The GAD-7 and Beck Anxiety Inventory both measure anxiety, but they capture fundamentally different symptoms. The GAD-7 focuses on worry, restlessness, and cognitive symptoms. The BAI emphasizes physical manifestations—racing heart, trembling, dizziness, difficulty breathing. Fifteen of its 21 items measure physiological symptoms.
A patient with constant rumination but few physical symptoms may score high on GAD-7 and low on BAI. Someone with panic attacks but less cognitive worry often shows the opposite pattern. Choosing the right instrument depends on what you're trying to measure.
What each instrument captures
The GAD-7 was designed for primary care screening and maps directly to DSM criteria for generalized anxiety disorder. Seven items assess worry, trouble relaxing, restlessness, irritability, and fear of something awful happening. Patients rate symptoms over the past two weeks on a 0-3 scale, yielding scores from 0-21. At the standard cutoff of 10, sensitivity is 89% and specificity is 82% for detecting GAD. Takes about two minutes.
The BAI was developed in psychiatric outpatient settings to distinguish anxiety from depression. Its 21 items lean heavily somatic: numbness, hot flashes, wobbliness, pounding heart, choking sensations, trembling hands, faintness. Patients rate severity over the past week, producing scores from 0-63. Research shows the BAI's strongest quality is detecting panic disorder—it reliably distinguishes patients with panic from those without. For other anxiety disorders like social phobia or OCD, which have stronger cognitive or behavioral components, it performs less well.
Key differences
Symptom focus. GAD-7 captures the worry-and-rumination side of anxiety. BAI captures physical arousal—it's essentially measuring panic-like symptoms. Neither fully covers both domains, which is why some researchers pair the BAI with the Penn State Worry Questionnaire for comprehensive assessment.
Diagnostic utility. GAD-7 items match GAD diagnostic criteria and predict GAD specifically. BAI doesn't align with any single disorder—it was built to separate anxiety from depression, not to diagnose. It functions best for panic disorder and less accurately for GAD, social anxiety, or OCD.
Cost. The GAD-7 is public domain. The BAI requires purchasing materials from Pearson, creating ongoing licensing costs.
Medical confounding. BAI's somatic focus becomes problematic in patients with cardiac, respiratory, or neurological conditions. A patient with COPD or heart disease may endorse palpitations, breathing difficulty, and dizziness that reflect medical illness rather than anxiety—leading the BAI to overestimate anxiety severity. GAD-7's cognitive items sidestep this issue.
Depression discrimination. BAI was specifically designed to minimize depression overlap by focusing on physical symptoms. GAD-7 includes irritability and restlessness, which can blur the line in patients with both conditions.
When to use GAD-7
For most clinical contexts, the GAD-7 is the default choice. It's free, brief, validated extensively in primary care, and built into most EHR systems. Quality measures and payer requirements typically specify GAD-7 for anxiety screening.
Use it for routine primary care screening, GAD assessment, and treatment monitoring. Its established minimally important difference (about 4 points) makes it reliable for tracking change over time.
For even quicker triage, the GAD-2—the first two items—works as an ultra-brief screener. A score of 3 or higher triggers the full GAD-7.
When to use BAI
BAI makes sense when panic disorder or somatic anxiety is the clinical focus. Research consistently shows it's most accurate for panic—reliably distinguishing patients with panic disorder from those without. If you're treating anxiety with interventions targeting physiological arousal (relaxation training, breathing exercises, biofeedback), BAI will be more sensitive to improvement than GAD-7.
It's also useful when distinguishing anxiety from depression matters diagnostically, or when research protocols require it for comparability with published literature.
Avoid BAI when cost is a constraint, time is short, medical comorbidities could confound the somatic items, or compliance with quality measures requires GAD-7. It's not the right tool for social anxiety, OCD, or generalized worry without prominent physical symptoms.
Using both instruments
Some situations warrant administering both. At initial evaluation, combining instruments provides complete coverage—cognitive symptoms via GAD-7, somatic via BAI. When treatment targets both worry and physical arousal, tracking both shows which interventions are working.
Discrepant results are clinically informative. High GAD-7 with low BAI suggests worry-predominant anxiety that may respond well to cognitive approaches. The reverse pattern—high BAI, lower GAD-7—points toward panic-spectrum or somatic anxiety requiring different intervention.
Practical considerations
GAD-7 is already integrated into most EHR systems. BAI often requires custom setup or separate administration. Both are generally well-accepted by patients, though BAI's physical-symptom focus may feel more comfortable for people who don't identify as "anxious" but acknowledge bodily symptoms.
In older adults and medical populations, BAI's somatic items become increasingly confounded. One study found that medical comorbidity correlated with somatic but not cognitive anxiety symptoms in older adults. GAD-7's cognitive focus provides cleaner data when physical symptoms have multiple possible explanations.
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For most providers, the GAD-7 handles anxiety screening and monitoring efficiently. Reserve BAI for cases where panic disorder, somatic symptoms, or anxiety-depression differentiation are central clinical questions. The PHQ-9 pairs well with either instrument when depression co-occurs—which it frequently does.