What is Generalized Anxiety Disorder (GAD)?
Anxiety disorders are one of the most common mental health problems in the United States. Generalized anxiety disorder refers to ongoing feelings of worry and anxiousness that persists for at least six months. Generalized anxiety disorder seems to run in families, making some individuals more vulnerable to stressors than others.
Symptoms include constant feelings of worry over both major and everyday events, difficulty concentrating or sleeping, feeling tired, irritability, as well as physical symptoms, such as headaches and body aches.
The diagnosis is made by patient history and physical examination to rule out physical causes. The individual may be referred to a mental health specialist for further evaluation and treatment, which may involve talk therapy to learn new ways to manage stress, medications, and lifestyle adjustments.
You should visit your primary care physician to further discuss your symptoms. It is likely you will be referred to a mental health professional. Your doctor will likely recommend talk therapy and/or antidepressant medication.
How common is generalized anxiety disorder (GAD)?
Symptoms that always occur with generalized anxiety disorder (GAD):
- General anxiety (stress)
Generalized anxiety disorder (GAD) is also known as
Generalized Anxiety Disorder (GAD) Symptoms
Everyone's experience with generalized anxiety disorder is a little different, but typically includes excessive worrying along with any number of other symptoms.
- Excessive worries: These occur most days over at least six months, revolve around a wide variety of events and activities, and are difficult to control. Worries may relate to job or school responsibilities, health, finances, health and safety of family members, children, or minor matters, such as arriving on time to scheduled appointments .
- Restlessness: Feeling on edge
- Fatigue: Feeling tired easily
- Impaired concentration: Feeling like you easily lose your train of thought
- Muscle tension: Feeling shakiness, twitchiness, and muscle aches
- Sleep problems: Having difficulty falling asleep or staying asleep, or not feeling well-rested after sleeping through the night
- Symptoms cause distress or impair function: The above symptoms prevent you from doing your best at work, school, or other responsibilities.
Though not part of the core diagnostic criteria, a number of other symptoms often are associated with generalized anxiety disorder. These include:
- Gastrointestinal distress: Such as diarrhea, stomach cramps, or nausea
- Startling easily: Feeling jumpy, reacting strongly to stimuli
- Fast heart rate (tachycardia)
Symptoms in children and adolescents
Many people with generalized anxiety disorder report having experienced symptoms which wax and wane in severity throughout life. Symptoms of this condition in childhood and adolescence may vary somewhat from those in adulthood.
- Worries: The content of worries is often developmentally specific, including concerns about school and sports, as well as concerns about being on time (punctuality), and catastrophic events, such as earthquakes and war.
- Overly conforming and perfectionistic: They may spend excessive amounts of time completing schoolwork and rechecking for errors.
- Seek reassurance and approval: Particularly about things they are worried about
- Physical complaints: Such as stomachaches and headaches [1,2]
Generalized Anxiety Disorder (GAD) Causes
Like most mental health conditions, generalized anxiety disorder results from a complex interplay of biological, psychological, and environmental factors. It can affect anyone at any point throughout the lifespan and is typically chronic, with symptoms occurring to varying degrees throughout life. Women are diagnosed with generalized anxiety disorder twice as often as men. People aged 45 to 49 are diagnosed with generalized anxiety disorder at rates higher than any other age group . Several well-researched explanations of anxiety are described below.
- Hyper-reactivity of the amygdala: Brain imaging studies suggest the amygdala, a brain structure that mediates strong negative feelings, such as fear, is larger and more active in people with generalized anxiety disorder . Brain structure is a result of both genetics and life experience.
- Worry as a coping mechanism: Chronic worrying may be used to distract from other unpleasant feelings .
- Environmental factors: Generalized anxiety disorder has been found to develop following unexpected negative life events, maltreatment, and loss. These events may lead to being constantly anxious in order to mentally prepare for subsequent unpredictable events .
- Attachment style and interpersonal relationships: Early relationships between children and their parents can influence later emotional regulation, sometimes leading to anxiety. Generalized anxiety disorder can be related to styles of understanding and relating to other people .
Secondary causes of anxiety
Your physician may order tests to rule out other medical conditions that can cause symptoms of generalized anxiety disorder . These conditions include, but are not limited to:
- Endocrine disorders: Such as hyperthyroidism
- Electrolyte abnormalities
- Heart problems: Such as arrhythmias and heart valve abnormalities
- Use of medications and substances: Caffeine, alcohol, methamphetamines, and some prescriptions medications can all lead to anxiety.
