GPAtlas🧭 When to suspect
Suspect generalised anxiety disorder (GAD) in a person with:
• Excessive, hard-to-control worry spanning several different topics
• Worry present more days than not for at least 6 months
• Worry 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
• Sleep disturbance
Unlike a specific phobia or panic disorder, the anxiety in GAD is “free-floating” – not tied to one situation.
Use two scales:
• The brief 2-item Generalised Anxiety Disorder scale (GAD-2) to screen – a score of ≥ 3 warrants fuller assessment.
• 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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