Diagnostic crosswalk

Generalized anxiety disorder in DSM-5-TR and ICD-11

Both systems recognize generalized anxiety disorder as persistent worry and anxiety, along with physical arousal symptoms, that causes distress and interferes with life. The criteria wording differs enough that some borderline cases fall on different sides of the threshold in the two systems. This is what actually differs.

DSM-5-TR Generalized anxiety disorder ICD-10-CM F41.1

ICD-11 Generalized anxiety disorder 6B00

Side by side

What	DSM-5-TR	ICD-11
Core feature ICD-11 requires 'several months' rather than a specific 6-month threshold; more flexible.	Excessive anxiety and worry occurring more days than not for at least 6 months, about a number of events or activities.	Marked symptoms of anxiety persisting for at least several months, for more days than not.
Multiple topics or free-floating ICD-11 explicitly allows free-floating anxiety as an alternative to multi-topic worry.	Worry is about a number of events or activities.	Either general apprehension not restricted to any specific circumstances (free-floating anxiety) or excessive worry focused on multiple everyday events.
Difficulty controlling worry Aligned.	The person finds it difficult to control the worry.	Same.
Associated symptoms Slightly different list. ICD-11 does not specify a count; DSM-5-TR requires 3 of 6.	3 or more of 6 symptoms: restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance. (1 for children.)	Multiple associated symptoms required from: muscle tension, motor restlessness, sympathetic autonomic overactivity, subjective experience of nervousness, difficulty maintaining concentration, irritability, sleep disturbance.
Duration DSM-5-TR is more prescriptive.	At least 6 months.	Several months (typically several months, aligned with 6 in most interpretations).
Functional impairment Aligned.	Symptoms cause clinically significant distress or impairment.	Symptoms cause significant impairment in personal, family, social, educational, occupational, or other important areas.
Exclusion Aligned.	Not attributable to a substance or medical condition. Not better explained by another mental disorder.	Not attributable to another medical condition and not better explained by another mental disorder.

Key differences

ICD-11 allows free-floating anxiety not restricted to any specific circumstance as an alternative to multi-topic worry. DSM-5-TR requires worry to be about multiple events or activities.
DSM-5-TR requires at least 3 of 6 specific associated symptoms. ICD-11 requires several associated symptoms without a hard count.
DSM-5-TR uses a 6-month duration threshold. ICD-11 uses 'several months,' which most clinicians interpret similarly but leaves more flexibility.
The clinical picture is essentially the same. Threshold differences are small but can matter for research or borderline cases.

Clinical implications

Cross-system agreement is high. Most patients meeting one set of criteria meet the other.
For patients presenting with free-floating anxiety without a specific worry focus, ICD-11 fits the picture more naturally than DSM-5-TR.
For patients close to the 6-month duration boundary, DSM-5-TR requires more waiting time than ICD-11 for a firm diagnosis.
First-line treatments are identical across systems: cognitive-behavioral therapy and SSRIs or SNRIs.

## Why this crosswalk exists GAD is a good example of two systems agreeing on the core picture while diverging on threshold detail. This page shows exactly where they differ, so a clinician can translate one to the other without losing information. ## Sources - American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). Section on Anxiety Disorders. 2022. - World Health Organization. International Classification of Diseases 11th Revision (ICD-11). Chapter 6, 6B00 Generalized anxiety disorder. 2022. - Reed GM, First MB, Kogan CS, et al. Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders. World Psychiatry. 2019;18(1):3-19. - Stein DJ, Craske MG. Classifying anxiety disorders: DSM-5 and beyond. American Journal of Psychiatry. 2017;174(10):919-923.