Generalized Anxiety Disorder (GAD) Symptoms, Causes, & Treatment
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What is generalized anxiety disorder?
Everyone feels anxiety during stressful moments. But if you are overwhelmed by worry and feel anxious more often than not, you may have generalized anxiety disorder (GAD). Anxiety disorders are one of the most common mental health problems in the U.S.
GAD is defined as constant worrying—about both major and everyday events—for at least 6 months. It interferes with daily activities. You may have difficulty concentrating, poor sleep, fatigue, and irritability.
There may also be physical symptoms, like headaches, muscle tension, stomachaches, and body aches.
While anxiety may come and go throughout life, the symptoms of GAD tend to be more intense and chronic. But they can be managed through therapy and sometimes medication.
GAD common symptoms
Sufferers of GAD often minimize their symptoms as normal and wait to seek treatment. The sooner you get help, the easier it is to treat. Be honest about the intensity, duration, and frequency of the worry—and share what you worry about. —Dr. Bobbi Wegner
People with GAD have near-daily worrying. The thoughts are hard to control and can be about big and small concerns—work, health, finances, safety of children, or just arriving on time to appointments. The anxiety can become so overwhelming that it interferes with work, school, and relationships.
Not all anxiety is GAD. Anxiety symptoms can be caused by a medical condition (like hyperthyroidism or abnormal heart rhythms) or substance use.
Sometimes what seems like GAD is actually another type of anxiety disorder, such as:
- Phobia: anxiety with a specific focus, i.e., fear of heights or insects
- Social anxiety disorder: anxiety about interacting with other people
- Obsessive compulsive disorder: repetitive thoughts and behaviors
- Panic disorder: anxiety about having a panic attack
- PTSD: anxiety caused by a scary or disturbing incident
- Excessive worry—almost constantly and about many things.
- Restless feeling.
- Trouble concentrating.
- Feeling irritable.
- Muscle tension or shakiness, twitching, or muscle aches.
- Sleep problems. It can be hard to fall asleep or stay asleep, or you wake up not feeling well rested.
- Changes in appetite.
Other symptoms you may have
- Upset stomach: such as diarrhea, stomach cramps, or nausea.
- Startling easily: feeling jumpy and overreacting to sudden noises.
- Rapid heart rate.
Generalized anxiety disorder causes
Yes, stress is a normative part of the human experience, but chronic worry that occurs more often than not is not. You do not have to feel the way you feel. GAD is a medical condition—not a measure of how hard you work. It can affect kids and adults. —Dr. Wegner
GAD is most likely caused by a combination of biological, psychological, and environmental factors. Below are some of the reasons it may happen.
- Overactive area of the brain: Studies show that the amygdala (the part of the brain that handles strong negative feelings, such as fear) is larger and more active in people with GAD.
- Personality and relationship patterns: Early relationships between children and their parents can influence how they manage their emotions, sometimes leading to anxiety. Chronic worrying may be a way to distract from other distressing feelings.
- Environmental factors: Stressful life events can trigger GAD.
Risk factors for generalized anxiety disorder
- Being female—GAD affects women much more often than men.
- Have a family history of anxiety.
- You experienced an unexpected negative life event, abuse, or loss. Your anxiety may be a way of mentally bracing for other negative events.
- Having another anxiety disorder makes you more likely to have GAD.
If you think you have GAD, see your doctor. They may refer you to a therapist or a psychiatrist (a medical doctor who specializes in mental health).
If you (or someone you know) have thoughts about ending your life or are not able to take care of yourself, call 911 or go to the ER. You will be given an emergency mental health evaluation.
Treatment for generalized anxiety disorder
Questions to ask your doctor: Is medication indicated and, if so, what type? How long do you think I need this? Is my GAD treatable without medication and, if so, how? —Dr. Wegner
It’s important to see a doctor or therapist if you think you have GAD. Sometimes people dismiss or play down their symptoms and don’t seek help.
Depending on your symptoms and medical history, your doctor may want to rule out other medical conditions that can cause anxiety (like breathing problems, hormonal changes, or heart problems). They will also ask about any medications you are taking and your substance use (including alcohol, caffeine, nicotine, and illicit drugs). Some substances can increase heart rate which mimics the feeling of anxiety and can trigger it.
Treatment may include a combination of psychotherapy, medications, and lifestyle changes.
Cognitive behavioral therapy (CBT) is a type of talk therapy that is an effective treatment for GAD. You’ll meet with a psychologist or other mental health professional. They will help you understand how your thoughts affect your feelings and behaviors. You’ll also learn to monitor symptoms and develop self-calming techniques, such as deep breathing, to give you more control over your anxiety. They may also address behaviors like your sleep routine, exercise, and having a balanced diet.
There are different types of medications that can help treat anxiety. Your doctor will choose the one that works best for you based on your symptoms, other medical conditions, and concerns about side effects.
Antidepressants work well for anxiety. It takes about 6 weeks before you feel an effect. They also can have side effects (like nausea, headaches, sexual problems), though these often lessen as your body adjusts to the medication.
Follow up regularly with your doctor who prescribed your medication and your therapist. If you have side effects, let them know. They can help you manage your side effects or change your medication.
- Avoid alcohol and other drugs: Alcohol, tobacco, and other drugs may seem to help at first, but can worsen symptoms overall. Often people use wine or alcohol to relax or to fall asleep. But when used this way, alcohol actually worsens anxiety, and can cause a restless sleep. People often wake up with increased anxiety due to the alcohol.
- Sleep well: Poor quality sleep can worsen your mood and anxiety. To improve your sleep, try to go to bed at the same time each day. Avoid caffeine, nicotine, alcohol, and big meals before bed. Turn off bright screens at least 2 hours before bed. A quiet bedroom can also help.
- Stay active: Regular exercise can relieve anxiety.
Children and generalized anxiety disorder
Children and teenagers can have GAD but their symptoms may vary somewhat from symptoms in adults.
- Worries: What children worry about is often age-dependent, including concerns about school and sports, being on time, missing homework, as well as catastrophic events, such as earthquakes and war.
- Being perfectionist: Children may spend excessive time on schoolwork and rechecking for errors.
- Frequently seeking reassurance about things they are worried about.
- Physical complaints such as stomachaches and headaches may be more common in children.
Dr. Becker is a psychiatry resident at the Mount Sinai Hospital. He received his undergraduate degree in Urban & Regional Studies from Cornell University (2012) and completed his medical degree at the Perelman School of Medicine at the University of Pennsylvania (2018). Prior to medical school, he worked as a pre-medical teaching assistant at Weill Cornell Medicine-Qatar, where he received an Excellence in Teaching Award. His research has focused on global health (including explanatory models of mental illness in Botswana, epidemiology of head trauma, and psychosocial aspects of HIV), adolescent and young adult mental health, and quality improvement. He enjoys communicating health-related science through writing and teaching and joined Buoy Health as a writer in 2018. In his free time he enjoys running, hiking, and exploring new places.