How can I differentiate between GAD and other anxiety disorders during a patient assessment?

To differentiate generalized anxiety disorder (GAD) from other anxiety disorders during a patient assessment, focus on the following key aspects:

• Symptom focus and duration: GAD is characterised by excessive, uncontrollable worry about a wide range of issues, persisting for at least 6 months, whereas other anxiety disorders often have more specific triggers or symptom patterns (e.g., panic attacks in panic disorder, specific social situations in social anxiety disorder) ¹,².
• Assessment of worry and control: Ask about the patient's ability to stop or control their worry, using tools like the 2-item Generalized Anxiety Disorder scale (GAD-2) to screen for GAD ¹.
• Functional impairment and distress: Evaluate not only the number and severity of symptoms but also the degree of distress and functional impairment caused by anxiety, which is crucial for diagnosing GAD and differentiating it from other anxiety disorders ¹.
• Symptom breadth: GAD involves worry about multiple domains (health, work, social, etc.), unlike other anxiety disorders that tend to focus on specific fears or situations ¹,².
• Comorbidities and differential diagnosis: Consider the presence of comorbid conditions such as depression or other anxiety disorders, and prioritise treatment based on the primary disorder causing the greatest impairment ².
• Clinical interview and consultation skills: Use a structured clinical interview to elicit personal history, symptom patterns, and cultural or individual factors, as no single screening tool is definitive for all anxiety disorders ¹.

Summary: Differentiation relies on identifying the pervasive, excessive, and uncontrollable nature of worry across multiple areas lasting at least 6 months, assessing functional impact, and using clinical judgement supported by screening tools like GAD-2, while considering comorbidities and symptom specificity to other anxiety disorders ¹,².