What is Generalised Anxiety Disorders according to the DSM-5?

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In this brief blog we will explore what general anxiety disorder is according to the DSM-5. 

We will also discuss the various criteria streamlined by the DSM5 for the diagnosis of GAD, the prevalence rates for the disorder, as well as the treatment options available for this disorder. 

What is Generalised Anxiety Disorders according to the DSM-5?

Generalised Anxiety Disorder (GAD) according to the Diagnostic and Statistical Manual of Mental disorders is an anxiety disorder that is characterised by persistent and excessive worry about a number of different things. 

People who are affected by this disorder experience worry and anxiety that is more severe than normal levels of worry and this particular experience persists for long periods of time, sometimes even years. 

They worry often about anticipated disasters, concerns about money, family members, and loved ones, health, and other various worries that are often inappropriate to the real levels of threat. 

People who have this particular disaster worry even when there is no actual threat and their anxiety and worry often affect their health, their relationships, their ability to work, and also socialise with others. 

They find it hard to control this worry and anxiety and it often affects their day to day activities including being able to focus on tasks at hand and also their sleep. 

What are the criteria for the diagnosis of Generalised Anxiety Disorder?

The diagnostic and statistical manual of Mental disorders published by the American Psychological Association has listed out the following criteria for the diagnosis of GAD. 

The information below has been retrieved from the DSM-5.

People experience excessive anxiety and worry occurring more days than not for at least 6 months about a number of events and activities such as performance at work, health, disasters etc)

The individual finds it difficult to control the worry.

The anxiety and worry symptoms are also associate with three or more of the following symptoms that have been present for more days than not for at least 6 months:

  • Restlessness, feeling keyed up or on edge.
  • Being easily fatigued.
  • Difficulty concentrating or mind going blank.
  • Irritability.
  • Muscle tension.
  • Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

The anxiety, worry, or physical symptoms cause significant dysfunction in multiple areas of their life such as the ability to work, meet the demands of their day to day life, maintain relationships, etc. 

The disorder is not caused by the physiological effects of a drug or substance, nor because of another medical condition.

The symptoms are also not explained by another Anxiety disorder, nor by obsessions in obsessive-compulsive disorder, PTSD, Separation from attachment figures, Weight gain in the case of Anorexia nervosa, Somatic disorders, nor due to delusional beliefs in the case of schizophrenia related disorders. 

What are the prevalence rates of Generalised anxiety disorder according to the DSM?

According to the DIagnostic And Statistical Manual of Mental disorders, the prevalence rates of generalised anxiety disorder are more in adults as opposed to any other population in the United States. 

The prevalence rates for Generalised anxiety disorder, as of 2013, was 2.9% in adults whereas it was 0.9% among adolescents. 

As of recent years the rates have increased to 3.1% of the U.S. population, where only 43.2% of 6.8 million adults are receiving treatment.

In the case of other countries, the rates vary from 0.4 to 3.6% with the rates of Generalised anxiety disorder rates being higher in developed countries as opposed to developing countries.

The rates of the disorder also increases among people of european descent as opposed to non-european descent such as Asian, african, Naitve American, and Pacific Islanders who report that they have had symptoms that meet the criteria of this disorder. 

Women are twice as likely to develop the disorder and it is most common among the population of middle aged adults with prevalence rates declining as people get older. 

In clinical settings the disorder is diagnosed more frequently in women above 55-60% of the people diagnosed are women as well as in epidemiology studies the rates in women are higher with symptoms being largely the same.  

The manifestation of generalised anxiety disorders differs according to cultures where in some cultures, somatic symptoms are more common whereas in others cognitive symptoms are more common during initial manifestation of the disorder. 

The research that explores the cause of these particular differences is limited but there is no evidence that points to the possibility that it is a result of cultural propensity to worry. 

What are the risk factors and comorbidity for Generalised anxiety disorder?

Some of the risk factors that makes the development of GAD more likely in individual include:

  • Temperament: High levels of Neuroticism related personality traits or temperament makes it more likely that a person will develop Generalised Anxiety Disorder in the face of life stressors as well as people who have high levels of harm avoidance. 
  • Environment: Early life experiences which were negative such as parenting styles, trauma in childhood, put individuals who experience them at a higher risk of developing this disorder. Interestingly there has been no environmental factors such as peer relationships, poverty, neighbourhood etc that has been identified as a necessary or sufficient risk factor for the development of this disorder.  
  • Genetic and physiological risks: People whose immediate family has also been affected by the disorder has a higher risk- at least 1/3trd of a higher risk to develop the disorder. 
  • Comorbidity risks for Generalised anxiety disorders include other anxiety disorders, and unipolar Depressive disorder. There is a chance for an individual to develop disorders related to substance use, psychotic, conduct, neurodevelopment, and neurocognitive disorders but it is less common. 

It has been observed that in females the disorder is comorbid with other anxiety and unipolar depression disorder whereas in men there is comorbidity with substance use disorder. 

