Generalized Anxiety Disorder (GAD) DSM-5 Criteria: Symptoms, Diagnosis and Treatment

Generalized Anxiety Disorder (GAD) DSM-5 Criteria

In our day to day lives, there are people who are always
worried. You will find people referring to them as worrywarts. It impacts so
much on their quality of life since they may even not do something because of
the fear. These people may be suffering from generalized anxiety disorder.

Without the presence of panic attacks, most people find it
hard to diagnose anxiety disorders. Since generalized anxiety disorder does not
have panic attacks it is hard for us to diagnose it. For people with
generalized anxiety disorder worry is a part of their lives. They are
excessively worried or tense all day long.

What is generalized anxiety disorder according to DSM-5 criteria?

Generalized anxiety disorder is an anxiety disorder defined
by excessive and constant fears and worries about general things that affect
the capacity to rest and perform the routine activities. The fears and worries
in most cases are unfounded when compared to the source.

The fear in GAD emanates from several things, situations or
places unlike specific phobias which presents with fear and worry about a
specific thing or place or situation. The main challenge with the fears and
worries is that you can’t control them thus they continue repeating themselves
in the brain.

GAD therefore removes color from your life because of the
constant fear, tension and worry. The feeling is long lasting and can make a
life unbearable even though it is less intense as compared to panic attacks.

An example of GAD is where one is worried about how the day
will fan out and believes that something will go wrong during the day. This can
even make you unable to leave the house because of the fear.

One of the GAD patients in our clinic stated this, “I am
always worried about small things in my life. Worried about what will happen to
my son as he goes to school every day, worried about what will happen at work,
worried about my family at home among other worries.

I can’t control the feeling all day long and sometimes for
days. For this reason I am unable to even perform at work and cannot relax at
home. Sometimes I cannot even sleep at night”

Symptoms of generalized anxiety disorder according to DSM-5

There are several symptoms associated with GAD. For a person
to be diagnosed with GAD according to DSM-5, he
or she must have excessive fear, worry or nervousness for a period of not less
than 6 months. The feeling must be present regularly where it should be present
in more days within the 6 months than when they are not there.

The feelings must be about several events, situations or
activities. The individual cannot easily control the anxiety/ worry feeling
thus meaning they continue repeating themselves in the brain now and then.

The 6 main symptoms of generalized anxiety disorder according
to DSM-5 include:

  • Being restless or feeling that you are on the
  • Experiencing frequent tiredness and also getting
    easily fatigued
  • Having an issue concentrating or feeling as if
    the mind is blank
  • Being easily irritated. Sometimes irritability
    can be noticed by other people or not.
  • Muscle tension. This presents with muscle pains
    or soreness.
  • Having sleep problems where one has trouble
    getting sleep, staying asleep, being restless as you sleep or having an
    unsatisfying sleep.

Out of these 6 main symptoms, you must have at least 3 of
them for a period of 6 months to be diagnosed with generalized anxiety disorder.
Also you must have one of the symptoms in more days that when you do not have
it. In children, having 1 of the symptoms for a period of six months is used
for diagnosis.

The symptoms of generalized anxiety disorder can be
classified into emotional symptoms, behavioral symptoms and physical symptoms.
In addition to the physical symptoms above, most people with GAD also present
with nausea,
sweating and diarrhea.

For anxiety diagnosis, it should be noted that the disturbance should not be associated with other medical conditions, use of medications (prescription drugs among other drugs) or abuse of substances like alcohol or recreational drugs. The medical conditions that can cause such a disturbance are for example hyperthyroidism.

Other mental disorders with symptoms similar to generalized anxiety
disorder symptoms

Also according to DSM-5 criteria for mental disorders, these symptoms must not be from another mental disorder. There are some mental disorders that can present with the same symptoms. Therefore the symptoms must not be better explained by another mental disorder.

Some of the other mental disorders that can present with the
same symptoms include:

  • Panic disorders where there is a fear or worry
    about having a panic attack.
  • Social anxiety disorder which presents with
    negative evaluation of circumstances and people.
  • Obsessive compulsive disorder where one
    experiences obsessions and compulsions which bring about fear and worry.
  • Post-traumatic stress disorder where one
    experiences negative feelings of fear, worry and reminders of previous
    traumatic experiences.
  • Separation anxiety disorder which has marked
    fear for being separated from familiar places or people in children and adults.
  • Illness anxiety disorder where there are strong
    feelings of anxiety emanating from having a chronic or serious disease
  • Anorexia nervosa where one has strong feelings
    about gaining weight that is recurrent
  • Somatic symptoms disorder where one has several
    physical complains which results in fears
  • Dysmorphic disorder which presents with feelings
    of worry about supposed imperfections in the personal looks and appearance.
  • Schizophrenia or delusional disorders where one
    has delusional beliefs.
  • Depression: Most of the GAD symptoms overlap
    with those of depression. Therefore it is good to check if the disorder is
    co-morbid with depression or either of the disorder is present.
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A person suffering from generalized anxiety disorder may
also have another mental disorder co-morbidity. It is therefore hard to
diagnose when one has one mental disorder or several. One of the best way of
dealing with this situation is getting transdiagnostic
of the emotional disorders.

