How Generalized Anxiety Disorder Is Diagnosed

Generalized anxiety disorder (GAD) is a condition that affects approximately 3.1% of Americans.

It is characterized by excessive worry about a variety of subjects, rather than one specific area of concern.

GAD is primarily diagnosed through a discussion of symptoms but can involve physical exams and diagnostic tools.

Learn more about how GAD is diagnosed.

Professional Screenings

The first point of contact for GAD is usually a primary healthcare provider. This often involves doing an examination, which can include:

• Getting a medical history, including mental health and substance use
• Getting a family medical history, including mental health and substance use
• Measuring height and weight (to check for significant changes which could indicate a health concern)
• Checking vital signs such as heart rate and blood pressure
• A review of current medications, including over-the-counter medications and herbal supplements
• A discussion about your overall lifestyle and environment
• A physical examination, including listening to the heart and lungs, feeling organs, looking in ears and throat, etc.
• A discussion about your symptoms (what are they, how intense they are, how long do they last, etc.)
• A discussion about how the symptoms interfere with your daily life
• An observation of your attitude and behavior
• Time to ask and answer questions

The Diagnostic and Statistical Manual of Mental Disorders (DSM–5)

Healthcare professionals refer to the criteria set out in The Diagnostic and Statistical Manual of Mental Disorders (DSM–5) published by the American Psychiatric Association when making a diagnosis of GAD.

According to the DSM-5, the following criteria must be met 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 individual 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 having been present for more days than not for the past 6 months):

Note: Only one item is required for children.

• Restlessness, 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 anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another mental disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder [social phobia], contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in post-traumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

In more basic terms, this means:

• The person experiences excessive worry about a variety of things rather than being focused on a specific concern
• This worry occurs most days and happens for at least six months
• This worry is intrusive and affects their daily life
• The person exhibits other symptoms in addition to worries such as restlessness or sleep problems
• This excessive worry can't be better explained by something else such as substance use, or another medical or mental health condition

Labs and Tests

While there is no lab test that can be used to diagnose GAD, tests (such as blood and urine tests) are sometimes performed to rule out other conditions that can cause similar symptoms to GAD, including:

• Hypoglycemia (low blood sugar)
• Irritable bowel syndrome (IBS)
• Chronic pain conditions
• Hyperthyroidism (overactive thyroid)
• Cushing's syndrome (excess of cortisol in the blood caused by a pituitary tumor)
• Mitral valve prolapse (one or both valve flaps of the mitral valve bulge upward into the left atrium)
• Carcinoid syndrome (carcinoid tumor secretes certain chemicals into the bloodstream)
• Hypocalcemia (low blood calcium)
• Chronic obstructive pulmonary disease (COPD)
• Heart failure
• Tourette's syndrome
• Pheochromocytoma (rare tumor of adrenal gland tissue)

Other diagnostic tools such as an electrocardiogram (ECG or EKG) may be performed if another medical condition is suspected or needs to be ruled out, but would not be used specifically to diagnose GAD.

Self/At-Home Testing

GAD is best diagnosed by a healthcare provider, but some of the questionnaires used by professionals to screen for GAD can be taken at home as a starting point.

Screening Test From the Anxiety and Depression Association of America

Please answer the following:

1. Do you experience excessive worry?
2. Is your worry excessive in intensity, frequency, or amount of distress it causes?
3. Do you find it difficult to control the worry (or stop worrying) once it starts?
4. Do you worry excessively or uncontrollably about minor things such as being late for an appointment, minor repairs, homework, etc.?

If you answered "Yes" for more than one of the questions, print and complete the full screening tool and share it with your primary healthcare provider or mental health professional.

Emerging Research

Routine Screenings

According to a 2012 study, American women are twice as likely as American men to experience an anxiety disorder during their lifetime.

With these things in mind, the Women's Preventive Services Initiative (WPSI) brought forth a recommendation of screening girls aged 13 and older and women for anxiety, whether or not they have a current diagnosis of an anxiety disorder.

They reached this recommendation through evaluating the results of:

• A systematic review of the effectiveness of screening
• The accuracy of screening instruments
• Benefits and harms of treatments in adolescent girls and adult women

Further studies into optimal screening intervals are needed. For now, the WPSI recommends clinical judgment should be used to determine the frequency.

If the results of a routine screening suggest the presence of an anxiety disorder, the WPSI indicates further evaluation and follow-up to determine a diagnosis and establish a treatment plan.

Neuroimaging

Some studies are examining the use of neuroimaging (images of the structure or activity of the brain or other parts of the nervous system) with anxiety disorders.

A 2019 systemic review encourages further studies into how neuroimaging may help with the diagnosis, treatment, and understanding of GAD.

Summary

Generalized anxiety disorder (GAD)—characterized by excessive worry about a variety of subjects—is primarily diagnosed through a discussion of symptoms but can involve physical exams and diagnostic tools. If you suspect you have GAD, speak with a healthcare professional.

A Word From Verywell

While GAD can be difficult to recognize, a thorough discussion with your primary healthcare provider is a great start on the road to diagnosis and treatment.

Through screenings, examinations, and sometimes diagnostic testing, GAD can be identified, and effective treatment plans can be established.