What to know about generalized anxiety disorder
Generalized anxiety disorder (GAD) is persistent and excessive worry or nervousness about everyday life that often interferes with daily activities and personal relationships.
GAD, a type of anxiety disorder, is very common. It affects 3.1% of the population (or 6.8 million adults) in the United States in any given year. It is more common in women.
Living with anxiety can be challenging. However, as with other anxiety disorders, GAD is highly treatable. Some of the most effective treatments include psychotherapy, medication, and making lifestyle changes.
This article provides an overview of GAD, including its symptoms and causes. It also lists some potential treatment options.
Doctors diagnose GAD when a person experiences anxiety for 6 months or more.
However, physical symptoms of the disorder can vary between cases. Symptoms may improve or worsen at different times. For example, periods of high stress or physical illness often cause symptoms to exacerbate for a while.
Emotional and cognitive symptoms of GAD include:
- uncontrollable and persistent worries, fears, and concerns
- an inability to deal with uncertainty about the future
- intrusive thoughts
- excessive planning and troubleshooting
- difficulty making decisions
- fear of making the “wrong” decision
- problems concentrating
- an inability to relax
Physical symptoms include:
- tense or tight muscles
- aches and pains
- difficulty sleeping
- feeling restless, jumpy, or twitchy
- heart palpitations
- digestive issues, such as nausea or diarrhea
- being easily startled
- excessive sweating
- frequent urination
Behavioral symptoms include:
- being unable to relax or spend “quiet” time alone
- switching between tasks or not finishing tasks due to finding it difficult to concentrate
- spending excessive amounts of time completing simple tasks
- redoing tasks because they are not “perfect”
- avoiding situations that trigger anxiety, including socializing with others and speaking in public
- missing school or work due to fatigue, fear, or other symptoms
- requiring reassurance and approval from others
It is important to note that children and adolescents may display tightening irritability and anger when experiencing depression or anxiety.
Learn more about the cognitive, physical, and behavioral effects of anxiety.
People with GAD often have co-occurring conditions. These may include:
- other anxiety disorders, such as phobias, obsessive-compulsive disorder, or social anxiety
- drug or alcohol misuse
Causes and risk factors
The exact cause of GAD is unknown. However, it most likely occurs as a result of a combination of several factors, including:
Having a family history of GAD increases the risk of developing it, according to some research. For example, children of people with GAD are more likely to develop the condition themselves than those whose parents do not have it.
Brain chemistry and structure
Differences in brain functioning may increase the risk of developing an anxiety disorder. People with GAD also show differences in brain structure in neuroimaging studies using functional MRI scans.
An imbalance of serotonin and other brain chemicals is also present in people with GAD and other anxiety disorders.
Learn more about the causes of anxiety.
Other risk factors
Other risk factors for developing GAD include:
- Personality characteristics: People who are timid or pessimistic may be more likely to develop GAD. Some 2016 research also suggests a link between anxiety disorders and neuroticism.
- Trauma and other life experiences: A history of trauma, such as abuse or bereavement, may also contribute to GAD.
- Chronic disorders: A chronic illness can increase the chance of developing an anxiety disorder, as can misusing addictive substances.
- Assigned sex: Estimates suggest that people assigned female at birth are twice as likely as males to have GAD.
- Age: GAD can affect anyone of any age. However, the risk of developing it seems to be highest between childhood and middle age.
A doctor or mental health professional may diagnose GAD according to the criteria in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR).
To receive a diagnosis of GAD, a person must have:
- excessive anxiety and worry in several areas of their life on more days than not for at least 6 months
- difficulty controlling these worries
- at least three of the following symptoms (or just one symptom in the case of children):
- difficulty concentrating
- tense muscles
- sleep issues
- significant distress or problems functioning in social or work settings
Also, these symptoms must not result from substance use or another medical condition.
To confirm a diagnosis or rule out physical conditions that may be causing symptoms, a doctor may:
- perform a physical examination
- take a detailed medical and family history
- use a psychological questionnaire
- order blood or urine tests
Treatment options for GAD depend on the severity of a person’s symptoms and any other conditions.
Many people require a combination of treatments, such as attending psychotherapy and making lifestyle changes. Medications may also be necessary.
Treatment options include:
Working with a therapist can help people effectively manage their symptoms. Doctors and mental health professionals often recommend cognitive behavioral therapy (CBT) for anxiety, as it is safe and effective.
Studies suggest that CBT reduces worry in people with GAD, with the effects equal to those of medications and more effective 6 months after treatment completion.
Other types of therapy that show promise in treating GAD include mindfulness-based therapies and acceptance and commitment therapy. This is a type of therapy that uses both acceptable and mindfulness techniques.
Learn more about the different online platforms for CBT.
Sometimes, a healthcare professional may recommend medication to help with the symptoms of GAD.
Several types of medication can treat GAD, including:
- Antidepressants: Most commonly, doctors prescribe selective serotonin reuptake inhibitors or serotonin and norepinephrine reuptake inhibitors for GAD. These drugs can take several weeks to work.
- Buspirone: This is an antianxiety medication that reduces the physical symptoms of anxiety. Buspirone can take several weeks to take effect.
- Benzodiazepines: Occasionally, doctors may prescribe a benzodiazepine for short-term anxiety relief. These medications are fast acting but are highly habit-forming and may not be suitable for people with a history of addiction.
Making lifestyle modifications can help people manage their worries and concerns. Some examples of helpful changes to make include:
- exercising regularly
- eating a balanced diet
- reducing exposure to stressors
- prioritizing issues and events
- practicing mindfulness, meditation, or yoga
- keeping a journal to help identify anxiety triggers and coping strategies
- avoiding alcohol and drugs, and limiting or avoiding nicotine or caffeine
- setting a sleep schedule to ensure 7–9 hours of sleep per night
Learn more ways to manage anxiety symptoms at home.
Anxiousness is a regular part of life, but excessive anxiety or worry — especially if it interferes with everyday functioning or relationships with others — can indicate an anxiety disorder.
GAD is common and highly treatable. Individuals concerned about their mental health should consult a doctor or psychotherapist for treatment. The earlier a person seeks treatment, the better the outlook.