What Is Generalized Anxiety Disorder? DSM 5 And Inclusion Criteria
Medically Reviewed By Lauren Guilbeault, LMHCAnxiety disorders can wear numerous hats. Some anxiety disorders are extremely narrow, and focus on a single aspect of living, as in the case of Social Anxiety Disorder. Some anxiety disorders masquerade as other things, as is the case with Obsessive Compulsive Disorder. Anxiety disorders are not always easy to decipher, by a casual observer or a trained mental health professional, as they often share symptoms and appear to be other mental health conditions. One diagnosis was created to identify a large, nonspecific category of anxiety disorders and the symptoms associated with that disorder: Generalized Anxiety Disorder.
What Is Generalized Anxiety Disorder?
Generalized Anxiety Disorder (GAD) is an anxiety disorder characterized by general, uncontrolled feelings of anxiety, without a single or definitive trigger or source. This disorder might be sparked as a result of a traumatic situation, but often seems to have no source at all when it springs to life. Generalized anxiety disorder involves chronic, persistent, and unresolved anxiety, often concerning everyday things that would not typically cause undue strain or stress. Although it can co-exist with other mental health disorders, the symptoms of anxiety are distinct on their own.
Difficulty concentrating, relaxing, and letting go all hallmarks of GAD, as your mind is essentially stuck on "worry" mode, and cannot seem to divert itself to other ways of thinking and feeling. Physical sensations are not unheard of in GAD, as headaches, stomachaches, throat closure, chest pain, and actual bowel dysfunction have all been reported as symptomatic of anxiety disorders. GAD is a diagnosable disorder and generally requires an evaluation by a psychotherapist or other mental health professional before a diagnosis is delivered.
GAD differs from other anxiety disorders in its scope; other anxiety disorders focus on a particular event, a specific set of symptoms, or a specific trigger, as is the case in Obsessive Compulsive Disorder, which describes a state characterized by anxiety surrounding impulses, obsessions, and behavior. General Anxiety Disorder, conversely, identifies a long-standing and non-specific stream of anxiety that affects all areas of life and proves potentially debilitating for patients with the disorder-in most areas, rather than a specific aspect of life.
What Is The DSM-5?
The Diagnostic and Statistical Manual of Mental Disorders (edition 5) is a print book that identifies the different mental disorders recognized by mental health professionals-or the mental health profession as a whole-and details the precise symptoms required to qualify for a diagnosis, as well as any available statistical information regarding these disorders.
The DSM is the standardized model by which most mental health professionals operate, and is referred to often as a source of guidance and understanding when evaluating, diagnosing, and treating patients. There are five iterations of the DSM now, and each of them seeks to update any changes in diagnostic criteria, symptoms, and research to provide those in the mental wellness field with accurate, safe, and effective information. The DSM-5 contains over ten years' worth of research and conclusions and is considered the most up-to-date and reliable method of identifying disorders and determining how to proceed with treatment.
The DSM-5 is likely to grace the bookshelves and arsenal of any mental health professional whose services you engage, as it is not merely used for diagnostics, but is also used for medical and insurance coding. Because medical coding is important in receiving a reimbursement and allowing a treatment routine to be implemented, these manuals are an integral aspect of diagnosing, treating, and billing for therapy services, as they allow insurance companies to determine exactly what the patient in question's condition is, and what treatment might involve.
Why Is The DSM-5 Used In Psychology?
Psychological symptoms can often mimic one another, and many of them do seem to blend or overlap in patients. Psychology is a vast field, filled with countless patients per doctor, and innumerable combinations of risk factors, family histories, and co-morbid conditions. Determining what exactly a patient is dealing with-and, by extension, what the doctor is dealing with-can be a lengthy process, and often requires the objective, distant assistance of a manual. The DSM-5 is that manual.
The DSM5: Anxiety Disorder Qualifications
The symptoms of different DSM 5 anxiety disorders changed, and the manual provides the insurance codes necessary to proceed with treatment. Qualifications include different symptoms unique to different forms of anxiety disorders. Panic Disorder, for instance, requires patients to experience panic attacks without a legitimate reason to incite panic, and attacks must happen with some regularity. Post-traumatic Stress Disorder requires that patients have experienced some form of the traumatic event before experiencing stress and (potentially) panic attacks.
The DSM-5 identifies the symptoms that must be present to diagnose a disorder safely. Aside from that, however, the DSM also offers treatment suggestions, symptom duration requirements, and co-morbidity protocols.
