Anxiety is not a simple diagnosis. It is not caused by a
germ that can be detected in a simple blood test. Anxiety can take many forms
and it can accompany many medical conditions. Some of these are serious; some
are not. A complete physical examination is essential. This will help discover
or rule out other illnesses that may be causing your symptoms or may be masked
by the symptoms. A complete personal history is also important. Your doctor
needs this information to make an accurate diagnosis.
You must be completely honest with your doctor about all
your conditions. Many things, such as some illnesses, medications, alcohol and coffee
consumption, and hormones can contribute to or be affected by anxiety.
Many of the
symptoms of anxiety are physical. These physical symptoms include racing heart,
shortness of breath, shaking, sweating, chills, hot flashes, chest pain,
twitching, dry mouth, nausea, vomiting, diarrhea, and frequent urination.
Medical conditions with similar symptoms include:
- heart attack
- mitral valve prolapse
- adrenal gland tumors
- side effects of certain drugs (such as those
for high blood pressure, diabetes, and thyroid disorders)
- withdrawal from certain drugs (such as those
used to treat anxiety and sleep disorders)
- substance abuse or withdrawal
Your doctor may
order a variety of tests to rule out these physical conditions.
A diagnosis of anxiety depends a lot on your description
of the symptoms you are experiencing.
Mental health professionals use
the Diagnostic and Statistical Manual of Mental Disorders to
diagnose anxiety and other mental disorders. The specific criteria are
different for each different form of anxiety disorder.
This manual lists the following criteria for diagnosing
generalized anxiety disorder:
- Excessive anxiety and worry most days about many things for at
least six months.
- Difficulty controlling the worry.
- Anxiety is associated with three of the following six symptoms:
restlessness, fatigue, irritability, muscle tension, sleep disturbance,
and difficulty concentrating.
- The symptoms interfere with your
- Anxiety is not caused by direct
psychological effects of medications or medical conditions.
Your doctor may use one or more of
the following tests to assess your level of anxiety:
Zung Self-Rating Anxiety Scale
The Zung test is a 20-item
questionnaire that asks you to rate your anxiety from “a little of the time” to
“most of the time” on subjects such as nervousness, anxiety, shaking, rapid
heartbeat, fainting, frequent urination, and nightmares. This test is completed
by the patient and assessed by a trained professional.
Hamilton Anxiety Scale (HAM-A)
Developed in 1959, the Hamilton test
was one of the first rating scales for anxiety, and it is still widely used in
clinical and research settings. It involves 14 questions that rate moods,
fears, and tension as well as physical, mental, and behavioral traits. Unlike
the Zung test, a professional administers the Hamilton test.
Beck Anxiety Inventory (BAI)
The BAI is a test to measure the
severity of your anxiety. You may take the test by yourself, or it may be given
orally by a professional or paraprofessional. There are 21 multiple-choice
questions. These questions ask you to rate your experience of symptoms such as
tingling, numbness, and fear during the past week. The answer choices are “not at all,” “mildly,” “moderately,”
Social Phobia Inventory (SPIN)
This 17-question, self-administered
test measures your level of social phobia. You are asked to rate your anxiety
in relation to various social situations. Rating is on a scale of 0 to 4. Zero
indicates no anxiety. Four indicates extreme anxiety.
Penn State Worry Questionnaire
This test is the most widely used
measure of worry. It is used to distinguish between social anxiety disorder and
generalized anxiety disorder. The test has 16 questions that measure the
generality, excessiveness, and uncontrollability of your worry.
Generalized Anxiety Disorder Scale
This seven-question test is a
screening tool for generalized anxiety disorder. You will be asked how often in
the past two weeks you have been bothered by symptoms such as feeling
irritable, nervous, or afraid. The answer choices are “not at all,” “several
days,” “more than half the days,”
or “nearly every day.”
Yale-Brown Obsessive-Compulsive Scale (YBOCS)
The YBOCS is used to measure the
severity of your obsessive-compulsive disorder (OCD). It is conducted as a
one-on-one interview between you and a mental health professional. From a
checklist of symptoms, you will choose the three that are the most disturbing.
You will then rate how severe they are. Then you will be asked whether you have
had certain other obsessions or compulsions in the past. Based on your answers,
your OCD will be graded as subclinical, mild, moderate, severe, or extreme.
It is important to remember that the
first step in finding relief for your symptoms is to see a doctor and get an