Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is a condition characterized by debilitating, excessive, unfocused worrying and anxiety. While occasional feelings of anxiety are a normal part of life, people with generalized anxiety disorder tend to experience a loss of control over their thoughts. 1

This significant anxiety can cause a person with GAD to struggle to function in important areas of life, such as socially or professionally. 2 Even everyday tasks may become difficult to complete.

In addition to prolonged and excessive feelings of anxiety, people with GAD may also experience physical symptoms, such as restlessness, muscle tension and difficulty sleeping. 3

Generalized anxiety disorder can appear at any age, but it often begins in adolescence or early adulthood. 4 GAD is generally a long-term condition, and people with this condition tend to experience fluctuations in their level of anxiety over time. 5 It is believed that around 5-10 percent of the U.S. general population are affected by generalized anxiety disorder at some point during their lifetime. 6 7 8

Treatment usually focuses on helping the person to manage the effects of GAD. Typically, a doctor will recommend treatment through psychotherapy, medication or, most often, a combination of the two. With effective treatment and support, it is often possible for an individual with GAD to manage the disorder and function effectively in everyday life. 9

Generalized anxiety disorder is a type of anxiety disorder. A number of different conditions fall under the category of anxiety disorder, each characterized by feelings of excessive anxiety, fear and/or worry. Alongside GAD, other anxiety disorders include: 4 7 10

• Panic disorder, resulting in recurrent and unexpected panic attacks, often without an established trigger.
• Social anxiety disorder, significant fear or anxiety of one or more social situations, where the person may feel scrutinized or negatively judged by others.
• Separation anxiety disorder, where a person experiences significant and persistent worry relating to the separation from or loss of, home or a significant person in their life, usually a parent or caregiver. It may be accompanied by physical symptoms including headache and stomachache. Although separation anxiety is a normal developmental stage in early childhood, it becomes a disorder in more developmentally mature children and is the most common anxiety disorder of childhood. Adults and adolescents may also suffer from this disorder, though it is much less common.
• Agoraphobia, an intense fear of situations where help or escape are perceived as being difficult, such as crowded places, enclosed spaces, moving vehicles or remote spaces.
• Specific phobias, intense fear or anxiety about a specific object or situation. Examples of common phobias are spiders, heights, flying and injections

Although each of these disorders can result in feelings of anxiety and fear, they are distinct conditions that may require different approaches and treatment. Generalized anxiety disorder is characterized by excessive anxiety that is either nonspecific, or focuses on certain general themes, such as work, health or safety. 7

Good to know: Obsessive compulsive disorder (OCD), acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) are no longer considered anxiety disorders, although they are closely related. 4

The most common and troublesome symptom of generalized anxiety disorder is persistent, invasive, and uncontrollable anxiety or worry. Unlike other types of anxiety disorder, people with GAD can experience anxiety around any issue or situation.

Anxiety-related signs to look out for that may indicate GAD include: 3 9 7

• Excessive anxiety and worry that is present on more days than not, for six months or longer
• Anxiety that significantly interferes with daily life, affecting things such as attention to tasks and normal social and occupational functioning
• Anxiety or worry that is stronger than is appropriate for the situation
• Anxiety or worry that is focused on various events or activities
• Difficulty controlling the feelings of anxiety
• Worries that may change over time
• Physical manifestations of anxiety, such as restlessness, muscle tension, irritability and sleep disturbances

The levels of anxiety experienced often fluctuate and can intensify during times of stress, e.g. new job, moving house, relationship changes. Common areas that can cause anxiety in a person with GAD include: 9

• Work
• Health
• Family and other relationships
• Safety
• Finances

Worried you may be experiencing generalized anxiety disorder? Download the free Ada app to carry out a symptom assessment.

The presentation of generalized anxiety disorder is consistent across all ages, with both children and adults experiencing similar symptoms. However, children generally experience more physical symptoms than adults and often have complaints such as stomachache or headache. Additionally, the focus of the anxiety often differs between age groups. For example, while adults are more likely to worry about the wellbeing of themselves and their family, children and adolescents with generalized anxiety disorder tend to worry more about: 11 12

• Academic performance
• Sporting events at school
• Natural disasters

Children with GAD may also appear overly perfectionistic, self-critical or reassurance-seeking. This can be a defence mechanism against concerns they are feeling relating to their own self-worth and performance. 11

Furthermore, adolescents tend to experience more severe symptoms than adults or children.

Good to know: Children with GAD can often present with physical complaints and irritability as significant symptoms. However, these are symptoms of pediatric anxiety disorders in general and are not specific to GAD. 13

GAD is a common disorder, believed to affect around 5-10 percent of people in the U.S. at some point during their lives. 6 7 8 However, despite its prevalence, GAD’s exact cause is still unknown.

