Generalised Anxiety Disorder (GAD): Symptoms and Criteria

Everyone has anxiety, and that is normal: it is part of a system that prepares us for danger. The question is not whether you worry but by which features ordinary worry is separated from a disorder. Let us go by the criteria rather than by the feeling of "I think I worry too much".

Four features, not one score

Generalised anxiety disorder (F41.1 in ICD-10, 6B00 in ICD-11) is defined by a set of features that must be present together:

1. The worry spreads across many things. Not one subject but several areas at once: work, health, money, the people close to you, everyday trifles. One worry is settled and the next takes its place.
2. It cannot be stopped on demand. This is the key point. "Just don't think about it" does not work; the thought circles and switching away fails.
3. It lasts. ICD-11 speaks of "several months", the American manual of six months or more. A short anxious stretch after a specific event is not GAD.
4. It costs something. In work, in relationships, in daily life, in health. Without a cost this is a hard state rather than a disorder — and that is not a formality but exactly what separates the two.

None of the four means anything by itself. That is why a scale returning one number answers only "is it worth going" and not "what do I have".

Anxiety disorder symptoms: the bodily side, tension and sleep

The criteria also require several features from this list:

• muscle tension — tight shoulders, neck and jaw, tension headaches;
• fatigue — tiredness out of proportion to the load;
• difficulty concentrating — "I read a page and cannot recall what it said";
• irritability — a short fuse with no visible cause;
• disturbed sleep — a long time falling asleep, or waking at night with the worry already on;
• restlessness — hard to sit still, hands looking for something to do.

Worth remembering separately: a permanently tense body is not the aftermath of a bad day but the background on which anxiety runs around the clock, spending the resource everything else needs.

The mechanism of constant worry: intolerance of uncertainty

The most useful thing to understand about GAD is how it sustains itself.

Worry feels like preparation: think through the worst in advance so as not to be caught off guard. The trouble is that the brain lives through the disaster as many times as it thinks it through, and none of that protects against the disaster itself. So the worry gets reinforced: "I worried — and it turned out fine", though there is no link between the two facts.

The second element is intolerance of uncertainty: an open question torments more than a bad answer. Hence endless checking, asking again, planning for every case. Each of those brings minutes of relief and makes the next stretch of uncertainty harder to bear.

How GAD differs from neighbouring pictures

• Panic disorder. There anxiety comes in episodes: a peak within minutes, the body joining in fully, the wait for the next one between attacks. In GAD the background is even and constant. How they are told apart is covered in panic attack or the heart.
• Obsessive-compulsive disorder. GAD worry is about real subjects and feels like the person's own thoughts. Intrusive thoughts in OCD are alien, arrive uninvited and often come with rituals.
• Health anxiety. When worry concentrates on illness and is reinforced by checking, it is closer to health anxiety than to GAD.
• Depression. A very frequent companion. The direction separates them: anxiety points to the future ("what if"), depression to the past and to self-judgement. They are looked at together, not one after the other.
• Burnout. Tied to load and easing when the load lifts; GAD does not pass with a holiday.

What is ruled out first

Anxiety is sometimes the consequence of a bodily cause, and a questionnaire cannot tell:

• TSH and free T4 — with an overactive thyroid, anxiety, tremor and palpitations often come first;
• a full blood count with ferritin — iron deficiency intensifies palpitations, breathlessness and irritability;
• fasting glucose;
• vitamin D and vitamin B12 — with brain fog and paraesthesia;
• an ECG — if there are episodes of palpitations.

Plus history: caffeine and energy drinks, withdrawal from alcohol or sedatives, heart-racing medication, short sleep, hormonal change. If results are already in hand, the service will read the whole panel.

What helps

Cognitive-behavioural psychotherapy and, where needed, medication prescribed by a clinician have an evidence base in GAD. No specific medication is discussed here: that is chosen in person.

What can be done alongside and does not contradict therapy:

• Postpone rather than forbid. Forbidding an anxious thought intensifies it. What works is an agreement with yourself: "I will think about this at six for twenty minutes" — and actually think about it at six.
• Separate the solvable from the unsolvable. The solvable has a next step, and it is worth writing down. The unsolvable has none, and thinking about it does not create one.
• Cut the checking. Every re-asking and every check brings an hour of relief and makes the next hour shorter.
• Sleep and rhythm. Short sleep raises the level of anxiety directly, not "through mood".
• Caffeine. Reduce it without stopping abruptly: an abrupt stop itself produces days of anxiety.

When it is not GAD but the picture next door

Worry sits in almost every anxious picture, so that one feature tells none of them apart. The shape does: where the anxiety lives and what it does to a life.

• OCD: symptoms and criteria — if the thought arrives uninvited and demands a ritual rather than thinking.
• Night-time panic attacks — if the attacks come in your sleep and the daytime background barely gets in the way.
• What agoraphobia is — if the main consequence is a narrowed circle of places.
• The old vascular label — if that old label is in your record and you want to know what it means today.
• Neurosis in plain words — if you were told «neurosis» and the explanation ended there.
• A nervous breakdown — if this is the point a long overload led to, not a background of many years.
• The psychiatric register myth — if what stops you is not doubt but fear of consequences for work and rights.

If you want to see where your picture adds up, the free GAD-7 scale gives one score about this very branch, and the anxiety and panic attacks test separates four pictures at once and shows which criteria your answers meet. Neither is a diagnosis.

This article is informational and does not diagnose. It claims neither that you have an anxiety disorder nor that you do not: a clinician determines that in person.