Generalised anxiety: the signs described in the literature

The World Health Organization fact sheet, updated on 8 September 2025, describes worry that is both intense and excessive, difficult to control, and that interferes with daily activities. It pairs that with trouble concentrating or making decisions, irritability, tension or restlessness, and a sense of impending danger.

What stands out in the reported descriptions is not the intensity of any one worry: it is the way it moves. One subject resolves, another takes its place, usually without transition and without the person choosing it. The questionnaire published by Meyer and colleagues in 1990 was built precisely to measure that tendency to worry itself, independently of whatever it currently attaches to.

Two figures set the scale. The same fact sheet reports that 359 million people were living with an anxiety disorder in 2021, that is 4.4% of the world's population, and that roughly one in four receives care. For generalised anxiety disorder alone, the international survey by Ruscio and colleagues, published in 2017 across 147,261 adults in 26 countries, reports a twelve-month prevalence of 1.8% and a lifetime prevalence of 3.7%.

Four markers recur in the literature: how long it lasts, how far it spreads, how hard it is to interrupt, and what it does to daily life. None is sufficient on its own, and it is their combination that matters. Duration is the easiest to observe for yourself, because it requires no interpretation.

Impact is not a matter of how it feels. In the Ruscio et al. survey, severe impairment in at least one area of life was reported by 50.6% of those concerned over the previous twelve months. It is also the most useful marker to describe in an appointment, because it is told in examples rather than adjectives.

Because anxiety is not only a thought. It draws on the same circuits as preparing for action, and that mobilisation shows in the body before it is identified as worry. This is why many people first consult about a physical complaint without making the connection.

• Palpitations, a racing heart with no physical effort behind it.
• Sweating, trembling or hands that will not settle.
• Nausea, abdominal discomfort or pain, often at the same times of day.
• Sleep that is hard to reach, or early waking with the same thoughts.
• Lasting muscular tension in the neck, the jaw or the shoulders.
• Difficulty concentrating and deciding, including on simple things.

The first four items on that list appear as such in the World Health Organization fact sheet. The review published by Szuhany and Simon in JAMA in 2022 also mentions palpitations, shortness of breath and dizziness among the physical symptoms associated with anxiety disorders.

One thing: how you describe your last two weeks. That is useful, because it puts words on a diffuse experience and gives you a point of comparison if you answer again later. It is not a measurement of your state, and it cannot confirm or rule out a condition.

The best-known short scale has seven items. It was developed by Spitzer and colleagues, published in 2006, with 2,740 patients across fifteen primary care sites: at the chosen cut point, the authors report 89% sensitivity and 82% specificity. Those figures are often quoted on their own, and that is where the reading becomes misleading.

The review published in JAMA in 2022 pools the studies run since and gives a far wider range: depending on the population, sensitivity runs from 57.6% to 93.9% and specificity from 61% to 97%. In other words, how a short questionnaire performs depends on who answers it and in what setting. A single figure lifted out of its original study says little about your situation.

• A short questionnaire covers a recent window, usually the past two weeks: it cannot see duration, which is precisely the central marker.
• It asks nothing about what else might explain what you are describing.
• Two sittings a few months apart say more than one, because they show a direction of travel.
• The most useful output is not the score but the list of items you answered with « nearly every day ».

In practice the first person to talk to is your family doctor: they know your history, they can examine what needs examining, and they are the ones who refer. In the 2017 international survey, about half of those concerned had sought care at some point. Arriving with precise material shortens that first conversation considerably.

1. Write down how long it has been going on, looking for a dated marker rather than an impression: a move, a new job, the start of a school year.
2. Write down the contexts in which it eases, even partly. Moments of respite are information, not a detail.
3. Describe the impact in concrete examples: every other night, a meeting avoided, a journey cut short. That says more than a score out of ten.
4. Note what has changed recently in your sleep, your workload or your personal life. These will be asked about, and they presume nothing.
5. Book an appointment with your family doctor and bring those notes, without waiting until you have worked everything out.

If you are supporting someone else, the most useful thing is often the simplest: listen without minimising and without dramatising, avoid distancing advice of the « just stop thinking about it » kind, and offer concretely to help book the appointment.