What You Need To Know About Generalized Anxiety Disorder

What is generalized anxiety disorder?

Feeling anxious is a normal response to a stressful situation. Usually, anxiety isn't a cause for concern as it serves a biological purpose, such as warning you of a potential threat, triggering your flight-or-fight response, or helping you to react quicker in a dangerous situation.

However, if you feel anxious most or all the time, that can be a problem and it may be an indication that you have a generalized anxiety disorder (GAD). According to the Anxiety & Depression Association of America, GAD is characterized by persistent and excessive worry that lasts for more than six months. People with GAD feel anxious even then they might not have a clear reason to feel that way. GAD is a common mental health condition that affects 6.8 million adults in the US.

Persistent anxiety can have a negative impact on your life and well-being. As a result of feeling anxious, you may limit your social activities, avoid accepting a promotion at work, or even feel reluctant to leave the house. People with GAD might worry about work, school, social situations, finances, or other topics, even when there isn't a reason for concern. They may also experience higher levels of anxiety than what would be considered a normal response to a particular situation.

GAD can manifest in physical symptoms, too, including muscle pain, digestive issues, and fatigue. Some of these symptoms can have a long-term impact on your health, including ulcers, migraines, insomnia, and chronic illnesses.

If you think you may have GAD, it's important to speak to your doctor for a diagnosis. If you do have GAD or another type of anxiety disorder, there are treatment options available that can help relieve physical symptoms and reduce feelings of anxiousness. Common treatment recommendations medication and therapy. A doctor or therapist may also be able to recommend lifestyle changes that can also help.

If anxious feelings are negatively impacting your life, it is important to seek treatment, as anxiety may become more severe and its impact can worsen.

Symptoms

GAD can have a wide range of mental, emotional, and physical symptoms which vary from person to person and depend on the severity of the anxiety.

Symptoms may also change over time, making it difficult to know whether certain symptoms are caused by GAD or another health concern. That's why it's important to discuss any symptoms you are having with your doctor so they can assess the cause and create a treatment plan to manage GAD.

Psychological symptoms of GAD include:

  • Inability to control feelings of anxiety or worry

  • Feeling more anxious than what would be considered a normal response to a situation

  • Consistently making plans for worst-case scenarios in every situation

  • Feeling under threat even when there is no threat present

  • Feeling like you can't relax, or having trouble falling or staying asleep 

  • Inability to make decisions because you worry you'll make the wrong one

  • Difficulty concentrating on tasks because your mind wanders to worries

  • Feeling irritable or being quick to anger without knowing why

Physical symptoms of GAD include:

  • Aches from muscle tension, particularly in the neck and shoulders

  • Headaches or migraines on a consistent basis

  • Feeling sweaty or out of breath without physical exertion

  • Feeling tired all the time

  • Trembling or shaking

  • Feeling sick to your stomach or vomiting

  • Needing to go to the bathroom often

  • Being easily startled 

The earlier you seek treatment, the easier it can be to treat the symptoms of GAD before they become too severe or lead to more serious health concerns. If symptoms become more severe, they can contribute to other issues¹ such as:

  • Ulcers

  • Heart disease

  • Irritable bowel syndrome (IBS)

  • Migraines

  • Chronic pain

  • Depression

While feeling worried sometimes is normal, you should see a doctor if anxiety symptoms are starting to interfere with your life, including your work or relationships. You should also see a doctor right away if anxiety is causing you to feel depressed.

If you are having suicidal thoughts, call 911 or go to your local emergency room immediately.

Learn more about what anxiety feels like, and when the symptoms turn into an anxiety disorder.

Causes

The cause of GAD is unknown, but research suggests it is likely due to a complex interplay of genetic and environmental factors.

GAD can develop in children, teens, and adults alike, but the risk for developing the disorder drops off after middle age¹. GAD can be triggered by stressful life events and prolonged trauma. It very often runs in families, though not all family members will develop it, and there is no clear reason as to why some people do and some do not.

Researchers have indicated² that there are several areas of the brain that control emotions and the fear response which can result in GAD. Further research will enhance our understanding of the role of brain composition and environmental factors in the development of GAD.

Risk factors

Causes and risk factors of developing GAD include:

  • Genetics – If other people in your family have GAD, you are more likely to develop it too.

  • Gender – The NIH reports³ that women are twice as likely as men to be diagnosed with GAD. 

  • Trauma – If you have experienced high levels of stress or prolonged exposure to trauma, you may be more at risk of developing GAD. 

  • Lifestyle – Consuming high amounts of caffeine or tobacco may make you more prone to feelings of anxiety. 

  • Personality – If you find it difficult to deal with stress are less emotionally resilient, you may be vulnerable to developing GAD if you don't learn healthy coping techniques to manage these feelings.