Other disorders where comorbidity with GAD includes bipolar
disorder, mood disorders, psychotic disorders among others.

Prevalence of generalized anxiety disorders

From several surveys/ studies, about 4 to 6 percent of all
individuals at one given tie in their lives will suffer from generalized
anxiety disorder. This translates about 15 million to 20 million residents of
the United States of America.

Of all the population, women are more susceptible to the
disorder than men. The number of cases in women are approximately double the
number of cases in men. This is also seen in almost all the other anxiety

Most of the cases of GAD are go undiagnosed. This means that
they are not treated, where only 40 percent of people suffering from GAD are
treated. When generalized anxiety disorder can become chronic. This will mean
the disorder will be present years after the appearance of the first symptoms.

The disorder is more prevalent in persons between 45 and 59
years. For younger and older persons, the cases are less as compared to that
age group.

What is the difference between being worried normally and generalized
anxiety disorder?

Normal anxiety vs generalized anxiety disorder

Everyone gets worried at one time in their lives. It is
always a worry when we have uncertainty about our finances, relationships,
health, exams, and presentations among other reasons. The main issue is
severity and duration.

The main differences between a person who is worried
normally and one who is suffering from generalized anxiety disorder includes:

  • GAD interferes with conducting of your daily activities, chores and responsibilities while normal worry does not interfere with your job, family life, social life, daily chores and activities.
  • People suffering from generalized anxiety disorder find it very hard to control their feelings of fear, worry and nervousness while in normal worry people can easily control the anxiety.
  • The feelings of anxiety in people with GAD are unsettling, stressing and upsetting whereas in normal people they do not cause significant stress or upsets even though they are distasteful.
  • Persons experiencing generalized anxiety disorder tend to worry about several things events or situations expecting the worst while in normal people the worry is about specific real situations.
  • The worry, fear and nervousness experienced in people with generalized anxiety disorder is way above in severity as compared to the causal situation while in normal people the anxiety is comparable.
  • The symptoms of anxiety are present almost every day for a period of not less than six months in people with GAD whereas in people experiencing normal worry the anxiety symptoms only lasts for a short time period.

Home remedy methods to manage generalized anxiety disorder

There are several tips that can be used to self-manage anxiety.
The methods either help in preventing the occurrence of generalized anxiety
disorder symptoms or overcome GAD symptoms when they occur.

Some of the common self-help tips for GAD include:

  • Sharing the problem with others
  • Learning and utilizing the relaxation techniques
  • Using simple techniques to help in calming down
  • Exercise
  • Learning more about anxiety and trying to use
    the information to help with worry
  • Diet and limiting the intake of coffee, alcohol
    and nicotine
  • Getting enough sleep

Sharing the problem with others

Sharing the worries and fears with others can go a long way
in solving the problem. Since human beings are social creatures, it is good to
tap in this strength to fight your anxiety. It is therefore important to find
someone who is always there to listen to you and try and find solutions

This person may be a close family member, a friend, a clergy
member, a spouse or sometimes someone who has experienced GAD before. Some people
also find help in a therapist.

This means that as someone who is suffering from GAD, you
can find a person or group of persons who can help you to deal with the
anxiety. The persons must be always available to offer a strong support system in
order to cope with anxiety.

It is also important to know the people around you. Some people
may even make the anxiety symptoms worse. This person may also be a chronic
worrier like you and when you talk to them it drives them and you down the road
of more worry. It is therefore good to avoid them when you start worrying.

In addition, GAD may make relationships not to work. The
worry may affect the way you relate with your spouse, family, friends,
colleagues and other people. Therefore, letting people know the effects of your
worry can help them sometimes not to feel offended or hurt when the symptoms

Learning and utilizing the relaxation techniques

There are several relaxation techniques that can be applied
to cope with or manage the symptoms of generalized anxiety disorder. Since
worry is controlled by body hormones that manage the fight-or-flight actions in
the body, learning how to relax can help ease this mechanism.

There are several techniques that can be used to help you
relax. They include:

  • Deep breathing
  • Meditation
  • Massage and other muscle relaxation techniques
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Deep breathing

In deep breathing, a person tries to minimize the effects of
hyperventilation that is causes by the fight-or-flight mechanism in the body. This
systems produces effects that can cause more anxiety or panic.

The fight-or-flight action in the respiratory system that
occurs during anxious moments includes faster breathing. In addition people
experience gasping, faintness, lightheadedness, chest
and tingly hands and feet.

