Generalised Anxiety Disorder (GAD) symptoms encompass a triad of cognitive, physiological, and behavioural manifestations arising from persistent, excessive, and uncontrollable worry about multiple everyday events. To meet DSM-5 diagnostic criteria, this excessive anxiety and worry must occur more days than not for ≥6 months, be difficult to control, and be accompanied by ≥3 of six key symptoms (only 1 required in children). The disorder affects approximately 5-6% of the population over a lifetime, with a 2:1 female-to-male ratio, and typically emerges at a median age of 31 years.
Core Diagnostic Features (DSM-5-TR Criteria)
- Duration & Impairment: Symptoms present for ≥6 months, causing clinically significant distress or impairment in social, occupational, or other vital domains
- Excessive Worry: Pervasive, uncontrollable anxiety about multiple events (work, health, finances, family) disproportionate to actual risk
- Difficulty Controlling Worry: The individual finds it hard to stop the worry cycle once initiated
- Symptom Threshold (Adults): Requires ≥3 of 6 associated symptoms most days for ≥6 months; children require ≥1
The Six Key Symptoms (Mnemonic: BESKIM)
| Symptom | Description |
|---|---|
| B – Blank mind | Difficulty concentrating, mind “going blank” |
| E – Easily fatigued | Persistent exhaustion not explained by physical activity |
| S – Sleep disturbance | Difficulty falling or staying asleep, restless unsatisfying sleep |
| K – Keyed up / restless | Feeling on edge, restless, or “wound up” |
| I – Irritability | Increased sensitivity, easy frustration |
| M – Muscle tension | Tightness, aches, or trembling in muscles (often neck, shoulders, jaw) |
Additional Common Manifestations
- Cognitive: Overestimation of threat, catastrophic thinking, intolerance of uncertainty, indecisiveness, excessive planning for worst-case scenarios
- Physiological (Autonomic Arousal): Sweating, palpitations, shortness of breath, dizziness, nausea, diarrhoea, exaggerated startle response, hot flashes or chills
- Behavioural: Avoidance of situations that trigger worry, reassurance-seeking, procrastination due to indecisiveness, redoing tasks for perfection
- Somatic Complaints: Headaches, gastrointestinal distress (IBS, nausea), chronic pain
Pediatric GAD Symptoms
Children may present with fewer cognitive symptoms and more somatic and behavioural manifestations:
- Excessive worry about school performance, fitting in with peers, family safety, or catastrophic events
- Perfectionism, redoing tasks, excessive homework time, seeking constant reassurance
- Physical complaints: frequent stomachaches, headaches, muscle aches
- School refusal, avoidance of social situations, difficulty separating from parents
Distinguishing GAD from Normal Anxiety
Unlike adaptive anxiety that is proportionate to a specific stressor and resolves when the trigger subsides, GAD worry is pervasive (across multiple domains), disproportionate to actual risk, uncontrollable, and chronic (≥6 months). Normal anxiety enhances performance and vigilance; GAD impairs functioning and causes significant distress.
Recognising this symptom constellation is vital for differential diagnosis from other anxiety disorders (panic disorder, social anxiety disorder, OCD) and medical conditions (hyperthyroidism, pheochromocytoma) that may mimic GAD. With early identification and evidence-based interventions—CBT and/or SSRIs/SNRIs—individuals can achieve substantial symptom reduction, reclaiming quality of life from the tyrannical grip of uncontrollable worry.
