GPAtlas🧭 When to suspect
Suspect generalised anxiety disorder (GAD) in a person with excessive, hard-to-control worry spanning several different topics, present more days than not for at least 6 months, that is out of proportion to events and causes clear distress or impairment. The worry is typically accompanied by at least some of: restlessness, being easily fatigued, difficulty concentrating, irritability, muscle tension and sleep disturbance.
Unlike a specific phobia or panic disorder, the anxiety in GAD is “free-floating” – not tied to one situation. Use the brief 2-item Generalised Anxiety Disorder scale (GAD-2) to screen (a score of ≥ 3 warrants fuller assessment), and the 7-item Generalised Anxiety Disorder scale (GAD-7) to grade severity and monitor response. Severity is judged on distress and functional impairment, not symptom count alone.
| GAD-7 score | Severity | Typical primary-care action |
|---|---|---|
| 0–4 | None / minimal | Reassure; no specific treatment needed |
| 5–9 | Mild | Psychoeducation, active monitoring, low-intensity self-help (steps 1–2) |
| 10–14 | Moderate | Low- or high-intensity therapy; consider drug treatment if functional impairment (steps 2–3) |
| 15–21 | Severe | High-intensity therapy and/or drug treatment; consider step 4 if high risk (steps 3–4) |
A GAD-7 of ≥ 10 is the usual threshold prompting further evaluation. Consider GAD particularly in frequent attenders – those repeatedly seeking reassurance about somatic symptoms, or worrying across many domains – and where anxiety complicates a chronic physical health problem.
Source: NICE CG113
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