The deep breaths alternated with counting to 10 can help to
calm you down. This breathing can be managed by breathing from the diaphragm
thus ensuring the rapid breathing is slowed down.

Mindfulness meditation

Mindfulness meditation can help in regulation of brain
chemicals. This helps you to relax when practiced regularly. The mindfulness
meditation utilizes breathing techniques, creating a calming mental image, mind
awareness and body awareness to help in body and mind relaxation.

In mindfulness meditation, one tries to keep in touch with
the thoughts and body feelings without being judgmental of self. That way your
body and brain can focus on the present and prevent anxiety attacks.

Meditation techniques in general help you to relax.

Massage and other muscle relaxation techniques

has been shown to help people to relax and manage anxiety symptoms. There are
different massage
techniques that can help with anxiety
. Massage can be done by a friend,
family member or a qualified massage therapist.

massage help in blood circulation and regulation of body hormones to offer
relaxation. Massage also helps the muscles and other body parts to heal thus
preventing generalized anxiety from developing.

muscle relaxation techniques on the other hand makes use of alternating and
systematic relaxation and tensing of groups of muscles in the body to enable

Using simple techniques to help in calming down quickly

socializing and using relaxation techniques helps to easily calm down. There are
several simple technique that can help to calm you down. These techniques helps
the brain to get soothed. The techniques centers on one or several body senses
to relieve anxiety.

techniques can utilize the following senses:

  • Sound: for some people listening to some calming
    music or even singing it can help to calm your nerves. The calming sound can be
    from a musical instrument, from a favorite song or from nature sounds (recorded
    or live sounds from wind sound, ocean waves, tree sounds, birds or insects). As
    for me, my nerves are calmed by listening to the sounds of birds singing.
  • Smell: some aromas and smells can help to calm
    your body. Some people light the scented candles, spray perfumes, burn incense,
    or walk in a garden to smell the flowers or natural scents. These smells can
    calm your brains.
  • Sight: There are things in this life that makes
    us happy when we look at them. These things can looked at to give you a sense
    of calmness. Examples of the things you can look at to ease GAD include a
    family photo, nature photos, animal pictures or a calming video.
  • Taste: Some things when chewed or tasted can
    help you to calm down. Some people find chewing gum, eating ice-cream, a hot
    cup of chocolate or chamomile tea among other treats to be calming.
  • Touch: Touch can also be relaxing. Whether it is
    someone or something touching you or touching something yourself can offer the
    calming sense for you. You can touch a pet, give yourself a massage, get in the
    way of a breeze or touch the coarseness of your jeans. These among others
    distracts you from the anxious thoughts helping you to calm down.
  • Imagination: Sometimes imagining things that make
    you happy can offer relief from the anxious thoughts. You can paint a picture
    of a calming place in your brain where you can always escape to when you
    experience anxiety.


Moving around or exercise can help to get relief from
anxiety and also prevent anxiety from happening. Exercise helps the body to
reduce tension and regulate the brain chemicals that affect sleep, anxiety, and
stress among others.

The exercise can either be intense or light. Bothe forms of
exercises help you to get relief from anxiety. At least 30 minutes of exercises
like walking, running, swimming, aerobic activity or dancing can work for your

It is recommended that the exercise can be done while practicing
mindfulness to maximize the effects. The mindfulness helps to concentrate on
things that bring out positive energy thus combining well with exercises.

Learning more about anxiety and trying to use the information to help with

Learning about anxiety can help you to prevent or cope with
the anxiety symptoms. Generalized anxiety disorder is an anxiety disorder that
is defined by constant worrying or fear about several things that happen in our

Learning about the disorder helps to know what triggers the
disorder, how to deal with it or ways to prevent the disorder. It helps to show
you that worrying is counterproductive since the fight-or-flight mechanism has
minimal uses in the current world.

When we learn about it we know that we are not protecting
ourselves when we get the anxiety symptoms. The materials we read also help to
show you that the worry in GAD is more extreme as compared to the causal
trigger or agent.

Sometimes reading also helps us to know that we can always
pull through the anxiety. It helps you to understand that anxiety about general
things can not harm us. This way we easily stop the recurrence of the anxiety

If you are worrying about “what if”, then we are getting
worried for nothing. The materials available will help us to learn how to stop
worrying, challenging the unproductive thoughts or getting through the anxiety
with minimal harm to ourselves or our relationships.

There are several materials that we can read or use to learn
about anxiety. They include anxiety
, audio books, videos, and lectures among others. These materials can
be available for free or bought from stores and though the internet.

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Diet and limiting the intake of coffee, alcohol and nicotine

There are changes in our day to day meals, drinks and
lifestyle that can help to manage generalized anxiety disorders. They include
checking what we eat, drink and smoke.


