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 life.
- 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,” or “severely.”
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 accurate diagnosis.