Differences In The DSM 5 And Previous Iterations
Although the most startling difference between the DSM-4 and the DSM-5 was the new characterization of Autism as a spectrum disorder rather than a single diagnosis, there were some alterations within the field of anxiety, as well. 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 disorders were brought into the classic sphere (Selective Mutism and Separate Anxiety Disorder). Other anxiety disorders also changed, as they were grouped into several distinct categories, including Obsessive Compulsive, Traumatic, and Dissociative.
Aside from changes made to the types of anxiety disorders, the DSM-5 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 disorder. The DSM-5 also identified potential crossovers in diagnoses and instructed providers on how to proceed with these crossovers.
Generalized Anxiety Disorders: DSM5 Criteria
Generalized Anxiety Disorder is not considered a diagnosable condition under the DSM-5 until patients have experienced uncontrolled anxiety for at least six months, sleep disturbances, changes in physical health, difficulty concentrating, significant impairment in functioning, and do not have another disorder, mental or physical to explain it. If each of these points is met, health professionals can then provide patients with a GAD diagnosis.
If symptoms are all present, aside from 6 months, each of them can be attributed to something else. A health issue could explain gastrointestinal distress or headaches. A dramatic life change could explain sleep disturbances, restlessness, or difficulty concentrating. The conglomeration of all of these symptoms, however, for six months or longer suggests that the potentially cause-less GAD is at play.
Treatment According To The DSM-5
GAD is treated in one of two ways: psychotherapy or pharmaceutical drugs. The most common form of psychotherapeutic treatment is Cognitive Behavioral Therapy, which seeks to target thinking patterns that reinforce anxiety and the symptoms anxiety produces. Cognitive Behavioral Therapy is a form of talk therapy and does not require any special practices or commitments to be utilized for GAD treatment.
Antidepressants may also be prescribed for GAD, as the symptoms of anxiety disorders often intersect with the symptoms of depression and depressive 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.
Both of these treatment methods used in conjunction may prove the most effective form of treatment, as they tackle both sides of the anxiety equation: biology and behavior. Engaging in treatment with a qualified professional with a strong history in anxiety disorders can help relieve many of the symptoms of anxiety, and can help keep the transition to engaging pharmaceutical help smooth and straightforward.
Anxiety And The DSM-5
Although the alterations made to the DSM-5's classification and characterization of anxiety were not drastic, they did make some of the inclusion criteria for anxiety disorders broader, allowing people with less severe symptoms to be able to receive treatment, instead of focusing primarily on individuals whose conditions are severe. Allowing more people to receive treatment at the beginning stages of anxiety conditions could potentially mitigate the symptoms early on, instead of devolving into several co-morbid disorders, such as GAD and Panic Disorder, or GAD and Social Anxiety Disorder (SAD).
As researchers learn more about anxiety disorders, their cause, and more effective treatment methods, changes must be made to not only treatment modalities, but also the parameters for diagnosis. The two greatest alterations came in the form of widening the scope of both Agoraphobia and Panic Disorder, two disorders experiencing a surge in diagnosis. As levels of anxiety as a whole continue to rise in people of all ages and backgrounds, mental health professionals need to adapt and learn quickly to adequately and effectively treat their patients. While the DSM focuses on identification and treatment, it encourages research that could allow professionals and laymen alike to better understand anxiety, what causes it, and how to keep it at bay.
Frequently Asked Questions (FAQs):
What are the DSM 5 anxiety disorders?
According to the most recent publication of the DSM, or the official manual of mental disorders used and endorsed by the American Psychiatric Association, the disorders recognized as anxiety disorders include Selective Mutism, Social Anxiety Disorder, agoraphobia, specific phobia/s, Separation Anxiety Disorder, Generalized Anxiety Disorder, Panic Disorder, Substance/Medication Induced Anxiety Disorder, and Anxiety Disorder-NOS (or Not Otherwise Specified). Although Post Traumatic Stress Disorder and Obsessive-Compulsive Disorder were once recognized as disorders falling under the heading of “anxiety,” they are now considered their own disorders, rather than falling under the anxiety heading, and both have their own variants under the umbrella of PTSD and OCD, respectively.
Is generalized anxiety disorder considered a mental illness?
