Generalized Anxiety Disorder
Generalized anxiety disorder (GAD) is an anxiety disorder marked by chronic, exaggerated worrying and anxiety about everyday life. The worry is so severe that it interferes with a person's ability to live his or her life.
Anxiety may be caused by:
- An abnormal neurotransmitter system
- Environmental factors
- Developmental factors
- Psychological factors
Anxiety is more common in females. Factors that may increase the risk of GAD include:
- Family members with an anxiety disorder
- Increase in stress
- Exposure to physical or emotional trauma
- Unemployment, poverty
- Drug abuse
- Medical condition or disability
- History of self-harm as a teenager, with or without suicidal intent
Symptoms of GAD usually develop slowly. People with GAD often have both psychological and physical symptoms of anxiety.
Psychological symptoms include:
- Excessive ongoing worrying and tension
- Feeling tense or edgy
- Irritability, overly stressed
- Difficulty concentrating, forgetfulness
Physical symptoms may include:
- Muscle tension
- Difficulty sleeping
- Shortness of breath
- Heart palpitations
- Chest pain
- Choking sensation
- Abdominal discomfort
- Numbness or tingling
Symptoms of Anxiety
You will be asked about your symptoms and medical history. A physical exam will be done.
You will be asked about any medications that you are taking, including over-the-counter products, herbs, and supplements. Some medications can cause side effects similar to the symptoms of GAD. You will also be asked about any other substances that you may be using such as nicotine, caffeine, illegal drugs, prescription medications, and alcohol.
To make a diagnosis of GAD, symptoms must:
- Be present more days than not
- Be present for at least six months
- Interfere with your life such as causing you to miss work or school
If you have a mild form of GAD, your doctor will probably first have you try therapy to learn to manage anxious thoughts.
Cognitive Behavioral Therapy
During cognitive-behavioral therapy (CBT), your therapist will work with you to change your patterns of thinking. This will allow you to notice how you react to situations that cause anxiety. You will then learn to change your thinking so you can react differently. This can decrease the symptoms of anxiety.
Your therapist will teach you relaxation techniques, including deep breathing, muscle relaxation, and visualization. Learning ways to relax can help you gain control over anxiety. Instead of reacting with worry and tension, you can learn to remain calm. Your therapist may also slowly expose you to the situations that cause worry and tension. This can allow you to reduce your anxiety in a safe environment.
Joining a support group or self-help group may be beneficial. This form of support allows you to share your experiences and learn how others have coped with GAD.
Biofeedback works by attaching sensors to the body. A therapist helps you understand your body’s signals so you can use them to reduce your anxiety.
Medication can be prescribed for symptoms that are severe and make it difficult to function. Medications can help relieve symptoms so you can concentrate on getting better. It is important to note that many medications cannot be stopped quickly but need to be tapered off. Check with your doctor before discontinuing any medication.
Medications may include:
—to relax your body and keep it from tensing in response to anxious thoughts
- Note: These medications need to be monitored closely because they may cause dependence.
- Buspirone—an anti-anxiety medication that does not cause dependence
- Antidepressant medications such as selective serotonin re-uptake inhibitors (SSRIs)—to help control anxious thoughts
The following lifestyle changes may be helpful:
- Learn relaxation techniques such as deep breathing, meditation, and yoga.
- Avoid tobacco, caffeine, and drugs. These can worsen anxiety.
- Exercise on a regular basis.
- Get an appropriate amount of sleep each night.
- Identify stressful situations. Avoid them when possible.
- If you drink alcohol, do so in moderation.
There are no guidelines for preventing GAD.
Anxiety and Depression Association of America
Mental Health America
Canadian Psychiatric Association
Canadian Psychological Association
Antidepressant use in children, adolescents, and adults. US Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273. Published August 12, 2010. Accessed November 11, 2014.
Anxiety disorders. Mental Health America website. Available at: http://www.nmha.org/conditions/anxiety-disorders. Accessed November 11, 2014.
Generalized anxiety disorder. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 29, 2014. Accessed November 11, 2014.
Generalized anxiety disorder. American Academy of Family Physicians' FamilyDoctor website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/generalized-anxiety-disorder/treatment.html. Updated March 2014. Accessed November 11, 2014.
Generalized anxiety disorder (GAD). National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/health/topics/generalized-anxiety-disorder-gad/index.shtml. Accessed November 11, 2014.
Gliatto MF. Generalized anxiety disorder. Am Fam Physician. 2000 Oct 1;62(7):1591-1600. Available at: http://www.aafp.org/afp/20001001/1591.html. Accessed November 11, 2014.
9/12/2012 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Li AW, Goldsmith CA. The effects of yoga on anxiety and stress. Altern Med Rev. 2012;17(1):21-35.
11/6/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Mars B, Heron J, et al. Clinical and social outcomes of adolescent self harm: Population based birth cohort study. 2014;349:g5954.
Last reviewed December 2014 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.