Appendix: Assessing generalised anxiety disorder

Appendix: Assessing generalised anxiety disorder

The assessment of generalised anxiety disorder (GAD) is based on the criteria in DSM‑IV. Assessment should include the number and severity of symptoms, duration of the current episode and course of the disorder.

Key symptoms of GAD

The key symptoms of GAD are:

  • excessive anxiety and worry about a number of events or activities

  • difficulty controlling the worry.

The worry should occur on a majority of days for at least 6 months. The focus of the worry should not be confined to features of another anxiety disorder (for example, not just about having a panic attack, social embarrassment, a traumatic event, being contaminated or having a serious illness).

If the 2 key symptoms are present, ask about the following associated symptoms:

  • restlessness

  • being easily fatigued

  • difficulty concentrating

  • irritability

  • muscle tension

  • disturbed sleep.

Then ask about duration, distress, impairment of functioning and past history of anxiety and mood disorders.

Factors that favour initial education about GAD and active monitoring only (step 1) are:

  • few symptoms of GAD or symptoms that are intermittent or of less than 6 months' duration (hence subclinical)

  • only mild distress and no or limited functional impairment

  • no comorbid anxiety or mood disorder

  • no past history of anxiety or mood disorders

  • individual not interested in any active treatment option.

Factors that favour initial active treatment with low-intensity psychological interventions, including GP-prescribed non-facilitated self-help (step 2) are:

  • diagnostic criteria for GAD met

  • clinically significant distress and/or impairment in social, occupational or other important areas of functioning

  • comorbid anxiety or mood disorder

  • individual wishes to pursue active treatment for GAD.

Factors that favour treatment with a high-intensity psychological intervention or a pharmacological intervention (step 3) are:

  • marked functional impairment

  • less marked but clinically significant functional impairment or distress and inadequate response to a step 2 intervention

  • past history of anxiety or mood disorders.

Factors that favour referral for specialist treatment (step 4) are:

  • GAD that is refractory to both cognitive behavioural therapy (CBT) and drug treatment

  • very severe functional impairment (such as self-neglect)

  • persistent suicidal thoughts

  • multiple psychiatric comorbidities.

  • National Institute for Health and Care Excellence (NICE)