Generalized Anxiety Disorder (GAD)

What is generalized anxiety disorder?

People with GAD find their ongoing anxiety difficult to control, excessive, and disruptive to daily life. There is often no reason for the excessive anxiety they experience. 

GAD’s symptoms can overlap with other types of anxiety disorders, including obsessive-compulsive disorder and panic disorder. ^[2] The main difference is that people with GAD worry about a range of everyday events, including finances, physical health, relationships, and performance at work or school.

Anyone can experience GAD, but it is more commonly diagnosed among women. The development of this anxiety disorder often has a slow onset, with fluctuating symptoms throughout life. ^[3]

Symptoms of generalized anxiety disorder

GAD symptoms are psychological and physiological and occur more days than not. The list of symptoms below is not exhaustive but includes the most commonly experienced by those with the anxiety disorder.

Psychological Symptoms:

• Excessive, uncontrollable worry and intense anxiety unconstrained to a specific topic
• Unrealistic anxious thoughts that are not the result of trauma
• Irritability 
• Difficulty concentrating or maintaining sustained focus
• Indecisiveness or overthinking daily activities or events
• Nervousness 
• Feeling a vague sense of impending doom

Physical Symptoms:

• Restlessness or feeling keyed up 
• Shortness of breath
• Muscle tension, muscle aches, or muscle pains
• Difficulty falling asleep
• Trouble staying asleep
• Stomach aches and digestion problems 
• Frequent headaches
• Fatigue
• Trembling or shaking
• Sweating
• Exaggerated startle response

Most people with GAD do not experience each symptom simultaneously. Symptoms often fluctuate throughout life, and the focus of worried thoughts may change. Some people find that symptoms worsen during stressful times. ^[3]

Children and teenagers with GAD may show perfectionism or express worry about not meeting adults' expectations. They frequently worry about their overall performance in school or sports or being accepted by peers. 

GAD is often comorbid with other anxiety disorders, mood disorders, and substance abuse. Medical illnesses that are associated with stress, such as irritable bowel syndrome, can also be present. ^[1]

Causes of generalized anxiety disorder

There is no singular cause for GAD, or anxiety disorders in general. Experts generally accept that the development of the disorder is a combination of complex factors.

However, research has found some risk factors for the development of anxiety symptoms:

• Genetics – Those with a family history of anxiety disorders may be more at risk of developing GAD. ^[3] It is unclear whether this is due to a genetic factor or if anxiety is passed through generations through learned behavioral responses.
• Brain Chemistry – There are several key parts of the brain involved in fear and anxiety, but no clear-cut answers on how or if brain chemistry leads to the development of an anxiety disorder. However, several medications targeting specific neurotransmitters within the brain have been found helpful in treating the disorder.^[5]
• Environmental factors – Stressful environments and traumatic events likely play a role in the development of GAD. Symptoms also tend to worsen with increased stress from environmental factors. ^[5]

Diagnosing generalized anxiety disorder

GAD can be diagnosed by a medical doctor or mental health professional. Assessment will involve questions about medical history, including mental health, and the psychosocial difficulties arising from anxiety's psychological and somatic symptoms. A standardized screening, such as the Generalized Anxiety Disorder 7-Item (GAD-7) questionnaire, may also be administered.

Several medical conditions can cause feelings of anxiety. A physical exam to rule out these conditions is likely to be conducted. Medical testing, including thyroid function tests, blood glucose testing, and toxicology screenings, may also be ordered ^[4].

Prevention of generalized anxiety disorder

There is no surefire preventative measure for GAD, given there is no singular cause for the disorder. There are, however, steps that can be taken to reduce overall anxiety. Anxiety is a natural by-product of the stress response, so learning ways to manage your daily stressors can help lower your feelings of stress.

