Assessment and Diagnosis of Anxiety Disorders

Initial Screening and Symptom Quantification

• The American Academy of Child and Adolescent Psychiatry recommends beginning with standardized screening using the GAD-7 scale, then conducting a structured diagnostic interview to distinguish clinically significant anxiety from normal worry 1, 2
• For children and adolescents, use age-appropriate validated scales including SCARED, Spence Children's Anxiety Scale, or Preschool Anxiety Scale 1, 4

Core Diagnostic Questions: Symptom Characteristics

• Ask about the specific nature and pattern of anxiety symptoms, including worry characteristics, duration and chronicity, physical manifestations, panic symptoms, avoidance behaviors, and social fears 1, 5, 6

Medical Differential Diagnosis

• Rule out medical conditions that mimic or cause anxiety symptoms, such as thyroid disorders, cardiac conditions, respiratory disorders, metabolic conditions, substance use, and other medical conditions 2, 4, 6

Psychiatric Comorbidities and Differential

• Screen for other psychiatric conditions that commonly co-occur with or mimic anxiety, including depression, substance use disorders, other anxiety disorders, trauma history, and obsessive-compulsive symptoms 2, 5, 6

Functional Impairment Assessment

• Quantify the impact of anxiety on daily functioning, including occupational/academic functioning, social relationships, self-care and daily activities, and quality of life 1, 2, 5, 6

Safety Assessment

• Evaluate immediate safety concerns, including suicidal ideation, self-harm behaviors, harm to others, and implement harm-reduction interventions if necessary 3, 9

Contextual and Historical Factors

• Gather information to develop a clinical formulation, including developmental history, family psychiatric history, stressors and precipitants, previous treatments, cultural and spiritual factors, and strengths and supports 1, 2, 5

Mental Status Examination Findings

• Observe for signs of anxiety during the interview, including appearance, behavior, speech, thought process, thought content, mood and affect, cognition, and insight and judgment 1, 7

Distinguishing Clinical Anxiety from Normal Worry

• Differentiate pathological anxiety from developmentally normal fears, with clinical anxiety distinguished by excessive intensity, duration beyond developmental stage, significant distress, functional impairment, and inability to control the worry 5, 6