Although some people may develop generalized anxiety disorder for no apparent reason, there are a number of risk factors which are believed to play a role in causing generalized anxiety disorder. These include: 3 4 9 7 11 14 15 16

• Gender. Women are twice as likely to be diagnosed with GAD as men, though this difference may be the result of the underdiagnosis of men
• Genetics. Having a predisposition towards GAD can run in families
• Age. The median age at onset for GAD is 30 years old, which is later than other anxiety disorders. However, a very broad range exists for the age of onset. GAD may develop gradually, beginning at a younger age and presenting initially as an anxious temperament.
• Substance abuse. Alcohol and drug abuse often occur simultaneously with GAD. An anxiety disorder that is believed to have resulted due to substance or medication intake is often referred to as a substance/medication-induced anxiety disorder.
• Mental health. People with GAD commonly suffer from other anxiety conditions, as well as depression.
• Stress. Stressful life experiences, such as the death of a family member may contribute towards the condition. This is also true for continual stressors relating to ongoing situations, such as working in a high-pressure environment

The role of genetics and environment as contributing factors for the development of anxiety disorders is an ongoing area of research. However, it is generally believed that there is no single cause of generalized anxiety disorder, and instead, it occurs as a combination of biological and social factors. 4 7

Diagnosis of generalized anxiety disorder may be made by a doctor or psychologist following an assessment of the person’s symptoms and personal history. There are specific clinical criteria to help diagnose generalized anxiety disorder. 2 This can help doctors to differentiate GAD from normal feelings of anxiety that arise in everyday life, as well as from other conditions that may be causing the symptoms.

In order to receive a diagnosis of GAD, a person must exhibit a specific set of symptoms in addition to: 2 7 8

• Excessive, nonspecific anxiety that is difficult to control and has occurred on more days than not during a six month period

Affected people must also display three or more of the following symptoms:

• Restlessness
• Muscle tension
• Difficulty sleeping
• Fatigue
• Difficulty concentrating
• Irritability

Even if the requisite symptoms are present, a doctor may suggest further tests before making a diagnosis to exclude other possible causes of the symptoms. These tests can include physical examination and blood tests.

Other conditions and substances can cause similar symptoms to GAD. Therefore, a doctor will need to exclude the following prior to making a diagnosis of GAD: 7 17 18

• Other anxiety disorders, such as panic disorder, social anxiety disorder, separation anxiety disorder, agoraphobia and specific phobias
• Other mental health disorders, including depression, schizophrenia, obsessive compulsive disorder (OCD), acute stress disorder and post-traumatic stress disorder (PTSD)
• Dementia
• Hyperthyroidism
• Substance abuse
• Prescription medication side-effects

Good to know: It is important for doctors to rule out other possible causes of anxiety, as the precise contributing factors are likely to influence the recommended treatment methods.

If you think you may have generalized anxiety disorder, you can share your symptoms and begin your personal health assessment using the free Ada app.

The treatment of generalized anxiety disorder usually involves a combination of psychotherapy and medication, 4 with treatment aimed at managing the symptoms of the disorder.

While some people make a full recovery, for most people GAD is a long-term condition that requires ongoing management with psychotherapy and/or medication. This usually allows people with the disorder to lead an otherwise healthy life. 19

Psychotherapy is a psychology-based treatment method that is often referred to as talk therapy. 20 There are a number of different types of psychotherapy, some of which can be used in the treatment of generalized anxiety disorder.

CBT is a form of psychotherapy that is often used in the treatment of generalized anxiety disorder. 9 Treatment using CBT takes place over a number of sessions, during which a trained psychologist or psychiatrist discusses a person’s problems with them. Thought processes that are contributing to anxiety are identified, and suggestions are made and discussed to help the person deal with these negative thoughts and behaviors. CBT can be carried out one on one, or in a group setting. 19

CBT aims to equip people with skills and strategies to enable them to: 21

• Recognize harmful or irrational thoughts and behaviors
• Gain control of negative thought processes using specific stress management techniques
• Alter negative behaviors accordingly

Doctors often prescribe medication to people with generalized anxiety disorder, usually in addition to psychotherapy, as the combination of the two has been suggested to be more effective than medication alone. However, the efficacy of combining medication and psychotherapy to treat GAD is an ongoing area of research. 22

Antidepressants, often used to treat depression, can also be beneficial in the treatment of GAD. Two types of antidepressant medication often used to treat GAD are selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). 8 Buspirone, a type of drug that also affects serotonin levels in the brain, has also been shown to be effective at reducing symptoms of GAD. 23

