Generalized Anxiety Disorder Diagnosis

Diagnosis of generalized anxiety disorder (GAD) can be difficult, since the distinction between normal anxiety and GAD is not always apparent. Diagnosis is based on a physical exam, psychological evaluation, and the criteria outlined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders(DSM-IV). The symptoms of GAD must be present for at least six months and cause impairment in your ability to function.

Initial Assessment

After obtaining your medical history, you may be asked about worries, anxiety, “nerves,” stress, and other symptoms. Your doctor may ask whether your anxiety is acute (brief or intermittent) or chronic (persistent).

Acute anxiety lasts from hours to weeks and usually occurs in response to a particular stressor. Persistent anxiety lasts from months to years and may be considered a part of your temperament. Persistent anxiety does not normally occur in response to stress. In susceptible people, though, stress may increase levels of persistent anxiety.

Evaluation of Medical Disorders

Before generalized anxiety disorder can be diagnosed, your doctor will look for and rule out other medical disorders that could cause your symptoms. Medical conditions commonly associated with anxiety include:

• Hypoglycemia
• Irritable bowel syndrome
• Chronic pain conditions
• Hyperthyroidism
• Cushing’s disease
• Mitral valve prolapse
• Carcinoid syndrome
• Hypocalcemia
• Chronic obstructive pulmonary disease
• Heart failure
• Pheochromocytoma

Your doctor should also ask what medications, herbal supplements , and vitamins you take. You may be asked to stop taking certain medications or supplements so that your doctor can more accurately pinpoint the cause of your symptoms. Medications that can contribute to or worsen anxiety include:

• Steroids
• Over-the-counter cold remedies and diet pills
• Antidepressants
• Digoxin
• Thyroxine
• Theophylline

Evaluation for Substance Abuse

Use or withdrawal from addictive substances can cause anxiety. Your healthcare provider may ask about your use of alcohol, caffeine, nicotine, addictive medications (particularly sedatives), illegal drugs, and other substances.

Evaluation of Other Psychiatric Disorders

You may be tested for:

• Depression
• Panic disorder
• Post-tranumatic stress disorder
• Social phobia
• Obsessive-compulsive disorder
• Other psychiatric disorders that often occur with generalized anxiety disorder

Evaluation for Scientific Research

When testing the effectiveness of a given treatment for Generalized Anxiety Disorder, certain evaluation tools are used to measure if/how much anxiety has been reduced after an intervention with the treatment. Among these are:

• Hamilton Anxiety Scale (HAM-A)

• Screening for Generalized Anxiety Disorder (GAD)

References:

Anxiety and panic: gaining control over how you're feeling. Family Doctor.org website. Available at: http://familydoctor.org/online/famdocen/home/common/mentalhealth/anxiety/013.html . Updated September 2006. Accessed October 29, 2008.

Ballenger JC, Davidson JR, Lecrubier Y, et al. Consensus statement on generalized anxiety disorder from the International consensus Group on Depression and Anxiety. J Clin Psychiatry.2001;62:53-58

Flint AJ. Generalised anxiety disorder in elderly patients: epidemiology, diagnosis and treatment options. Drugs Aging.2005;22:101-14

Moore DP, Jefferson JW. Handbook of Medical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier Mosby; 2004.