The term “mental illness” is no longer used with any real regularity among mental health professionals, as it comes along with preconceived notions, stigma, and general fear and discomfort. Instead, the term “mental disorder” or “mental condition” is the preferred moniker. That being said, Generalized Anxiety Disorder (GAD) does fall under the qualification of a mental disorder or medical condition. Why? A disorder or medical condition involving mental health is classified as any condition wherein thought processes, behavioral patterns, or emotional states deviate from what is considered the norm. Anxiety disorders of all shapes and sizes fit this qualification, including Generalized Anxiety Disorder, and therefore qualify as mental disorders or conditions.
What is the DSM 5 criteria for generalized anxiety disorder?
To properly recognize and diagnose Generalized Anxiety Disorder, the American Psychiatric Association and the DSM 5 require incoming clients to exhibit all of the following impairments in areas of functioning to some degree, and occurring more days than not:
- Worry that is considered excessive or a hindrance to daily function. Occasional bouts of worry or stress are not uncommon and experiencing anxiety and worry during stressful or uncertain situations is not enough to signal the presence of an anxiety disorder. Instead, psychologists and other mental health professionals are looking for signs of chronic worry (lasting 6 months or longer) that is far outside of the norm for anxiety experiences. This often means excessive anxiety and worry that causes clinically significant distress or impairment, is debilitating, and negatively impacts careers, educational pursuits, and relationships.
- The presence of physical symptoms indicating anxiety. Chronic anxiety takes a hearty toll on the body, and there are a series of physical symptoms often associated with anxiety. The most common physical manifestations of anxiety include headaches, stomachaches, racing heart, elevated respiratory rates, and unexplained muscle tension or soreness.
- Ongoing mental issues that do not have another explanation. Sleep disturbance and difficulty concentrating are two hallmark mental issues tied to the presence of an anxiety disorder, but irritability and chronic anger have also been associated with anxiety disorders. The presence of any of these mental and emotional changes can signal the presence of an anxiety disorder.
- The worry and anxiety experienced is difficult or impossible to control. While standard anxiety might respond to reason and managing that anxiety might be as simple as talking yourself through the issue, preparing for the day or challenge, and simply diving in to complete whatever is at the root of the feeling, anxiety disorders do not usually respond to the standard methods to quell symptoms and an inability to control the worry is considered clinically significant.
In the absence of these four symptoms, Generalized Anxiety Disorder is not likely to be diagnosed. Because GAD can be a difficult diagnosis to make, mental health professionals are looking for any other possible explanation of symptoms, including physical ailments, and other mental health conditions, including other anxiety disorders. Although Generalize Anxiety Disorder is not rare, the lack of specific anxiety focus can make it difficult to quantify, and it takes a thorough investigation of symptoms and signs to determine if GAD is truly at the root of the issue.
What is the code for generalized anxiety disorder?
Generalized Anxiety Disorder’s code is 300.02 and describes a state of anxiety characterized by at least 6 months of persistent, unrealistic, and uncontrolled anxiety, fear, or worry.
What is anxiety f41 9?
This particular code is used to describe an anxiety disorder that is not specified, or Anxiety Disorder-NOS (not otherwise specified). This particular code is used to describe any type of anxiety disorder that demonstrates clear symptoms of anxiety—ongoing, persistent worry that lasts 6 months or longer, along with physical symptoms and cognitive issues—but does not demonstrate a clear delineation between general anxiety symptoms and the focus of those symptoms. In Social Anxiety Disorder or social phobia, for instance, anxiety symptoms revolve around social situations and how those situations make the person feel. In Generalized Anxiety Disorder, anxiety symptoms are persistent and unfocused, and can be found in virtually all facets of an individual’s life. In Anxiety Disorders-NOS, symptoms might focus on a specific area of an individual’s life that is not currently recognized as an anxiety disorder or might be even more broad than Generalized Anxiety Disorder symptoms.
What are the 6 types of anxiety disorders?
The 6 types of anxiety disorders currently recognized by the Diagnostic and Statistical Manual 5 include:
- Separation Anxiety Disorder.
- Specific Phobia.
- Social Anxiety Disorder (also called “Social Phobia).
- Generalized Anxiety Disorder.
- Panic Disorder.
Although panic attacks are often associated with anxiety disorders as a whole, they are actually unique to Panic Disorder, as not all types of anxiety will come with recurring panic attacks. It is possible to have Panic Disorder in conjunction with other anxiety disorders, however, which can make it seem as though the conditions are intertwined.
Although these are the 6 anxiety disorders currently identified in the DSM-5 and recognized by the American Psychiatric Association, there are two additional disorders that were previously categorized as anxiety disorders and are still considered anxiety-adjacent. These conditions are Post Traumatic Stress Disorder and Obsessive-Compulsive Disorder. Although they share most symptoms with anxiety disorders, both PTSD and OCD have expanded to become their own separate disorders, with various subtypes within those diagnoses.