A study published by Psychiatric Clinics of North America found that those with GAD were also often diagnosed with other depressive or panic disorders. Patients diagnosed with GAD may also be more prone to substance abuse⁴ as a way to deal with their anxiety.

Diagnosis

A report from American Family Physician⁵ acknowledges that while GAD is one of the most common mental disorders in the US, it's also the most often misdiagnosed. This is partly because it shares so many symptoms with other health concerns.

Doctors will need to do a thorough health evaluation of a patient to determine if the symptoms they are experiencing are due to GAD or another health concern.

Guidelines for a diagnosis of GAD include:

  • Out of control worry

  • Excessive anxiety more days than not in a six-month period

  • Experiencing three or more typical symptoms of GAD such as irritability, fatigue, difficulty sleeping, muscle tension, poor concentration, or restlessness

  • Anxiety that disrupts work, relationships, or healthy functioning on a day-to-day level

Before you are diagnosed with GAD, your doctor may want to perform a physical examination to rule out any physical cause for your symptoms. They may order tests to screen for any other illnesses or conditions. This will help your doctor to determine if there are physical issues contributing to anxiety, such as a hormone disorder or thyroid problem.

Your doctor may also refer you to a mental health professional who can perform a further mental health evaluation to ensure you are properly diagnosed.

Learn more about getting a mental health diagnosis.

Treatments

If either your doctor or mental health professional diagnoses you with GAD, they'll then be able to recommend treatment options.

The most common and effective treatments for GAD are psychotherapy and medication. Your doctor or mental health professional may recommend one or both, along with lifestyle changes that can help reduce your exposure to anxiety or increase your ability to handle it in a healthy way.  anxiety/

Psychotherapy

According to the Anxiety & Depression Association of America¹, cognitive behavioral therapy (CBT) is the most researched form of therapy for anxiety conditions.

There is strong evidence for the effectiveness of CBT in the treatment of anxiety. CBT helps you to recognize unhelpful thoughts and behaviors that underpin and perpetuate feelings of anxiety and equips you with the tools to manage and replace them with positive feelings and behaviors.

By exploring your anxiety through therapy, you may become more desensitized to it and be better equipped to handle stressful situations. This, in turn, can help you make better decisions when you are feeling anxious. A therapist may also be able to teach you relaxation strategies, such as breathing, muscle relaxation, and mindfulness exercises, to break the worry cycle and improve your focus.

Medication

There are several medications available to treat anxiety disorders, including GAD. Your doctor or mental health professional will work with you to determine whether medication is appropriate for you, and which is right for your needs. This process can take some time.

Medication options include:

Anti-depression medication

Categories of medication known as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) are most commonly used to treat depression, but according to the NIH², they are effective at treating GAD as well.

These medications can take several weeks to reach effective levels in your body. Because of this, they are often paired with therapy with a mental health professional who can support you while the medication takes its time to work.

Benzodiazepines

These are sedatives that work quickly to treat the immediate symptoms of GAD, and can also be effective in treating panic attacks. While they work quickly for short-term help, they aren't suitable for long-term use.

Over time, you can build up a tolerance of their effects, which reduces their effectiveness. They can also lead to you developing a dependency where you rely too much on medication instead of developing important psychological strategies for managing anxiety. To prevent dependence and tolerance, your doctor will prescribe a small number of benzodiazepines.

It is important to note that all medications can come with side effects. The side effects of SSRIs and SNRIs can include³:

  • Constipation

  • Upset stomach

  • Headaches

  • Insomnia

  • Loss of libido

  • Erectile dysfunction

  • Dizziness

  • Dry mouth

  • SNRIs, in particular, can also increase blood pressure

You should always discuss new or worsening symptoms with your doctor. In some cases, medication can make the symptoms of GAD worse. If that happens to you, contact your doctor immediately.

Lifestyle changes

Along with therapy and medication, making lifestyle changes that help to reduce stress or increase your resilience to stress in a healthy way can further alleviate the symptoms of GAD.

Depending on your situation, a doctor or mental health professional may recommend: 

  • Meditation and yoga

  • Daily exercise

  • Eating a healthy diet

  • Getting more sleep

  • Avoiding stimulants like caffeine

  • Reducing alcohol intake

With any treatment plan for GAD, it's important to stick with it even if it doesn't seem to work immediately. Therapy, medication, and lifestyle changes can all take time to start working. Continue with recommended treatments for at least a few weeks before you explore making changes with your doctor.

However, if your symptoms get worse, talk to your doctor or mental health professional.

Learn more about anxiety treatment with this comprehensive guide.

  1. Treatment | Anxiety & Depression Association of America

  2. Generalized Anxiety Disorder: When Worry Gets Out of Control | National Institute of Mental Health

  3. SSRI’s vs SNRI’s - What's the difference between them? | Drugs.com

Prevention

Just as the specific cause of GAD is not known, there is no way to prevent it. It is difficult to predict whether someone will or will not develop GAD because the causes are so complex, multifactored, and depend on a person’s individual makeup.