• Avoid the use of unhealthy substances, including alcohol, nicotine, and caffeine. Many people find that reducing their use of these substances leads to lower anxiety intensity throughout the day.
• Practice time management skills. This includes prioritizing issues as they arise, asking for help from others when needed, and setting boundaries between work and other areas of life.
• Practice healthy sleep habits. This includes following a regular sleep routine, which is often difficult when anxiety is high. The disruptions to sleep may play a large role in the feelings of fatigue, irritability, and concentration struggles that occur during the day. 
• Exercise daily. Physical activity is a fantastic way of boosting natural feel-good hormones throughout the body and reducing cortisol (the stress hormone) levels.

Treatment for generalized anxiety disorder

Treatment for GAD involves either medication, psychotherapy (also known as “talk therapy”), or a combination of both. 

Psychotherapy treatments

Cognitive-behavioral therapy is the most widely used psychotherapy approach to treating GAD. This approach teaches skills for managing anxious cognitions through identifying unhelpful thought patterns and working on changing them with the help of a therapist during regularly held appointments. The therapist will also teach new ways of responding to distressing situations that typically provoke anxiety, and de-sensitization strategies to reduce avoidance.

Medications

Antidepressants such as Lexapro, Cymbalta, Effexor, or Paxil, may be prescribed by your medical provider. These antidepressants fall into two categories: selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). ^[4] These medications are helpful for the long-term management of symptoms when medically called for. These types of medications can take a few weeks before improvements are felt.

Benzodiazepines may be prescribed for short periods to manage severe symptoms. These medications pose the risk of patients building a tolerance to them and possible addiction. Benzodiazepines should not be prescribed for long-term symptom management. ^[3]

There is the risk of side effects from medication, including dry mouth, nausea, diarrhea, weight changes, and suicidal thoughts. If prescribed medication, it is important to be honest about possible adverse effects during follow-ups. Daily tracking of symptoms and side effects can help in remembering what information to share with healthcare professionals.

Self-care for generalized anxiety disorder

There are self-care strategies that people with GAD can do to manage the condition. These strategies are also great for overall stress management and anxiety prevention.

• Regular exercise. Exercise increases the release of feel-good chemicals in the brain and leads to reduced cortisol in the body. Cortisol is known as the stress hormone.
• Healthy eating habits. Eating a well-balanced diet with meals scheduled at regular intervals helps regulate the body.
• Healthy sleep hygiene skills. These skills include following a daily sleep routine, reducing caffeine and other stimulant use, and avoiding napping during the day.
• Social supports. Building and utilizing social support among friends and family members.
• Use relaxation and calming techniques. These include practicing deep breathing, meditation, and yoga.

Helping someone with generalized anxiety disorder

People who want to help someone with anxiety disorders are often unsure of how to adequately provide support. There are some general tips on how to approach your loved one.

• Actively listen to them. Many people with GAD recognize that their anxiety is excessive. Reassuring them that the worry is unrealistic may result in their avoiding talking about their anxiety. Allow them a supportive space to share and avoid minimizing their struggle.
• Learn about anxiety and the available treatment options. Assist them in finding formal support, such as medical care or psychotherapy, and offer to attend the appointment with them as support. 
• Make lifestyle changes with them. This might look like going to the gym with them or cooking healthy meals together. Many people find it easier to make long-term changes with an accountability partner. 
• Find support. Providing care and support to someone with an anxiety disorder can be draining. Having a support system in place and following healthy lifestyle habits can prevent burnout.

Frequently asked questions about GAD

What is the outlook for people with GAD?

The outlook for people diagnosed with generalized anxiety disorder is positive. 

Anxiety can be effectively managed with proper treatment, lifestyle changes, and stress management tools. Proper treatment for anxiety disorders includes psychotherapy and medication, or a combination of both. 

How common is GAD?

GAD is diagnosed more often in women than men. It is estimated that one in four children will experience symptoms of anxiety. It is estimated that up to 20% of adults are affected by an anxiety disorder each year, and GAD is one of the most common mental health conditions. ^[4]

GAD vs Social Anxiety Disorder – What is the difference?

The anxiety and worry that occur with GAD occur across a range of situations, activities, and events. Social anxiety disorder is marked by anxiety that occurs specifically in social situations or when thinking about social interactions.