coffee (38861808_s)The theme lately has been anxiety disorders. Let's continue now with generalized anxiety disorder (GAD). Criteria for GAD are pretty straightforward:

A. Excessive anxiety and worry occurring more days than not for at least six months, about a number of events or activities.

B. The worry is difficult to control.

C. The worry comes with three or more of these (or just one in children):

   1. Restlessness, feeling keyed up or on edge.

   2. Being easily fatigued.

   3. Difficulty concentrating or mind going blank.

   4. Irritability.

   5. Muscle tension.

   6. Sleep problems.

Plus the usual...

D. Symptoms cause clinically significant distress or impairment.

E. Not substance induced

F. Not better explained by another condition (e.g., panic, OCD, PTSD, anorexia, somatic symptom disorder, body dysmorphic disorder, illness anxiety disorder, schizophrenia, or delusional disorder).

That is, lots of anxiety, lots of the time. Which is simple enough as far as the social work licensing exam goes, until you get to the "e.g." in letter F. All those rule outs. To be able to identify GAD, you have to be able to identify what it isn't. That means you have to have a pretty good idea what all of those other anxiety and related disorders look like. Suddenly, learning GAD for the exam becomes a little more complicated than expected.

On the test, you might see GAD as a frequent distractor (an appealing answer that isn't the correct answer). It's a catch-all for anxiety-related symptoms. How to ready yourself to tell when GAD's a distractor and when it's the answer? Piecing together your own practice question might help. It could go something like this:

A client tells a social worker he's been an "anxious mess" ever since dropping out of college, worrying about a variety of things "all of the time." He reports difficulty falling asleep even though he's usually exhausted early in the day. He has trouble with self-care like reading or meditating--"my mind just keeps going."

If you leave it there, you've got GAD. Worry for more days than not, significant distress, three of the six offered symptoms. But here's a quiz. Imagine there's an added line. What's the MOST likely diagnosis then?

The client reports everything is easier when he drinks fewer than four cups of coffee in a day.


The client reports he is "obsessed" with how much he weighs. His MD wants him to put on 20 additional pounds--"but he's a quack."


The client reports he witnessed a suicide in his college dorm room--"I've never been the same since."

Etc. Now you're into something that may not be GAD. Four cups of coffee--sounds like the symptoms may be "attributable to the physiological effects of a substance." Weigh obsession and weight loss--sounds like anorexia nervosa. Witnessed a suicide--sounds like the client's symptoms might be better explained by PTSD.

And so on. You get the idea.

For more reading about generalized anxiety disorder, check out:

For exam-style questions about GAD, anxiety disorders, and lots more, sign up for SWTP full-length practice tests!


[Post by Will Baum, LCSW]

April 13, 2016
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