Generalised anxiety disorder

What it is

Generalized anxiety disorder is excessive worry and anxiety that the patient finds difficult to control. The focus of the worry is broad: the patient's own health or that of others, life circumstances, finances, job performance, and more global issues. Put another way, it is unrealistic worry about life circumstances accompanied by motor tension, autonomic hyperactivity, or vigilance and scanning. In the history notes it is put in one line as anxiety about everything with no specific trigger, associated with apprehension, motor tension and autonomic symptoms for several weeks at a time and usually for several months.

The criteria require at least 3 of 6 symptoms, present for more days than not over a period of 6 months: 1) restlessness, or feeling keyed up or on edge; 2) easy fatigability; 3) difficulty concentrating; 4) irritability; 5) muscle tension; 6) sleep disturbance. A second page puts the same count as 3 or more, or 1 in kids, of restlessness, fatigue, sleep issues, muscle tension, poor focus and irritability. A third source puts it as worry for most days for at least 6 months with irritability, inability to concentrate, insomnia, fatigue and restlessness.

One further condition is set out only in that third source, and it is the one that stops the diagnosis being made on worry alone: the diagnosis requires evidence of social dysfunction - poor school grades, job stagnation, or marital strains - to rule out normal anxiety.

The general features of the anxiety disorders are a duration over 6 months, distress or impairment, and medical and substance causes to rule out, with CBT plus an SSRI as the first-line treatment.