DSM-5-TR diagnostic criteria summary
Generalized Anxiety Disorder (GAD) requires the presence of:
- Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (e.g., work or school performance).
- The person finds it difficult to control the worry.
- At least three of the following six symptoms (only one required in children): restlessness or feeling keyed up; being easily fatigued; difficulty concentrating; irritability; muscle tension; sleep disturbance.
- The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other areas of functioning.
- The disturbance is not attributable to a substance (e.g., drug of abuse, medication) or another medical condition.
- The disturbance is not better explained by another mental disorder (e.g., panic disorder, social anxiety disorder, OCD, PTSD).
Source: American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), p. 250–252.
Differential diagnosis
Conditions to consider before settling on F41.1:
- Panic Disorder (F41.0), recurrent unexpected panic attacks with persistent worry about additional attacks. Often comorbid with GAD; coded separately when both are present.
- Social Anxiety Disorder (F40.10), anxiety specifically about social or performance situations.
- Major Depressive Disorder (F33, F32), anxiety symptoms can be prominent in depression; if a depressive episode better explains the presentation, code MDD.
- Substance/Medication-Induced Anxiety Disorder (F19.9 etc.), caffeine, stimulants, alcohol withdrawal, and others.
- Anxiety Disorder Due to Another Medical Condition (F06.4), hyperthyroidism, pheochromocytoma, cardiac arrhythmias.
- Adjustment Disorder with Anxiety (F43.22), anxiety in response to an identifiable stressor, lasting less than 6 months after the stressor ends.
Common comorbidities
Lifetime comorbidity rates for GAD are high. Common co-occurring conditions include Major Depressive Disorder (F33, F32), Panic Disorder (F41.0), Social Anxiety Disorder (F40.10), and Alcohol Use Disorder (F10.20). Comorbid presentations should be coded separately and screened with the appropriate validated scales (PHQ-9 for depression, AUDIT for alcohol use, etc.). See the PHQ-9 vs GAD-7 comparison for guidance on selecting between scales in overlapping anxious-depressive presentations.
Documentation patterns
- Initial visit: GAD-7 score, brief symptom timeline (≥6 months), functional impairment statement, ruling-out items (substance, medical), provisional or confirmed F41.1.
- Follow-up visits: GAD-7 re-administered every 2–4 weeks during active treatment. A 4-point reduction is considered a clinically meaningful change.
- Comorbidities: PHQ-9 routinely co-administered to capture depressive comorbidity. Both codes recorded if criteria met.
Sources
- American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), F41.1, p. 250–252.
- Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097.
- Centers for Disease Control and Prevention. ICD-10-CM Official Coding Guidelines.