When is anxiety a medical disorder?

When is anxiety a medical disorder?

OVERVIEW

Everyone has feelings of anxiety. Normal anxiety is an adaptive response to stress, meaning that the sensation of feeling anxious can be helpful. For example, anxiety about a math test can cause a student to work harder when studying and, ultimately, to perform better than if there was no anxiety. Similarly, the anxiety somebody might feel about walking alone down a poorly lit street at nighttime can cause an individual to be more alert and prepared as they walk (or to choose a different, safer route). Feelings of anxiety are normal when the anxiety has a helpful, adaptive effect. When the feelings of anxiety are not helpful – they interfere with normal functioning or negatively affect an individual’s well-being, they might constitute a medical disorder.

The goal of this post is to describe the specific features that fulfill a diagnosis of generalized anxiety disorder so that readers can better understand when anxiety represents a medical problem and when it does not.

GENERALIZED ANXIETY DISORDER

The DSM (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) lists the specific diagnostic criteria for generalized anxiety disorder,1 which are summarized below:

A. Excessive anxiety and worry, occurring more days than not for at least 6 months, about a number of events or activities (such as school performance or work).

B. The person finds it difficult to control the worry.

C. The anxiety and worry are associated with three or more of the following six symptoms:

  1. Restlessness or feeling keyed up or on edge
  2. Being easily fatigued
  3. Difficulty concentrating or mind going blank
  4. Irritability
  5. Muscle tension
  6. Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)

D.  The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E.  The disturbance is not caused by a substance (for example, a medicine or a drug of abuse) or another medical condition (for example, hyperthyroidism).

F. The disturbance is not better explained by another mental disorder.

KEY FEATURES THAT MAKE ANXIETY A MEDICAL PROBLEM

There are several features that must be present to make feelings of anxiety a medical problem. Using the criteria listed above for generalized anxiety disorder, some of the differences between normal and abnormal anxiety become apparent:

  1. Frequency of the feelings: Generalized anxiety disorder causes symptoms on more days than not.
  2. Duration: Generalized anxiety disorder requires at least 6 months of symptoms. Shorter periods of anxiety can still be considered abnormal.
  3. Lack of control: Anxiety that is helpful and adaptive also tends to be under some control. Using our previous example about an anxiety-provoking walk on a dark street, the feelings of worry could be avoided altogether by finding an alternative, well-lit route and walking with friends.
  4. Impaired functioning: The key feature that differentiates normal feelings of anxiety from generalized anxiety disorder is its effect on how a person functions. Generalized anxiety disorder – by definition – impairs important areas of functioning or causes significant distress.

OTHER ANXIETY DISORDERS

General anxiety disorder was used an example. Other anxiety disorders (for example, social anxiety disorder and panic disorder) have different features and criteria.

References

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, D.C.: American Psychiatric Association; 2013