SSRIs, SNRIs and buspirone medication can take at least two weeks to begin working. Benzodiazepines, another type of anti-anxiety medication , are sometimes prescribed on an urgent basis to manage anxiety symptoms in the short-term. Benzodiazepines, however, are not a suitable long-term treatment option, as they very often lead to drug dependency. 7

Various self-help techniques can be used to help manage the symptoms of generalized anxiety disorder. However, these self-help measures are best used as part of a controlled treatment plan, and are often suggested by a doctor alongside psychotherapy and/or prescription medication. 24

Possible self-help techniques include: 1 24 25

• Exercise
• Healthy diet
• Meditation
• Relaxation techniques, including controlled breathing and muscle relaxation

A reliable source of emotional support may also help ease stress. A support person may also help a person with GAD recognize the signs of worsening anxiety and support the person in seeking appropriate help. Emotional support may come from family, friends or even support groups. However, this is not a replacement for psychotherapy or prescription medication. 9

Good to know: Once treatment has begun, the progress of people with generalized anxiety disorder will be regularly monitored. The frequency of this depends on the severity of the disorder as well as the chosen treatment methods, but often starts with reviews every four to eight weeks. 24 These reviews allow healthcare professionals to track the success of the chosen treatment methods and, if they are not suitably effective, potentially modify the approach. 25

Although research has provided some evidence that the risk of developing generalized anxiety disorder can be minimized in certain groups, anxiety prevention is a relatively new field of research, and studies are still ongoing. 6 26

• GAD
• Anxiety disorder
• Generalised anxiety disorder

Q: What are the main symptoms of generalized anxiety disorder?
A: The main symptom of GAD is anxiety that is excessive and difficult to control. The source of the anxiety can be anything, but worries around general areas such as work, health and relationships are common. Other symptoms of GAD that may accompany the feelings of anxiety, include:

• Restlessness
• Muscle tension
• Difficulty sleeping
• Fatigue
• Difficulty concentrating
• Irritability

A person with GAD may also display physical signs linked to their feelings of anxiousness, such as sweating, trembling and increased heart rate.

Q: Is there a test to check for generalized anxiety disorder
A: Although there is not a single test that will confirm the diagnosis of GAD, there is specific diagnostic criteria that is based on the presence of certain signs and symptoms. This diagnostic criteria usually allows doctors to make a diagnosis of generalized anxiety disorder based on a clinical evaluation of a person’s symptoms.

It is important, however, to differentiate GAD from other types of anxiety disorders as well as any other factors that may be causing or contributing to anxiety, e.g. depression or drug misuse. A doctor may therefore suggest additional tests, such as physical examination and blood tests to exclude other possible causes.

Q: Are there different types of anxiety disorders?
A: Yes, there are a number of different types of anxiety disorders of which generalized anxiety disorder is one. Other types of anxiety disorders are:

• Panic disorder
• Social anxiety disorder
• Separation anxiety disorder
• Agoraphobia
• Specific phobias

Each of these anxiety disorders is a distinct condition that requires its own approach and management.

Q: Can medication be used to treat generalized anxiety disorder?
A: Yes, medication is often used to treat GAD and is generally prescribed alongside a program of psychotherapy. Combining the two treatment methods aims to help the affected person both manage their symptoms as well as address their negative thought and behavior patterns.

Q: Can children have generalized anxiety disorder?
A: Yes. GAD is the most common anxiety disorder in children. The symptoms experienced by children may be similar to those of adults, but children tend to have more physical symptoms, and their anxiety focuses on different themes than adults, such as school performance. Treatment of childhood generalized anxiety disorder is usually accomplished through psychotherapy and, potentially, also prescription medication. 27

Research into pediatric anxiety disorders has shown a genetic link in the disorders, where a child of a parent that suffers from an anxiety disorder, is more likely to suffer from an anxiety disorder themselves. However, both genetic and environmental factors can place a child at higher risk of developing GAD.

Q: Are generalized anxiety disorder and depression related?
A: Although generalized anxiety disorder and depression are two separate conditions, there is the high possibility of a person with one of these disorders to develop the other. This is due to the similarities in brain abnormalities that causes similar symptoms in both conditions. 28 Such symptoms include restlessness, fatigue, difficulty concentrating and difficulty sleeping. 29

There are, however, some key differences between the two. People with GAD tend to feel anxious about the future, whereas people with depressive disorders are more likely to be past-oriented. Furthermore, mood swings and suicidal thoughts are uncommon in GAD, but are common in people with depressive disorders. 7

If you are concerned you may have symptoms of anxiety or depression, you can use the Ada app to carry out a free symptom assessment.