Anxiety can be controlled by eating a balanced diet and not
skipping some meals. This is because the balanced diet is able to give you all
the required nutrients to enable your body to function, balance the brain and
body chemicals, and repair.

The meal should have lots of fruits and vegetables. These
helps to regulate the brain chemicals like serotonin and body chemicals like
insulin. While reducing the refined sugars and carbohydrates to enable the body
to get right amounts of sugars in the blood stream.

Skipping meals always leave us hypoglycemic which can
trigger the anxiety thoughts. Therefore wherever you feel that you might not
get a meal during some time, kindly carry a snack that can help in energizing
the body.

Reduce caffeine intake

There are several effects of caffeine that make generalized
anxiety disorder and other disorders worse or trigger them. Caffeine among
other stimulants can make you to have a pounding heart, sleeplessness,
trembling extremities, restlessness and irritation.

Some of those effects of stimulants feels like symptoms of
generalized anxiety disorder or other disorders thus can trigger a panic. The
effects can also make the GAD symptoms worse.

Avoid alcohol and nicotine

Alcohol makes anxiety symptoms worse especially when it is
wearing off from the system. Most people take a few pints of alcohol to mask of
the effects of anxiety. You will find someone who has anxiety about being
around people taking a few pints to make him sociable. However, when the
alcohol is wearing off it can give you a hangover which can trigger anxiety.

Nicotine is also used by several people to try and calm the
anxiety. However, nicotine is a stimulant which increases anxiety. Therefore,
persons with GAD should not smoke or take alcohol.

Getting enough sleep

sleep for management of GAD

It is well known that when we are anxious we find sleep hard
to come by. This lack of sleep then makes anxiety worse. It is therefore
recommended that we should always strive enough quality sleep to get relief
from anxiety.

The ability to handle stress or think straight when we are
sleep deprived is compromised. This is because of emotional imbalance that is
created by not going through all the sleep stages. Sleep helps to regulate brain
chemicals thus preventing anxiety.

There are several ways
to get a good night
sleep every night. They include:

  • Regular exercise
  • Minimizing the use of alcohol and stimulants
    like caffeine and nicotine
  • Weight reduction
  • Having a regular sleeping pattern and minimizing
  • Making the bedroom comfortable for sleep
  • Not using blue light emitting devices for some
    time before sleep
  • Working on stress
  • Eating meals that will facilitate sleep

How can generalized anxiety disorder be treated?

There are 2 broad ways of treating generalized anxiety
disorder and other anxiety disorders. The treatment methods are:

  • Psychotherapy
  • Use of medications


 This is talk therapy
whereby by visiting a specialist for anxiety a person suffering from GAD is
treated. Cognitive-behavioral
(CBT) is one of the commonly used treatment method for anxieties. It
uses the following components to treat anxiety:

  • Education
  • Monitoring
  • Physical control strategies
  • Cognitive control strategies
  • Behavioral strategies.

There are different CBT strategies which are either single
diagnostic therapy techniques or transdiagnostic
treatment techniques
for emotional disorders. The techniques that work for
a single emotional disorder are the single diagnostic therapy techniques while
transdiagnostic therapy for emotional disorders work for different emotional
disorders. Examples of the transdiagnostic treatment for emotional disorders
include the unified
, MATCH. CETA, cognitive therapy among others.

Use of medications for generalized anxiety disorders

There are several medications that can be used for GAD. Some
of these medications include:

  • Buspirone:
    It is one of the most effecting and safest medications for anxiety. It should
    be used to manage the symptoms of anxiety but does not eliminate anxiety.
  • Benzodiazepines:
    They are some of the fastest medications for GAD. They however can cause
    dependence with long term use. Also withdrawal from benzodiazepines leads to
    withdrawal symptoms.
  • Antidepressants: There are several antidepressants
    that are used to treat anxiety. It is good to check the times that it will take
    to work, the side effects and the interactions before taking antidepressants.
    They form the first line of treatment against GAD.
  • GABA:
    It is also used to treat GAD. Since it is a body chemical it is better
    tolerated than most other medications for anxiety. However it is good to check
    on the side effects and effects of GABA.
  • Beta
    : They are also used for anxiety treatment. Like other medication,
    it is good to discuss with your doctor before taking the medication for
    treatment of generalized anxiety disorder.

The final word

Generalized anxiety disorder DSM-5 classification criteria
is an anxiety disorder that can lower the quality of life. The symptoms of GAD
are also found in several other mental disorders or conditions.

A proper diagnosis of generalized anxiety disorder as per
the DSM-5 criteria is important in getting an effective treatment or get ways on
how to prevent or cope with the disorder.

There are treatment methods available to treat GAD. These
include the several psychotherapy techniques or use of medications. The two
should be explored and the right treatment method used for GAD.

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