What Is Generalized Anxiety Disorder? Exploring The DSM-5’s Diagnostic Criteria

If you worry excessively or feel like you’re always waiting for disaster to strike, you may be experiencing the symptoms of generalized anxiety disorder. These worries often focus on everyday things, like your health, daily chores, or appointments. This condition can have physical symptoms, too. Learning how to identify signs of generalized anxiety and when to seek help from a professional can help you better control your symptoms so they don’t have as much of an effect on your day-to-day life.

What is generalized anxiety disorder? DSM-5 criteria

Generalized anxiety disorder (GAD) is a mental disorder characterized by general, uncontrolled feelings of anxiety, without a definitive trigger or source. This disorder might be sparked by trauma, but it usually has no specific cause. Generalized anxiety disorder involves chronic, unresolved, and excessive anxiety and worry, often concerning everyday things that would not typically cause undue strain or stress. Although it can coexist with other mental disorders, anxiety symptoms are distinct from symptoms of other conditions.

Difficulty concentrating, relaxing, and letting go are all hallmarks of GAD. The mind is essentially stuck in worry mode and cannot seem to divert itself to other ways of thinking and feeling. Physical symptoms are not unheard of in GAD, as headaches, stomachaches, muscle tension and muscle aches, throat closure, chest pain, and gastrointestinal issues can all be symptoms of anxiety disorders. GAD is a diagnosable mental health disorder and generally requires an evaluation by a psychotherapist or other mental health professional.

What is the DSM-5?

The Diagnostic and Statistical Manual of Mental Disorders (edition 5) is a book identifying diagnosable mental health disorders and detailing the symptoms required to qualify for a diagnosis.

The DSM-5 is the standardized model by which most mental health professionals operate and is a source of guidance when evaluating, diagnosing, and treating patients. There are now five iterations of the DSM. Each version updates any changes in diagnostic criteria, symptoms, and research to provide accurate, safe, and effective information. The DSM-5 contains over 10 years' worth of research and is considered the most up-to-date and reliable method of identifying disorders and determining how to proceed with treatment to pursue mental health.

The DSM-5 is used for diagnostics and medical and insurance coding. Because medical coding is essential in receiving reimbursement and allowing a treatment routine to be implemented, these manuals are an integral aspect of diagnosing, treating, and billing for therapy services. They allow insurance companies to determine what the patient's condition is and what treatment might involve.

The American Psychiatric Association, a national psychiatric institution, wrote and has revised the Diagnostic and Statistical Manual of Mental Disorders. As a national institute, the American Psychiatric Association focuses on creating a manual for the assessment and diagnosis of a medical condition rather than treatment for each disorder.

Why is the DSM-5 used in psychology?

Psychological symptoms of mental health, such as anxiety symptoms, can often mimic one another, and many of them seem to blend or overlap in patients. Psychology is a vast field, filled with countless patients and innumerable combinations of risk factors, family histories, and comorbid conditions. Determining what a patient is dealing with and, by extension, what the primary care doctor is facing — can be a lengthy process and often requires the objective assistance of a manual. The DSM-5 is that manual.

The DSM-5: Anxiety disorder qualifications

The anxiety symptoms of different DSM-5 anxiety disorders changed with the last DSM update, and the manual provides the insurance codes necessary to proceed with treatment. Qualifications include various symptoms unique to each type of anxiety disorder. Panic disorder, for instance, typically causes recurring unexpected panic attacks without a legitimate reason to incite panic. 

In addition to panic disorder, the following disorders fall under the anxiety disorder umbrella:

• Social anxiety disorder.
• Separation anxiety disorder.
• Agoraphobia.
• Specific phobias.
• Selective mutism.

Symptoms of anxiety disorders can be classified into four main categories:

• Cognitive (e.g., difficulty concentrating, intrusive thoughts).
• Emotional (e.g., intense fear, irritability).
• Behavioral (e.g., significant distress or impairment, hypervigilance).
• Physical (e.g., muscle tension, being easily fatigued, experiencing consistent sleep disturbance, panic attack).