Does anxiety worsen with age?
There are many factors that can impact the answer to this question, the most significant of which is the presence or lack of treatment. In the absence of consistent anxiety treatment, anxiety can absolutely worsen with age. If anxiety starts in childhood, and is consistently coped with in a healthy, effective manner, anxiety can actually decrease substantially with age. Although age is associated with a large number of changes to the body and mind, age is not a reliable or consistent indicator of any mental health symptoms, including anxiety symptoms.
It could be argued that, as you grow older, your responsibilities increase, and your commitments increase, which can both contribute to additional worries and stressors. While this may be true, healthy coping skills and a healthy ability to adjust to changes and setbacks could easily mitigate the likelihood of developing anxiety symptoms in adulthood, and adulthood or increasing age alone has not been shown to be a risk factor in clinical studies evaluating anxiety onset and proliferation.
What do psychiatrists usually prescribe for anxiety?
There are two common types of medication used and recommended by the American Psychiatric Association for anxiety treatment: SSRIs and benzodiazepines. Both of these medications can be used for the management of anxiety symptoms, but both operate differently and both target different goals for anxiety treatment. SSRIs are most often known as anti-depressants, and they can have a mood-stabilizing effect on the brain and body, which can help alleviate some of the mental and physical symptoms associated with anxiety disorders. That being said, not everyone with anxiety responds well to SSRIs, as they can have numerous side effects, can be habit-forming, and can take months of tweaking and changing before dosages effectively quell symptoms.
Benzodiazepines are also common medications used to treat anxiety, with different results. While SSRIs target mood stabilization, benzodiazepines work by calming the body, which has a domino effect on the brain. These medications are essentially relaxants, allowing body and mind to experience a reprieve from the most intense symptoms of anxiety. Like SSRIs, however, benzodiazepines can be habit-forming, and are often used as an acute form of treatment, used in short bursts or over a short period of time, until a more effective, safer treatment method is landed upon.
Is anxiety considered a disability?
Yes. When you hear the word “disability,” you might immediately leap to war veterans, but mental disorders are similarly debilitating, even if their effects are not as readily visible as the effects of a physical disability that might require a cane, a wheelchair, or another tangible source of assistance.
Some types of anxiety can even require the use of a service animal, as someone who is blind or deaf might have. PTSD and Panic Disorder can both benefit from the use of service animals, as service animals can provide a soothing effect, and can patrol the immediate area for sources of panic, disorientation, or excess fear or worry.
Though there are those who do not recognize mental disorders as disabilities, despite mountains of evidence to the contrary, mental and psychiatric disorders are recognized as disabilities by mental health professionals and primary care physicians alike, and people with mental disorders typically enjoy the same government protections as those with more visible challenges.
What is the best job for someone with anxiety?
Finding a job that accommodates anxiety symptoms will depend entirely on the type of anxiety someone experiences, the severity of anxiety, and the individual’s ability to cope with and manage symptoms. Someone with Social Anxiety Disorder, for instance, might prefer to have a job that allows them to work from home, or work largely on their own, such as a job working at the back end of retail, fulfilling orders, or working as an online customer service representative in order to combat the physiological effects of their disorder. Someone with Panic Disorder would likely want to avoid any position that is extremely fast-paced, or requires lofty monthly goals to be met, as you might find in a finance position, or a sales position. Someone with agoraphobia might prefer to work outdoors or with animals and may find some comfort and fulfillment in working as a veterinarian or ranger.
Determining the best job for you and your anxiety requires you to identify what triggers your most severe anxiety symptoms and use that as a starting point to find a job that, as a whole, avoids those triggers and prevents you from feeling keyed up or overwhelmed.
What triggers generalized anxiety disorder?
Perhaps one of the greatest challenges of Generalized Anxiety Disorder is the vast number of potential triggers. Generalized Anxiety Disorder is so named because anxiety symptoms arise in response to any number of potential triggers, most of them highly variable and unique to the individual with the disorder. Someone with GAD might experience their most significant triggers in response to changed plans and sudden, unexpected losses, while others may take changes in stride and absolutely balk at the prospect of having to take on more responsibility in their roles, or work with a team to accomplish a singular goal. Triggers for GAD can come from just about anywhere, and there is no single, predetermined list of potential catalysts for a surge in GAD symptoms.
