Generalised Anxiety Disorder

Generalised anxiety disorder is a common mental health condition where persistent and excessive worry about everyday situations takes over your life. Unlike normal worry that comes and goes, this type of anxiety is difficult to control, lasts for months, and can make getting through the day very difficult.

Table of contents

• What is Generalised Anxiety Disorder?
• Symptoms and Warning Signs
• What Causes Generalised Anxiety Disorder?
• How is Generalised Anxiety Disorder Diagnosed?
• Treatment Options
• What You Can Do to Help Yourself
• Living with Generalised Anxiety Disorder

What is Generalised Anxiety Disorder?

It’s normal to feel anxious from time to time, especially if your life is stressful. However, generalised anxiety disorder (GAD) is different from everyday worries. It’s a mental health condition where you feel excessive worry about everyday situations that happens often and is hard to manage^[1][2].

People with generalised anxiety disorder worry excessively about a wide range of everyday situations and events, even when there’s little or no clear reason to worry. The worries are often about minor issues like health, money, family, or work performance, and they are out of proportion to the actual impact of the events^[1][5]. These feelings are typically difficult to control, cause significant distress, and interfere with daily activities at home, work, or school^[2].

Generalised anxiety disorder is common. It currently affects about 3% of the adult population in the United States and 5% of people at any point during their lives^[2]. Worldwide, it affected 359 million people in 2021, making anxiety disorders the most common of all mental disorders^[7]. However, only about 43% of those affected receive treatment^[2].

The condition can develop at any age but most commonly begins during childhood, adolescence, or early adulthood. About one third of people with GAD experience onset in childhood or adolescence^[4][6]. It’s possible to develop generalised anxiety disorder as a child or an adult, and it can occur at any point in life, including middle age^[1][10].

Symptoms and Warning Signs

The main symptom of generalised anxiety disorder is persistent and excessive worry about a number of different things that occurs more days than not for at least six months^[1][4]. People with GAD find it difficult to control this worry^[4].

Common mental and emotional symptoms include:

• Persistent worrying or anxiety about multiple areas that are out of proportion to the impact of the events
• Overthinking plans and solutions to all possible worst-case outcomes
• Perceiving situations and events as threatening, even when they aren’t
• Difficulty handling uncertainty
• Indecisiveness and fear of making the wrong decision
• Inability to set aside or let go of a worry
• Inability to relax, feeling restless, and feeling keyed up or on edge
• Difficulty concentrating, or the feeling that your mind “goes blank”
• Being easily fatigued
• Irritability^[1][4]

Physical symptoms may accompany the worry and include:

• Fatigue or getting tired easily
• Trouble sleeping (difficulty falling or staying asleep, or restless, unsatisfying sleep)
• Muscle tension or muscle aches
• Trembling, feeling twitchy
• Nervousness or being easily startled
• Sweating
• Heart palpitations or increased heart rate
• Shortness of breath
• Nausea or stomach problems
• Headaches
• Feeling lightheaded or dizzy
• Unexplained pains like muscle aches or stomachaches^[1][2][14]

Symptoms may come and go, and they’re often worse when you feel stressed^[2]. The worries are typically future-oriented, focusing on what might happen rather than what is happening^[18].

It’s important to note that generalised anxiety disorder is different from other types of anxiety disorders like panic disorder (sudden attacks of anxiety and panic) and phobias (overwhelming fear of something specific), though it’s common to have more than one anxiety disorder at the same time^[1][14].

What Causes Generalised Anxiety Disorder?

Researchers don’t know the exact cause of generalised anxiety disorder, but it likely involves a combination of several factors^[2].

Brain function and chemistry play an important role. There may be differences in how the brain manages worry and stress. Research points toward abnormalities in important chemical messengers in the brain called neurotransmitters, which are substances that send signals between nerve cells. These include serotonin, dopamine, and GABA (gamma-aminobutyric acid), which affect thought patterns and emotions^[2][13].

Genetics also plays a role. Generalised anxiety disorder may run in families, suggesting that genetic differences can be inherited. Just as you can inherit physical traits like eye color or height, you can also inherit a tendency toward excessive anxiety^[2][6]. Current research suggests that about one-third of the risk of experiencing GAD is genetic^[6].

Life experiences and environmental factors can shape how you respond to everyday situations. Stressful or challenging experiences over time, particularly traumatic events or significant stress, may contribute to developing GAD^[2][6].

Temperament may also be a factor. A child whose temperament is timid or shy, or who avoids anything dangerous, may be at increased risk^[6].

You may be more at risk of developing generalised anxiety disorder if you:

• Are female (women are more commonly affected than men)
• Are biologically related to someone diagnosed with GAD
• Experienced a traumatic event or significant stress in your life
• Experienced child abuse
• Live with another mental health condition, like panic attacks, depression, or a strong fear (phobia)
• Manage a chronic illness
• Frequently use substances like tobacco, alcohol, or marijuana^[2][7]

Generalised anxiety disorder can occur along with other mental health conditions, including substance use disorder and depression. When this happens, it’s important to treat both conditions at the same time^[2][4]. GAD can also raise the risk of thinking about suicide or wanting to hurt yourself^[2].

How is Generalised Anxiety Disorder Diagnosed?

If you see a healthcare provider about symptoms of generalised anxiety disorder, they’ll ask you questions about your worries and physical symptoms. It’s important to try and be honest with them, even if it may be difficult to talk about your emotions. This will help them diagnose or rule out an anxiety disorder^[14].

To help diagnose generalised anxiety disorder, your doctor or mental health professional may^[8]:

• Do a physical exam to look for signs that your anxiety might be linked to medications or an underlying medical condition
• Order blood or urine tests or other tests if a medical condition is suspected
• Ask detailed questions about your symptoms and medical history
• Use psychological questionnaires to help determine a diagnosis
• Use the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

A healthcare provider, like your primary care physician, may refer you to a mental health specialist, like a psychologist or psychiatrist^[2].