The DSM-5 dictates that symptoms must be present and occurring more days than not to diagnose a disorder safely. Aside from that, the DSM also offers treatment suggestions and symptom duration requirements. It also offers comorbidity protocols, as people with disorders such as bipolar disorder and substance use disorder (Note: “Substance abuse disorder” is an outdated term) are more likely to also have an anxiety disorder.

Differences in the DSM-5 and previous iterations

The DSM-5 changed some of the categories previously delineated for anxiety disorders. The most significant change within anxiety disorders came in the form of organization. While the classic anxiety disorders remained intact, two new conditions were brought into the traditional sphere (selective mutism and separation anxiety disorder). Other disorders also changed, as they were regrouped into several distinct categories, including obsessive-compulsive, traumatic, and dissociative. In line with the new delineations, obsessive-compulsive disorder and post-traumatic stress disorder, which were once classified as anxiety disorders, have been reclassified.

Aside from changes made to the types of anxiety disorders, the DSM-5 also altered the symptoms and classification of both agoraphobia and panic disorder to more pared-down versions of themselves, allowing for a greater scope of patients to be diagnosed with each condition. The DSM-5 also identified potential crossovers in diagnoses and instructed providers on how to proceed with these crossovers.

Generalized anxiety disorder: DSM-5 criteria

Generalized anxiety disorder is diagnosable when patients have experienced anxiety that is difficult to control on most days for at least six months, as well as sleep disturbances, changes in physical health, difficulty concentrating, and significant impairment in functioning. They also must not be experiencing symptoms due to the physiological effects of a substance or have another mental or physical disorder that explains these symptoms.

Treatment for excessive anxiety according to the DSM-5

Generalized anxiety disorder is treated in one of two ways: through psychotherapy or through pharmaceutical drugs. The most common form of psychotherapeutic treatment for generalized anxiety disorder is cognitive behavioral therapy, which seeks to target thinking patterns that reinforce anxiety and the symptoms anxiety produces to pursue better mental health.

A doctor may prescribe benzodiazepines and antidepressants such as selective serotonin reuptake inhibitors (SSRIs)to improve brain chemistry and mental health, as the symptoms of anxiety disorders often intersect with the symptoms of depression and other mood disorders. These interventions typically work as a means of calming fear and other intense, adverse reactions on a biological level and can help alleviate some of the physical symptoms of anxiety. A medical professional can prescribe medication to treat depression, GAD symptoms, and other mental and physical illnesses after a physical exam.

Engaging in treatment with a qualified professional who has a strong history of treating anxiety disorders can help relieve many anxiety symptoms. Some research suggests that therapy can be more effective than medication.

Impact of the changes in the DSM-5

Although the alterations made to the DSM-5's classification and characterization of anxiety were not drastic, they did broaden some of the inclusion criteria for anxiety disorders, allowing people with less severe symptoms to receive treatment instead of focusing primarily on individuals with severe conditions. Allowing more people to receive treatment at the beginning stages of anxiety conditions could mitigate symptoms early on.

As researchers learn more about anxiety disorders, their causes, and more effective treatment options, changes must be made to treatment modalities and the parameters for diagnosis. While the DSM-5 focuses on identification and treatment, it encourages research that could allow professionals and laypeople to better understand anxiety, what causes it, and how to keep it at bay. 

Getting help for generalized anxiety disorder (GAD)

Cognitive behavioral therapy is a recommended way to treat generalized anxiety disorder. If you’re curious about this type of treatment and want to learn more, consider online therapy with a BetterHelp therapist. 

Online therapy has many benefits for people with anxiety. It alleviates the stress of finding a local therapist and meeting face-to-face to discuss things you might not be comfortable discussing in person. Some people find the distance and safety of being behind a computer comforting, making it easier to communicate. You also don’t have to worry about waiting weeks or months for an appointment. With online therapy, you’ll be matched with an available therapist so you can start treatment from the comfort of your own home right away.

Research shows that online therapy is effective, too. One study review showed that online CBT effectively treats various disorders, including GAD, social anxiety disorder, phobias, and panic disorders/the tendency to have panic attacks as well as obsessive-compulsive disorder (OCD), and depression, which commonly occurs with anxiety.