However, the sooner you get help for any anxiety you are experiencing, the better your recovery. Symptoms start gradually and worsen over time, but early intervention can prevent them from becoming more severe.

If you are struggling with anxiety, seek help from your doctor or mental health professional. They can work with you to develop a care and treatment plan that equips you with the tools to reduce stress and anxiety.

Help reduce anxiety

You can also take action now to help reduce anxiety:

Limit your intake of stimulants, including caffeine

These can trigger your flight-or-fight response and make you more prone to feelings of high anxiety. 

Eat a balanced diet

A report by Harvard Health¹ found that a diet rich in antioxidants could help reduce the severity of symptoms from anxiety disorders like GAD. Antioxidant-rich foods include beans, apples, berries, nuts, and leafy greens. 

Get plenty of exercise

Harvard Health² also found that engaging in regular exercise can ease anxiety and help the body deal with the effects of stress. 

Yoga or meditation

A study by the East Carolina University Brody School of Medicine³ found yoga and meditation had positive effects on patients with anxiety.

Get help

If you are feeling overwhelmed by anxiety or are unable to control anxious thoughts, reach out to your doctor or mental health professional. Counseling and therapy can be effective treatments for anxiety and building strategies for dealing with stressful situations.

Find ways to help prevent anxiety attacks and identify their triggers here.

Statistics

Anxiety disorders are the most common mental illness in the US¹, affecting more than 40 million adults. Of those, around 6.8 million¹ have GAD.

While anxiety is a treatable condition, only about one in three people suffering from anxiety seek help¹ for their symptoms.

Prevalence

  • Adults between the ages of 18 and 29 make up the largest percentage of patients with GAD in the US².

  • Women are twice as likely to be diagnosed with GAD compared to men³.

  • Roughly one in three people with GAD are severely impaired by their anxiety⁴.

  • Around 2.2% of adolescents in the US have GAD⁴.

Anxiety disorders often co-occur with depression or substance abuse⁵ and treating one condition often leads to improvements in the other. Recommended treatments include medication, therapy, and lifestyle changes.

Continue learning about anxiety prevalence, demographics, and treatment rates with the latest statistics.

  1. Facts & Statistics | Anxiety & Depression Association of America

  2. Symptoms of Generalized Anxiety Disorder Among Adults: United States, 2019 | Centers for Disease Control and Prevention

  3. Generalized Anxiety Disorder (GAD) | Anxiety & Depression Association of America

  4. Generalized Anxiety Disorder | National Institute of Mental Health

  5. Mental Health Disorder Statistics | John Hopkins Medicine

Doctors & specialists

If anxiety is starting to negatively impact your life, it's important that you get help from a doctor or mental health professional. The following health professionals can help you with a diagnosis, treatment plan, therapy, or medication for GAD:

General practitioner (GP)

Your GP or family doctor can provide you with an initial consultation about your anxiety-related concerns. They may do a physical examination and order routine tests to assess whether you have any other health concerns that could be contributing to feelings of anxiety.

It's important to rule out other health conditions because GAD shares many symptoms with problems, such as an overactive thyroid, hormone imbalances, or irritable bowel syndrome. 

Psychologist

A psychologist may give you a diagnosis for GAD as well as provide therapeutic services. The most common type of therapy for GAD is CBT which targets negative thinking and behaviors, helping you redirect them in healthy, positive ways. This can reduce the severity of your anxiety and build resilience to stressful situations. 

Psychiatrist

A psychiatrist can diagnose GAD as well as provide counseling. Additionally, a psychiatrist can prescribe medication such as SSRIs or SNRIs that can help to alleviate symptoms. 

When seeking therapy for GAD, it's important that you find a mental health professional you are comfortable talking with to ensure your therapy is as effective as possible. Every mental health professional has a slightly different process and style, but during your first appointment, you can expect to:

  • Fill out forms, usually insurance and payment information along with your health history

  • Answer questions about your lifestyle and background

  • Discuss why you are seeking treatment

  • Talk about your therapy goals and desired outcomes

Remember that therapy is there to benefit you and meet your needs. If you aren't ready to answer a question or discuss a certain topic, take it at a pace you are comfortable with. You should trust your mental health professional and feel able to ask them any questions, including what treatment plans they recommend.

See advice on finding the right doctor to get help for your anxiety.

Clinical trials for generalized anxiety disorder

Actively recruiting
Sleep and Emotional Memory in Peripubertal Anxiety
FL (US)
Actively recruiting
Efficacy Trial of the CALM Intervention
CT, MD (US)
Actively recruiting
Trial With the Treatment of Sertraline in Youth With Generalized, Separation and/or Social Anxiety Disorders.
NY, OH (US)

Medications for generalized anxiety disorder