Generalized anxiety disorder
GAD; Anxiety disorder
Generalized anxiety disorder (GAD) is a mental disorder in which a person is often worried or anxious about many things and finds it hard to control this anxiety.
The main symptom is frequent worry or tension for at least 6 months, even when there is little or no clear cause. Worries often seem to float from one problem to another. Problems may involve family, other relationships, work, school, money, and health.
Even when they are aware that worries or fears are stronger than appropriate for the situation, a person with GAD still has difficulty controlling them.
Other symptoms of GAD include:
- Problems concentrating
- Problems falling or staying asleep, or sleep that is restless and unsatisfying
- Restlessness when awake
The person may also have other physical symptoms. These can include muscle tension, upset stomach, sweating, or difficulty breathing.
Do you have trouble falling asleep at night? Or, do you go to sleep, only to wake up a few hours later and stay awake for hours at night? Well, let's today talk about insomnia. Your sleep-wake cycle is a delicate pattern run by something called circadian rhythms. These rhythms are physical, mental, and behavioral changes in your brain that roughly follow a 24-hour cycle. Your daily and nightly habits, many you learned as a child, may affect your circadian rhythms and how well you sleep at night. Poor sleep or lifestyle habits that may cause insomnia include going to bed at different times each night, daytime napping, and a poor sleeping environment such as too much noise or light. Spending too much in time in bed while you're awake can change your sleep patterns too. Likewise, working evenings or night shifts and not getting enough exercise can affect your sleep. People who use alcohol or recreational drugs may have trouble sleeping. Heavy smoking and drinking too much caffeine can also cause insomnia. And, even using some types of sleep medications a lot can cause you to lose sleep. Medical problems can cause insomnia too. People with anxiety disorders, bipolar disorder, thyroid disease, depression, and chronic pain problems may have trouble going to sleep or staying asleep. So, what do you do about insomnia? Well, it's important to remember that not everyone needs 8 hours of sleep every night. Some people do just fine on 6 hours of sleep, while others need much more. If you need more sleep, your doctor will probably ask about any medications you're taking, your drug or alcohol use, and your medical history. Spend some time thinking about your lifestyle and sleep habits. It's best to avoid caffeine and alcohol at night. If you don't exercise, starting regular exercise might help you sleep better. If you're depressed or anxious, talk to your doctor to see if relaxation techniques can help, if medication might be helpful, or if seeing a mental health provider is best. If you're suffering from bouts of insomnia, take heart. Most people can return to more normal sleep patterns when they make simple changes in their lifestyle or habits.
Exams and Tests
There is no test that can make a diagnosis of GAD. The diagnosis is based on your answers to questions about the symptoms of GAD. Your health care provider will ask about these symptoms. You will also be asked about other aspects of your mental and physical health. A physical exam or lab tests may be done to rule out other conditions that cause similar symptoms.
The goal of treatment is to help you feel better and function well in daily life. Talk therapy or medicine alone can be helpful. Sometimes, a combination of these may work best.
Many types of talk therapy may be helpful for GAD. One common and effective talk therapy is cognitive-behavioral therapy (CBT). CBT can help you understand the relationship between your thoughts, behaviors, and symptoms. Often CBT involves a set number of visits. During CBT you can learn how to:
- Understand and gain control of distorted views of stressors, such as other people's behavior or life events.
- Recognize and replace panic-causing thoughts to help you feel more in control.
- Manage stress and relax when symptoms occur.
- Avoid thinking that minor problems will develop into terrible ones.
Other types of talk therapy may also be helpful in managing symptoms of an anxiety disorder.
Certain medicines, often also used to treat depression, may be very helpful for this disorder. They work by preventing your symptoms or making them less severe. You must take these medicines every day. DO NOT stop taking them without talking with your provider. They include:
- Selective serotonin reuptake inhibitors (SSRIs) are most often the first choice of antidepressant.
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) are another choice.
Medicines called sedatives or hypnotics may also be prescribed.
- These medicines should only be taken under a health care provider's direction.
- Your provider will prescribe a limited amount of these drugs. They should not to be used every day.
- They may be used when symptoms become very severe or when you are about to be exposed to something that always brings on your symptoms.
- If you are prescribed a sedative, do not drink alcohol while on this medicine.
Other than taking medicine and going to therapy, you can help yourself get better by:
- Reducing caffeine intake
- Not using street drugs or large amounts of alcohol
- Exercising, getting enough rest, and eating healthy foods
You can ease the stress of having GAD by joining a support group. Sharing with others who have common experiences and problems can help you not feel alone. Support groups are usually not a good substitute for talk therapy or taking medicine, but can be a helpful addition.
- Anxiety and Depression Association of America --
- National Institute of Mental Health --
How well a person does depends on how severe the condition is. In some cases, GAD is long-term and is difficult to treat. Most people get better with medicine and/or talk therapy.
Depression and substance abuse may occur with an anxiety disorder.
When to Contact a Medical Professional
Contact your provider if you frequently worry or feel anxious, especially if it interferes with your daily activities.
American Psychiatric Association. Anxiety disorders. In: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing. 2013;189-234.
Calkins AW, Bui E, Taylor CT, Pollack MH, LeBeau RT, Simon NM. Anxiety disorders. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 32.
Lyness JM. Psychiatric disorders in medical practice. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 369.
National Institute of Mental Health website. Anxiety disorders.
Last reviewed on: 4/30/2022
Reviewed by: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.