Generalized Anxiety Disorder (GAD)

🔍 When to Suspect

Excessive, uncontrollable worry about various topics, occurring more days than not for at least 6 months, with associated physical symptoms

From the full topic in The Ocean Library: Generalized Anxiety Disorder (GAD)

🧭 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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