Clinical Review

Generalized anxiety disorder: diagnosis and treatment

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7500 (Published 27 November 2012) Cite this as: BMJ 2012;345:e7500
  1. Elizabeth A Hoge, assistant in psychiatry123,
  2. Ana Ivkovic, assistant in psychiatry1,
  3. Gregory L Fricchione, associate chief of psychiatry12
  1. 1Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
  2. 2Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital
  3. 3Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital
  1. Correspondence to: G L Fricchione gfricchione{at}partners.org

Summary points

  • Generalized anxiety disorder (GAD) is associated with substantial distress and disability

  • GAD is often associated with other medical and psychiatric disorders

  • Antidepressants, such as sertraline, are generally first line medical treatment options

  • Psychotherapy and other psychosocial treatments can also be effective

  • GAD increases the risk of major depression, so preventive approaches should be put in place

Generalized anxiety disorder (GAD) is relatively common, with lifetime prevalence rates of 4-7%. It is a disorder of chronic uncontrollable worry, compounded by physiological symptoms such as disturbed sleep, muscle tension, and difficulty concentrating. The disorder is associated with seriously impaired social and occupational functioning, comorbidity with other disorders, and increased risk for suicide.1 GAD can go undiagnosed because of a focus on physical symptoms and because of the stigma of mental illness. However, the disorder can be treated. This article reviews current knowledge about the diagnosis and treatment of GAD, including pharmacotherapy and psychosocial therapies.

Sources and selection criteria

We based this review on articles found by searching PubMed and the Cochrane Database of Systematic Reviews using the terms “generalized anxiety disorder” and “generalised anxiety disorder”. Our search was limited to English language articles published between 2005 and 2012. Meta-analyses, reviews, and randomised controlled trials were prioritized.

What is generalized anxiety disorder?

GAD is characterized by excessive worry and symptoms of physiological arousal such as restlessness, insomnia, and muscle tension (box). To meet Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for the disorder, the patient must have excessive and difficult to control anxiety about several different events or activities.2 For example, anxiety confined to concern about personal safety would not qualify (but should elicit inquiries about symptoms of post-traumatic stress disorder or agoraphobia, for example). In addition to worry, patients must have at least three of the six physiological arousal symptoms listed in the box. …

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