Treatment Options and Prevention
Treatment may include a combination of medications, psychotherapy, and lifestyle modifications.
Talk therapy with a trained professional is an effective treatment for anxiety. A variety of styles of therapy exist. Cognitive behavioral therapy (CBT) is a well-researched form of therapy, involving multiple sessions with a trained physician, psychologist, or another mental health professional, often over a few months. CBT addresses how thoughts affect feelings and behaviors and trains you to monitor your symptoms in order to better understand and control your anxiety. It may also include helping you learn how to use self-calming techniques, such as deep breathing, to control symptoms .
A variety of medications can be used to treat anxiety. Your physician will select the best medication for you based on your other medical conditions and concerns about side effects, which vary across medications.
- Antidepressants: Selective serotonin reuptake inhibitors (SSRIs), such as escitalopram (Lexapro), and serotonin-norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (Effexor), are effective for anxiety as well as depression, but usually don't start to work until they've been taken for several weeks . When started, antidepressants can cause nausea, sexual dysfunction, and difficulty sleeping, but these side effects tend to be mild .
- Benzodiazepines: Medications such as lorazepam (Ativan), clonazepam (Klonopin), and diazepam (Valium) are often immediately effective for anxiety symptoms, but can be sedating and lead to physical dependence with long-term use . Additionally, they are not always well-tolerated in older age .
- Buspirone (Buspar): An alternative to benzodiazepines that does not cause sedation, buspirone becomes effective after being taken for a couple weeks.
- Hydroxyzine (Vistaril): An anti-histamine (similar to diphenhydramine, Benadryl), acts quickly but can cause sedation and may require multiple doses throughout the day.
In addition to the treatments listed above, making adjustments to live a healthier lifestyle may also help relieve symptoms of anxiety.
- Avoid alcohol and other drugs: Alcohol, tobacco, and other drugs, despite sometimes seeming to relieve anxiety in the short-term, can worsen symptoms overall. Quitting is difficult, but your physician can offer you resources to help.
- Practice good sleep hygiene: Do your best to get seven to eight hours of quality sleep every night. Quality sleep is best ensured by going to sleep at the same time each day, avoiding caffeine, nicotine, alcohol, and large meals before bed, avoiding bright screens for an hour before bed and maintaining a quiet and comfortable bedroom.
- Stay physically active: Exercise has substantial benefits for the mind, as well as the body. Work to develop a routine of exercising at least five days per week. The type of exercise, be it team sports, running, hiking, or swimming, does not matter, as long as it gets your heart rate up and you can do it regularly. Relaxing exercise, like yoga, can also be helpful.
When to Seek Further Consultation
If your anxiety is difficult to control and interferes with your daily life
A mild amount of anxiety is normal and can be healthy in some circumstances. However, if you feel like your anxiety is out of control and gets in the way of work, family, school, and other responsibilities, report these concerns to your physician.
If you are feeling depressed
Anxiety and depression are both common conditions throughout the lifespan. The combination of anxiety and depression can be especially distressing and debilitating. If you are feeling down or experiencing other symptoms of depression such as losing interest in things you previously enjoyed or losing your appetite, report these symptoms to your physician to get more help, especially if they persist for more than two weeks.
If you are having thoughts of ending your life
If for any reason you are feeling that life is no longer worth living, report these thoughts to your physician, call 911, or seek help at the nearest emergency room.
If you are having problems controlling the use of substances
If the use of alcohol, tobacco, or other substances is getting in the way of your life, talk to a physician about other ways to control your symptoms and regain control of your life.
Questions Your Doctor May Ask to Diagnose
To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.
- Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
- How long has your current headache been going on?
- Have you lost your appetite recently?
- Have you experienced any nausea?
- Are you sick enough to consider going to the emergency room right now?
The above questions are also covered by our A.I. Health Assistant.
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- AACAP practice parameters: Practice parameter for the assessment and treatment of children and adolescents with anxiety disorders. J Am Acad Child AdolescPsychiatry. 2007;46(2):267-283. AACAP Link
- Kavan MG, Elsasser GN, Barone EJ. Generalized anxiety disorder: Practical assessment and management. Am Fam Physician. 2009;79(9):785-791. AAFP Link
- Newman MG, Llera SJ, Erickson TM, et al. Annu Rev Clin Psychol. 2013; 9: 275-297. NCBI Link
- Barnhill JW. Generalized anxiety disorder (GAD). Merck Manual Professional Version. Revised July 2018. Merck Manuals Professional Version Link