (ADAA) and speaking with a mental health professional or your physician.

Your clinician will meet with you and ask about your symptoms in an open-ended way.

They use the diagnostic criteria, standardized assessments, and their clinical judgment to make a diagnosis. 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.

Standardized Assessment Tools

In specialized care settings, like an anxiety disorders clinic, standardized assessment tools are sometimes used to evaluate symptoms. In this case, your clinician gives you 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 parent and child are asked about the child’s symptoms. These interviews also evaluate the presence of other associated conditions such as depression.

A Word From Verywell

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 with persistent anxiety.

Sources:

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, Williams JBW, Benjamin LS, Spitzer RL, First MB. SCID-5-PD: structured clinical interview for DSM-5® personality disorders. Arlington, VA: American Psychiatric Association Publishing; 2016.

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