There are some disorders and conditions that are linked to the onset of Generalized Anxiety Disorder. Substance abuse and addictive disorders can trigger the onset of anxiety symptoms, as substance abuse can create feelings of shame, isolation, and fear. Certain events or activities can lead to the onset of generalized anxiety, too, as some events and activities can trigger feelings of fear and overwhelm. Anorexia nervosa and other eating disorders can also trigger feelings of generalized anxiety, because anorexia nervosa can lead to feelings of fear, isolation, and paranoia, as attempts to hide the disorder escalate.
What are reasonable accommodations for anxiety?
Reasonable accommodations for anxiety will differ from person to person and industry to industry. Because the Americans with Disabilities Act (or ADA) identifies disabilities as protected, but does not give concrete, easily identified traits that deserve the title of “disability,” much of the accommodations required are left up to employers and can change from year to year and person to person.
That being said, there are several common accommodations used for individuals with anxiety as a disability. These can include:
- Flexible scheduling. Because people with anxiety may experience an unexpected and even unprecedented spike in anxiety symptoms, some employers allow these individuals to work on a flexible schedule by shifting hours to another day or working some hours from home instead of in the office. The ability to allow flexible scheduling will vary from employer to employer, but this is a common method to meet the needs of individuals with anxiety.
- Break schedules that accommodate individual needs. For some people with anxiety, short, frequent breaks are preferable to a single large break, or two medium-sized breaks. Taking short breaks can be requested, provided that those breaks do not exceed the standard amount of time allotted for employee rest periods.
- A private area for breaks during work hours. This is particularly important for people who might experience Panic Disorder and related panic attacks, as being watched during a panic attack can exacerbate symptoms, and a calm, quiet space is often needed to recover.
- Accommodations for support or service animals or support personnel. Someone with an anxiety disorder might have a service or support animal or caretaker they bring with them to quell symptoms or effectively manage anxiety, and employers may be required to provide space or facilities for these animals or individuals.
- The reduction of known sources of anxiety or known triggers. If triggers and sources of anxiety are well-known to the worker and the employer, the employee may be able to ask for some of these triggers to be reduced, including loud noises, unexpected changes to scheduling, or unexpected work requests.
The above accommodations are far from an exhaustive list of potential anxiety accommodations but does provide a window into some of the common, potential types of accommodations granted to those with verified anxiety disorders. Anxiety disorders can cause people to experience physiological effects, including difficulty falling or staying asleep, being easily fatigued, and experiencing significant impairments in important areas of daily functioning, such as difficulty concentrating and difficulty maintaining a stable, steady mood. To determine how likely, you are to qualify for accommodations, contact the mental health services found at your company, or your personal provider for mental health services, and go over your symptoms.
Can you get accommodations for anxiety?
It is possible to receive accommodations for anxiety, but it is important to recognize that not all employers are required to give accommodations. Business size, employee volume, and the amount of money a company makes can all provide some degree of wiggle room or outright exemption from accommodation requirements. Checking with prospective employers prior to beginning work can help make sure that you are able to receive accommodations you need for your anxiety disorder before you start working, in order to avoid a contentious or painful workplace situation down the road. Small businesses, for instance, are more likely to be exempt from some accommodation requirements than large corporations and may not be an ideal fit for someone seeking anxiety-related work accommodations.
Is anxiety disorder protected by ADA?
The precise wording of ADA protections is somewhat murky, which means that individual cases of anxiety are evaluated for coverage under the ADA. Someone with only mild anxiety symptoms, for instance, is unlikely to receive any protections under the ADA, because symptoms are not severe or challenging enough to warrant accommodations, and do not significantly impair that individual’s ability to work or live. People with severe anxiety symptoms, multiple anxiety disorders, or uncontrolled anxiety disorders are more likely to receive protections under the ADA.
Is generalized anxiety disorder curable?
There is not some concrete “yes” or “no” to this question, because the answer depends on several factors, including the length and intensity of treatment of Generalized Anxiety Disorder, the severity of symptoms, and the presence of risk factors for anxiety disorders. For some, anxiety symptoms can be tempered and even quelled with treatment, and may only ever pop up periodically, and without any real severity. For others, Generalized Anxiety Disorder is a lifelong disorder, which will require consistent management and ongoing therapy in order to manage symptoms and create a life of ease and fulfillment. While the answer to an anxiety disorder cure is not quite cut and dried, Generalized Anxiety Disorder is regarded as a highly treatable disorder, and many people with the condition go on to leave happy, stable, and fulfilled lives following treatment.
