Description: This short scale covers all the diagnostic symptoms of generalized anxiety disorder (GAD) as defined in DSM-5 (Diagnostic and Statistical Manual, 5th Edition, of the American Psychiatric Association). Additionally, the scale can help you to be sure you consider all the necessary symptoms of GAD. Box 1 matches DSM-5 criterion A for GAD, box 2 matches DSM-5 criterion B, box 3 matches criterion C, and box 4 matches DSM-5 criterion D.
You may use this scale to screen for GAD in adult patients. As with any screening test, a high score on this scale raises the likelihood that GAD is present.
Administration: The scale is self-rated, but health professionals can administer the scale, too. They should explain why you want the patient to complete the scale. Ideally, provide a private location. Arrange for an assistant to help the subject if needed (e.g. low literacy skills, visual impairment or difficulty writing). Later, your health care provider should review the responses. Be sure to ask about any missing responses or double responses (i.e. if both the “YES” and “NO” responses are checked for an item). Edit the responses as needed after this review.
Scoring: Record the total number of YES responses to the 12 statements.
Interpretation: 95% of healthy non-anxious volunteer adults scored from 0-2 in our tests of this scale. A score of 6 or above is suggestive of GAD (sensitivity = 84% and specificity = 83%) in field tests. The positive likelihood ratio (PLR) = 5.0. PLR provides a measure of the true positive rate divided by false positive rate. A score of 6 or above raised the likelihood of GAD over 3-fold from a base rate of 15% to 48% (odds ratio 5.05). Patients with scores of 6 or above who did not have a final GAD diagnosis had other important psychiatric problems. These are most often major depression or another anxiety diagnosis.
A score of 0-2 during treatment of a patient with GAD is consistent with remission of the disorder.
Diagnostic Crosswalk: The DSM-5 criteria require at least one YES response in boxes 1, 2 and 4, and at least three YES responses in box 3, making at least 6 YES responses. In field tests, this diagnostic crosswalk identified patients with GAD with a sensitivity = 64% and a specificity = 90%. The PLR = 6.3. A positive result on this diagnostic crosswalk raised the likelihood of GAD over a base rate of 15% to 53% (odds ratio = 6.3).
Before making a final diagnosis of GAD, the clinician should review the DSM-5 “rule-out” criteria E and F. Criterion E excludes patients whose anxiety symptoms are attributable to physiological effects of a substance (e.g. drug of abuse, a medication) or a medical condition (e.g. hyperthyroidism). Criterion E excludes those whose anxiety is better explained by another mental disorder.
During treatment of a patient with GAD, this diagnostic crosswalk can indicate when the patient no longer meets DSM-5 criteria for the disorder.
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The following pages on this site provide more information about CDGAD©:
- CDGAD© Main Page
- About the CDGAD© Scale
- Obtaining the CDGAD© Scale
- Frequently Asked Questions (FAQ)
To learn more about GAD, visit the National Institute of Mental Health’s GAD page.