What are the functional consequences of Generalised anxiety disorder according to the DSM5?

The DSM5 noted that functional dysfunction is one the major criterias for the diagnosis of Generalised anxiety disorder. 

The functional impairments caused by the disorder includes the following:

The symptoms of the disorder such as excessive worrying as well as other somatic symptoms impairs one’s ability to do things quickly, work efficiently in various settings. This can cause disruption in their performance at work as well as hinder their ability to meet the demand of their daily responsibility.

The disorder, specially the cognitive symptoms manifested in the form of excessive worrying can impair their ability to parent and often causes impairment in their ability to instil confidence in their children with them experiencing low self esteem. 

The associated somatic symptoms can also cause them to experience tiredness, lethargy, muscle tension, and difficulty focusing and concentration that can majorly impact their ability to function. 

The disorder causes impairment and distress that is independent of that caused by a comorbid disorder and often even individuals who are not hospitalised experience moderate to severe anxiety. 

What are the treatment options for Generalised anxiety disorder?

People affected by this disorder often struggle for months and years before seeking treatment. As of recent years, many people have become aware about the barrios services that are available that provide treatment for mental health disorders. 

One of the first things you can do, if you suspect you have this disorder, is to get medical help- talking to your general physician or a psychiatrist/psychologist is advisable.

Based on their assessment of you, they will most probably refer you to a psychiatrist, a clinical psychologist who is a licensed practitioner. 

The treatments available for Generalised anxiety disorder include:

Psychotherapy

For Generalised Anxiety Disorder, Cognitive behavioural therapy (CBT) appears to be an effective strategy for the treatment of the disorder. 

This form of treatment will involve meeting regularly to talk with a mental health professional with the goal to change your cognitive processes- restructure your beliefs- as well as change behaviours that are dysfunctional and replace them with healthier ones. 

In therapy sessions, you will learn how to identify irrational thoughts, fears, and worries, and also manage them while your therapist also teaches you various strategies to cope with worry such as medication, relatastion, disputing etc. 

Medication

Often, general physicians and psychiatrists also prescribe you medication based on their assessment of your condition. 

If your doctor recommends medication, they will create a medication plan for you that works to reduce symptoms such as muscle tension and stomach cramps etc. 

These medications, called anti anxiety medications will also be prescribed along with antidepressants for long term treatment plans. 

These medications that have been prescribed often work within two two three weeks before you start seeing results in terms of physical symptoms while psychological symptoms might take longer to resolve with continued psychotherapy and medication combination treatment. 

These medications can also have side effects, such as dry mouth, nausea, and diarrhoea and can cause people to stop taking medication which is not advisable.

The best thing you can do for yourself is to talk to your doctor when you experience any side effects- physical and psychological side effects. 

These symptoms can bother some people so much that they stop taking these medications.

Lifestyle changes

Along with pharmacological and therapy treatments, people can also engage in lifestyle changes that have been observed to bring some improvements when it comes to this disorder. 

Lifestyle changes can include:

  • Regular exercise
  • Balanced diet
  • Enough sleep
  • Meditation
  • Avoiding stimulants like coffee
  • Seeking out and establishing support from friends and family
  • Avoiding substances like alcohol and drugs

Conclusion

In this brief blog we have explored what general anxiety disorder is according to the DSM-5. 

We have also discussed the various cereals streamlined by the DSM5 for the diagnosis of GAD, the prevalence rates for the disorder, as well as the treatment options available for this disorder. 

FAQ related to Generalised Anxiety Disorder DSM5

What is the DSM 5 code for GAD?

Generalised Anxiety Disorder (GAD) DSM-5 300.02 (F41. 1) 

What do you do for GAD?

The two things you can do to manage and cope with Generalised anxiety disorder are psychotherapy and medications. Research also finds that people most often benefit most from a combination of the two.

Is GAD treatable?

Yes, GAD can be effectively treated with psychotherapy, medication, or a combination of both. The best form of psychotherapy available for GAD and other anxiety disorders is Cognitive-behavioural therapy.

Is GAD a serious mental illness?

Generalised Anxiety Disorder (GAD) a serious mental illness that causes high levels of dysfunction and impairment in an individual. It is characterised by long term struggle of chronic worry- over six months- with added symptoms that affect their day to day life such as inability to focus, do work effectively, and even affects sleep. 

References

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association, 2013.

Carey. E, An Overview of Generalised Anxiety Disorder. 27th October 2021. Retrieved on 15th Dec 2021. https://www.healthline.com/health/anxiety/generalized-anxiety-disorder#treatment

Glasofer. D. Generalised Anxiety Disorder: Symptoms and Diagnosis. 15th February, 202. Retrieved on 15th Dec 2021. https://www.verywellmind.com/dsm-5-criteria-for-generalized-anxiety-disorder-1393147#toc-differential-diagnosis

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