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
B. The worry is difficult to control.
C. The worry comes with three or more of these (or just one
1. Restlessness, feeling keyed up or on
2. Being easily fatigued.
3. Difficulty concentrating or mind going
5. Muscle tension.
6. Sleep problems.
Plus the usual...
D. Symptoms cause clinically significant distress or
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
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
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
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
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
For exam-style questions about GAD, anxiety disorders,
and lots more, sign
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