20 - Generalised anxiety disorder (GAD)

Generalised anxiety disorder (GAD)

© SPMM Course 6. Classification of Neurotic Disorders

Though the term ‘neurotic’  is retained, neurosis is not a major organising principle for classification in ICD10. DSM abandoned the name completely in 1994. In ICD-10, ‘Neurotic, Stress related and Somatoform disorders’ have been categorized under seven headings; phobic anxiety disorders, anxiety disorders (including panic disorder and generalized anxiety), obsessive compulsive disorders, reaction to severe stress and adjustment disorders, dissociative disorders (conversion) disorders, somatoform disorders and other neurotic disorders. In ICD-10, obsessive-compulsive disorder has a separate place in the classification but in DSM-4 it is classified as one of the anxiety disorders. ICD-10 contains a category of mixed anxiety and depressive disorder, but DSM-4 does not. In DSM-4, 12 distinct anxiety disorders are listed. Anxiety disorders include various combinations of psychological and physical symptoms not attributable to real danger and occurs as a persisting state (generalised anxiety disorder) or occurring either in attacks (panic disorder) Generalised anxiety disorder (GAD) GAD is characterised by prominent tension, excessive worry with generalised free-floating persistent anxiety and feelings of apprehension about everyday events leading to significant stress and functional impairment. To diagnose generalised anxiety disorder, ICD-10 requires duration of at least 6 months and the symptoms should have been present on most days during 6 months. The ICD-10 list contains 22 physical symptoms of anxiety whilst there are only 6 in the DSM-4 list. To diagnose GAD in ICD-10, at least 4 (with at least 1 from  ‘autonomic  arousal) of the following should be present:

1. Symptoms of autonomic arousal: palpitations/tachycardia; sweating; trembling/shaking; dry mouth.
2. ‘Physical’  symptoms:  breathing  difficulties;  choking  sensation;  chest  pain/discomfort;   nausea/abdominal distress.
3. Mental state symptoms: feeling dizzy, unsteady, faint or lightheaded; derealisation/depersonalisation; fear of losing control, going crazy, passing out, dying.
4. General symptoms: hot flushes/cold chills; numbness or tingling sensations.
5. Symptoms of tension: muscle tension/aches and pains; restlessness/ inability to relax; feeling keyed up, on edge, or mentally tense; a sensation of a lump in the throat or difficulty swallowing.