3.6 Diagnosing generalised anxiety disorder
GAD is typically diagnosed if a patient shows anxiety symptoms that do not adequately fit any of the criteria for the other anxiety disorders listed in Table 3, but do fulfil those for generalised anxiety disorder. The DSM-IV-TR criteria for GAD are listed in Box 4.
As you look at Box 4, look back also at Suzanna’s account of her anxiety (Vignette 2) and think about how her experience relates to the criteria below.
Box 4 Brief diagnostic criteria for generalised anxiety disorder
(Adapted from DSM-IV-TR (APA, 2000))
Criteria A–F need to be satisfied for a diagnosis of GAD.
- A.Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).
- B.The person finds it difficult to control the worry.
- C.The anxiety and worry are associated with three (or more) of the following six symptoms, with at least some symptoms present for more days than not for the past 6 months (Note: only one item is required in children):
- restlessness or feeling keyed up or on edge
- being easily fatigued
- difficulty concentrating or mind going blank
- irritability
- muscle tension
- sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep).
- D.The focus of anxiety and worry is not about having a panic attack (as in panic disorder), being embarrassed in public (as in social phobia), being contaminated (as in obsessive-compulsive disorder), being away from home or close relatives (as in separation anxiety disorder), gaining weight (as in anorexia nervosa), having multiple physical complaints (as in somatisation disorder), or having a serious illness (as in hypochondriasis), and the anxiety and worry do not occur exclusively during post-traumatic stress disorder.
- E.The anxiety, worry or physical symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning.
- F.The disturbance is not due to the direct physiological effects of a substance (e.g. a drug of abuse, a medication) or a general medical condition (e.g. hyperthyroidism) and does not occur exclusively during a mood disorder, a psychotic disorder or a pervasive developmental disorder.
Activity 5 Diagnosing types of anxiety
Does Suzanna’s experience (in Vignette 2) suggest state or trait anxiety? Explain your answer.
Answer
Susanna’s anxiety is not temporarily elicited by particular circumstances, after which it disappears, as would be the case in state anxiety. Her anxiety seems to be ever-present, so it is like ‘trait anxiety’.
There is evidence that those who have a tendency to be anxious (have trait anxiety) can benefit from psychotherapy, relaxation and meditation.