Anxiety Disorders 253
her performance at work, she worried about her children’s well being (whether they had been hurt
or killed while out playing in the neighborhood). She also worried about her relationships with
men, and minor things such as getting to work on time, keeping her house clean, and maintain-
ing regular contact with friends and family. A. H. recognized that her fears were both excessive
and uncontrollable, but she couldn’t dismiss any worry that came to mind. She was irritable, had
insomnia, frequent muscle tension and headaches, and felt generally on edge.
(Adapted from Brown & Barlow, 1997, pp. 1–3)Table 7.1 • DSM-IV-TR Diagnostic Criteria for
Generalized Anxiety Disorder (GAD)A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for
at least 6 months, about a number of events or activities (such as work or school performance).B. The person fi nds it diffi cult to control the worry.C. The anxiety and worry are associated with three (or more) of the following six symptoms (with
at least some symptoms present for more days than not for the past 6 months).
Note: Only one item is required in children.
(1) restlessness or feeling keyed up or on edge
(2) being easily fatigued
(3) diffi culty concentrating or mind going blank
(4) irritability
(5) muscle tension
(6) sleep disturbance (diffi culty falling or staying asleep, or restless unsatisfying sleep)D. The focus of the anxiety and worry is not confi ned to features of an Axis I disorder, e.g., the
anxiety or worry is not about having a Panic Attack (as in Panic Disorder [discussed later in this
chapter] ), being embarrassed in public (as in Social Phobia [discussed later in this chapter] ), being
contaminated (as in Obsessive-Compulsive Disorder [discussed later in this chapter] ), being away
from home or close relatives (as in Separation Anxiety Disorder [Chapter 14] ), gaining weight (as in
Anorexia Nervosa [Chapter 10] ), having multiple physical complaints (as in Somatization Disorder
[Chapter 8] ), or having a serious illness (as in Hypochondriasis [Chapter 8] ), and the anxiety and
worry do not occur exclusively during Posttraumatic Stress Disorder [discussed later in this chapter].E. The anxiety, worry, or physical symptoms cause clinically signifi cant distress or impairment in
social, occupational, or other important areas of functioning.F. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of
abuse, a medication) or a general medical condition (e.g., hyperthyroidism) and does not occur
exclusively during a Mood Disorder [Chapter 6], a Psychotic Disorder [Chapter 12], or a Pervasive
Developmental Disorder [Chapter 14].
Source: Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Text Revision,
Fourth Edition, (Copyright 2000) American Psychiatric Association.The content of the worries of people with GAD
is infl uenced by their culture and the types of
catastrophic events most likely to occur in their
locale. Those who live along the Gulf coast of
the United States may worry about hurricanes;
those who reside in California may worry about
earthquakes.AP Photo/Dave MartinBecause the symptoms are chronic (lasting at least 6 months) andbecause many people with GAD can usually function adequately in
some areas of their daily lives, they come to see their worrying and anx-
iety as a part of themselves, not as a disorder. However, as happened to
A. H., not having control over anxious thoughts and worrying can lead
to problems in work and social life. The worrying may be so intrusive
that people feel restless, have diffi culty concentrating or sleeping, and
become irritable. See Table 7.2 for more facts about GAD.
As noted in Table 7.2, GAD and depression have an extremely highcomorbidity. Among people who have both disorders at the same time,
only 27% eventually experience remission, compared to 48% of those
who have only GAD and 41% of those who have only depression (Scho-
evers et al., 2005). People with both disorders are also likely to have