Anxiety is a common human experience, a natural response to stress. While feelings of worry or apprehension are universal, the formal recognition of specific anxiety conditions has evolved significantly. Generalized Anxiety Disorder (GAD), characterized by persistent and excessive worry about everyday events, has a distinct history as a diagnosable condition.
Historical Roots of Anxiety Concepts
Before Generalized Anxiety Disorder was formally recognized, chronic and diffuse anxiety symptoms were described under broader, less specific terms. In the 18th century, concepts like “panophobia” emerged, describing intense, unreasoning fear. By the mid-19th century, “neurasthenia” became a prominent diagnosis. Neurasthenia, first described by George Miller Beard in 1869, encompassed a wide array of symptoms, including fatigue, irritability, and chronic nervousness, without clearly distinguishing generalized anxiety from other conditions.
A significant precursor to GAD was “anxiety neurosis,” a term introduced by Sigmund Freud in 1895. This concept grouped together chronic apprehension and physical symptoms, often alongside panic attacks. In the Diagnostic and Statistical Manual of Mental Disorders, Second Edition (DSM-II), published in 1968, “anxiety neurosis” was broadly defined by “anxious over-concern extending to panic” with associated physical symptoms. These earlier terms highlighted the presence of pervasive anxiety but lacked the specificity to differentiate it as a distinct disorder from other forms of anxiety or general nervousness.
The Emergence of Generalized Anxiety Disorder
The formal recognition of Generalized Anxiety Disorder as a distinct diagnostic entity occurred with the publication of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) in 1980. The previously broad category of “anxiety neurosis” was split into more specific conditions: GAD and Panic Disorder. This differentiation was influenced by observations that these conditions responded differently to certain medications.
The initial DSM-III criteria for GAD described it as “uncontrollable and diffuse anxiety or worry that is excessive or unrealistic,” requiring symptoms to be present for at least one month. At its introduction, GAD was sometimes considered a “residual category,” diagnosed when a patient’s symptoms did not fit other, more specific anxiety disorders. Its inclusion in the DSM-III led to a clearer understanding of chronic, pervasive worry as a stand-alone condition.
Refining the Diagnosis: GAD Through the DSM
The understanding and diagnostic criteria for GAD continued to evolve through subsequent revisions of the Diagnostic and Statistical Manual of Mental Disorders. In the DSM-III-R, the duration criterion for GAD symptoms was extended from one month to six months. This change aimed to enhance the diagnosis’s stability and reduce its overlap with other mental health conditions. Emphasis was also placed on worry concerning multiple life circumstances, rather than a single issue, along with the requirement of at least six specific associated symptoms.
The DSM-IV, published in 1994, maintained the six-month duration for excessive anxiety and worry. It further refined the definition of excessive worry and the specific number of associated physical and cognitive symptoms required for diagnosis. This edition also integrated “overanxious disorder” in children into the GAD category, acknowledging similar presentations across age groups.
The most recent edition, DSM-5, released in 2013, largely retained the core diagnostic criteria for GAD. It continues to specify excessive anxiety and worry occurring more days than not for at least six months, difficulty controlling the worry, and the presence of at least three associated symptoms, such as restlessness, fatigue, difficulty concentrating, irritability, muscle tension, or sleep disturbance. For children, only one associated symptom is necessary.