# 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.