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.
Critères diagnostiques du DSM-5-TR
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
Protocoles d'évaluation
Outils validés pour le dépistage et le suivi de la gravité
GAD-7
Generalized Anxiety Disorder-7
Brief 7-item self-report measure of GAD symptom severity; most widely used screening tool in primary care.
0-4 minimal, 5-9 mild, 10-14 moderate, 15-21 severe anxiety; score ≥10 suggests GAD
PSWQ
Penn State Worry Questionnaire
Criterion-standard 16-item measure of trait worry, the cardinal feature of GAD.
Score range 16-80; cutoff ≥62 suggests clinically significant worry; highly sensitive to treatment change
HAM-A
Hamilton Anxiety Rating Scale
Clinician-rated 14-item scale assessing psychological and somatic anxiety symptoms.
<17 mild, 18-24 mild-moderate, 25-30 moderate-severe, >30 severe anxiety
BAI
Beck Anxiety Inventory
21-item self-report focusing on somatic symptoms of anxiety over the past week.
0-7 minimal, 8-15 mild, 16-25 moderate, 26-63 severe anxiety
Causes et étiologie
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
Sources scientifiques
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.