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Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is the most common of the anxiety disorders. It is defined as unrealistic or excessive anxiety and worry about two or more life circumstances for at least six months.

DSM-IV Diagnostic Criteria for Generalized Anxiety Disorder

Excessive anxiety worry is present most days during at least a six month period, and involves a number of life events.

The anxiety is difficult to control.

At least three of the following:

Restlessness or feeling on edge

Easy fatigability

Difficulty concentrating


Muscle tension

Sleep disturbance

The focus of anxiety is not anticipatory anxiety about having a panic attack as in panic disorder.

The anxiety or physical symptoms cause significant distress or impairment in functioning.

Symptoms are not due to  substance use or a medical condition, and symptoms are not related to a mood or psychotic disorder.

Clinical Features of Generalized Anxiety Disorder

Other features often include insomnia, irritability, trembling, muscle aches and soreness, muscle twitches, clammy hands, dry mouth, and a heightened startle reflex. Patients may also report palpitations, dizziness, difficulty breathing, urinary frequency, dysphagia, light-headedness, abdominal pain, and diarrhea.

Patients may report that they "can't stop worrying," which may revolve around valid concerns about money, jobs, marriage, health, and the safety of children.

Mood disorders, substance related disorders, and stress related disorders, such as headaches, commonly coexist with GAD.

Up to one fourth of GAD patients develop panic disorder.

Excessive worry and somatic symptoms, including autonomic hyperactivity and hypervigilance, occur most days, and they anxiety occur during most of the day.

Chronic worry is a prominent anxiety feature of generalized anxiety disorder unlike the intermittent terror that characterizes panic disorder.

30-50% of patients with anxiety disorders will also meet criteria for Major Depressive Disorder.

Drugs and alcohol may cause an anxiety.