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Generalized Anxiety Disorder

Epidemiology
1. Most common Anxiety Disorder
2. Adult Prevalence: 2 to 8%
3. Onset peaks in ages 20 to 40 years
4. Occurs in men and women equally
Symptoms: Topics for Excessive Worry
1. Children
  1. School performance
  2. Sports performance
  3. Catastrophic events (e.g. earthquake, nuclear war)
2. College students
  1. Academic performance
  2. Relationships
3. Adults
  1. Children's well-being
  2. Illness or injury
  3. Family and other relationships
  4. Occupational and financial concerns
4. Elderly
  1. Health
  2. Social relationships
  3. Finances
Symptoms: Physical
1. See Anxiety Symptoms
Symptoms: Avoidance behaviors
1. Avoidance of activities may be subtle
2. Limited interpersonal relationships
3. Procrastination
4. Non-assertive in new situations
Diagnostic Criteria (DSM IV)
1. Excessive anxiety and worry for 6 months on most days
2. Involves two or more life circumstances
3. Anxiety or worry is difficult to control
4. Associated symptoms (3 present in adult, 1 in child)
  1. Restless
  2. Fatigue
  3. Difficult concentration
  4. Irritable
  5. Muscle tension
  6. Sleep disturbance
5. Impaired social or occupational functioning or distress
6. No Anxiety Secondary Cause
  1. Not related to other psychiatric illness
    1. See Differential Diagnosis below
  2. Not related to underlying medical condition
  3. Not related to Substance Abuse
Differential Diagnosis
1. See Anxiety Secondary Causes
2. Anxiety Adjustment Disorder
3. Major Depression
4. Other Anxiety Disorder
5. Personality Disorder (Anxiety Cluster)
Management
1. See Anxiety Non-pharmacologic Management
2. See Anxiety Medications
Prognosis: Predictors of better outcomes
1. Lower anxiety level
2. Lower demoralization level
3. Higher level of Major Depression at presentation
References
1. APA (1994) DSM IV, APA, p. 432-6
2. Derogatis (1989) Anxiety and Depressive Disorders, p.42
3. Zal (1995) Fam Prac Recert 17(10):17

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.