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Clinical Condition Guide

Generalized
Anxiety Disorder

An anxiety disorder characterized by excessive, persistent worry about multiple domains of life, accompanied by physical tension and difficulty controlling the worry.

  • 5-6%
    Prevalence
  • ~31
    Onset Age
  • 2:1
    Ratio
  • 50-60%
    Response Rate

DSM-5-TR Diagnostic Criteria

  • Criterion A: Excessive Worry

    Persistent worry for at least 6 months

    • • Excessive anxiety and worry occurring more days than not about a number of events or activities

  • Criterion B: Control

    Difficulty controlling worry

    • • The individual finds it difficult to control the worry

  • Criterion C: Associated Symptoms

    3+ required (only 1 in children):

    • • Restlessness or Feeling Keyed Up (Feeling on edge, unable to relax)
    • • Easily Fatigued (Mental and physical exhaustion from worry)
    • • Difficulty Concentrating (Mind going blank, distracted by worry)
    • • Irritability (Increased impatience and frustration)
    • • Muscle Tension (Chronic tightness, especially jaw, neck, shoulders)
    • • Sleep Disturbance (Difficulty falling/staying asleep, restless sleep)

  • Additional Requirements

    Diagnostic caveats:

    • • Causes clinically significant distress or functional impairment
    • • Not attributable to substance use or medical condition
    • • Not better explained by another mental disorder

Assessment Protocols

Validated tools for screening and severity tracking

  • GAD-7

    Generalized Anxiety Disorder-7

    Brief 7-item self-report measure of GAD symptom severity; one of the most widely used screening tools in primary care.

    Scoring:

    0-4 minimal, 5-9 mild, 10-14 moderate, 15-21 severe anxiety; score ≥10 suggests GAD

    Time:2-3 minutes

  • PSWQ

    Penn State Worry Questionnaire

    Criterion-standard 16-item measure of trait worry, the cardinal feature of GAD.

    Scoring:

    Score range 16-80; cutoff ≥62 suggests clinically significant worry; highly sensitive to treatment change

    Time:5-7 minutes

  • HAM-A

    Hamilton Anxiety Rating Scale

    Clinician-rated 14-item scale assessing psychological and somatic anxiety symptoms.

    Scoring:

    <17 mild, 18-24 mild-moderate, 25-30 moderate-severe, >30 severe anxiety

    Time:15-20 minutes

  • BAI

    Beck Anxiety Inventory

    21-item self-report focusing on somatic symptoms of anxiety over the past week.

    Scoring:

    0-7 minimal, 8-15 mild, 16-25 moderate, 26-63 severe anxiety

    Time:5-10 minutes

Causes & Etiology

  • Neurobiological

    • Amygdala hyperactivity (threat detection)
    • Prefrontal cortex hypoactivity (worry regulation)
    • Anterior cingulate cortex dysfunction
    • GABA and serotonin dysregulation

  • Genetic

    • Heritability: 30-40%
    • Polygenic risk involving multiple genes
    • SLC6A4 polymorphisms
    • COMT gene variants

  • Environmental

    • Childhood adversity and overprotective parenting
    • Chronic stress and major life transitions
    • Socioeconomic instability
    • Medical illness

  • Psychological

    • Intolerance of uncertainty
    • Negative beliefs about worry
    • Thought-action fusion
    • Attentional bias toward threat

Scientific Sources

Evidence-Based

  • GAD-7 Validation

    Spitzer RL, Kroenke K, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092-1097.

  • DSM-5-TR Criteria

    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). 2022.

  • CBT for GAD Meta-Analysis

    Cuijpers P, Cristea IA, et al. The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: a meta-analysis. World Psychiatry. 2016;15(3):245-258.

  • Pharmacotherapy Efficacy

    Baldwin DS, Anderson IM, et al. Evidence-based pharmacological treatment of anxiety disorders. J Psychopharmacol. 2014;28(5):403-439.

  • Intolerance of Uncertainty Model

    Dugas MJ, Gagnon F, et al. Generalized anxiety disorder: a preliminary test of a conceptual model. Behav Res Ther. 1998;36(2):215-226.

  • Neurobiology of GAD

    Etkin A, Prater KE, et al. Disrupted amygdalar subregion functional connectivity and evidence of a compensatory network in generalized anxiety disorder. Arch Gen Psychiatry. 2009;66(12):1361-1372.

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Send a PHQ-9 or GAD-7 by secure link and read the scored result before the session.

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