A doctor may diagnose GAD if you have the typical symptoms and^[14]:

• You often worry about a wide range of things
• Feelings of anxiety are affecting your daily life
• You’re finding it hard to control your feelings
• You have felt anxious a lot of the time for at least 6 months

The main diagnostic feature is excessive anxiety and worry that occurs more days than not for at least six months, about a number of events or activities. The person finds it difficult to control the worry, and the anxiety is associated with at least three of the following symptoms: restlessness or feeling keyed up or on edge, being easily fatigued, difficulty concentrating or mind going blank, irritability, muscle tension, and sleep disturbance^[4].

The GAD-7 (Generalized Anxiety Disorder 7-item scale) is a validated screening tool that can aid in diagnosis and assessment^[4].

Treatment Options

Treatment for generalised anxiety disorder can help you manage your symptoms, but it may take time. In many cases, the condition improves with treatment, which may include psychotherapy, medications, or a combination of both^[1][14].

Psychotherapy (Talk Therapy)

Psychotherapy, also known as talk therapy or psychological counseling, involves working with a therapist to reduce your anxiety symptoms^[8].

Cognitive behavioral therapy (CBT) is the most effective form of psychotherapy for generalised anxiety disorder. Generally a short-term treatment, cognitive behavioral therapy focuses on teaching you specific skills to directly manage your worries and help you gradually return to the activities you’ve avoided because of anxiety. Through this process, your symptoms improve as you build on your initial success^[8].

Psychotherapy can be as effective as medication for GAD. CBT is usually offered with the support of a therapist, either by yourself or in a group^[4][14].

The therapy has two parts: a cognitive part that deals with thoughts and feelings, and one that deals with behavior. The goal of the cognitive approach is to change thought patterns that trigger or worsen anxiety. The behavioral part helps you face situations that make you anxious rather than avoiding them^[10].

Because CBT involves directly confronting your fears, the therapy itself can sometimes be quite distressing, but it has benefits that go beyond just helping to reduce anxiety. It can also help with symptoms of depression, which may accompany generalised anxiety disorder^[10].

Medications

Several types of medications are used to treat generalised anxiety disorder. The choice depends on your specific situation and other health conditions you may have^[8].

Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are recommended as first-line medications for treating GAD. These are types of antidepressants that work by affecting certain chemical messengers in the brain^[4][8].

Antidepressants should be continued for at least six to 12 months after achieving treatment response to decrease the rate of relapse^[4].

Benzodiazepines are not more effective than antidepressants for anxiety disorders and should not be used as first-line therapy. They are not recommended for long-term use because of adverse reactions, risk of dependence, and higher mortality^[4].

A healthcare provider will usually advise you to try talking therapies before they prescribe medicine or refer you to a specialist^[14]. You may benefit most from a combination of psychotherapy and medication. It may take some trial and error to discover which treatments work best for you^[8].

What You Can Do to Help Yourself

If you have generalised anxiety disorder, there are things you can try yourself that may help ease the symptoms of anxiety^[14].

Things you should try:

• Try talking about your feelings to a friend, family member, health professional, or counselor
• Try recommended self-help therapies, such as books, online tools, or courses that you can do in your own time
• Learn how to relax using calming breathing exercises, or try activities such as yoga or pilates
• Try to get enough sleep – this can help you have the energy you need to cope with difficult feelings and experiences
• Exercise regularly – activities such as running, walking, swimming, and yoga can reduce anxiety and stress and help you sleep better
• Eat a healthy diet with regular meals to keep your energy levels stable^[14][16]

Physical activity, in particular, has been shown to reduce symptoms of anxiety. Regular exercise may be beneficial as a prevention strategy for GAD^[4].

Things you should avoid:

• Do not focus on the things you cannot change – focus your time and energy into helping yourself feel better
• Do not avoid situations that make you anxious – try slowly building up time spent in worrying situations to gradually reduce anxiety
• Do not drink lots of coffee, tea, cola, or energy drinks – they contain caffeine, which can disrupt your sleep and make it harder to control your anxiety^[14][16]

Many people with generalised anxiety disorder try to manage their fears on their own using relaxation techniques such as progressive muscle relaxation, autogenic training, breathing exercises, or yoga. Some people try herbal sedatives like valerian, lavender, chamomile, or passion flower. However, there is a lack of good-quality research on how effective these approaches are when used without professional support^[10].

It’s important to seek professional help rather than trying to manage severe anxiety on your own for an extended period, as effective treatments are available^[10].

Living with Generalised Anxiety Disorder

Living with generalised anxiety disorder can be a long-term challenge. In many cases, it occurs along with other anxiety or mood disorders^[1]. The condition is often chronic (ongoing), but may have only a moderate impact on a person’s ability to function in daily life, which means it can remain undetected and undiagnosed for some time^[5].

However, the outlook is generally positive with proper treatment. In most cases, generalised anxiety disorder improves with psychotherapy or medications. Making lifestyle changes, learning coping skills, and using relaxation techniques can also help^[1].

Around half of the patients treated for GAD may fail to respond to initial treatment. This is known as treatment-resistant GAD, defined as failure to respond to at least one trial of antidepressant therapy at adequate dose and duration. If this happens, there are several other medication options and augmentation strategies that can be tried^[13].

If you think you might have generalised anxiety disorder or you’ve been diagnosed with GAD and treatments are not helping, see a healthcare provider. A healthcare provider can help you manage GAD and improve your quality of life^[2][14].

If you’re ever in a difficult spot or having thoughts about suicide or hurting yourself, don’t hesitate to reach out for help. Support is available 24/7^[2].