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Generalized Anxiety Disorder

(GAD)

Definition

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 their life.

Causes

GAD may be caused by:

  • An abnormal neurotransmitter system
  • Genetics
  • Environmental factors
  • Developmental factors
  • Psychological factors

Risk Factors

GAD is nearly twice as common in women than in men. Other factors that may increase your chances of GAD:

  • 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

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
  • Lightheadedness
  • Trembling
  • Difficulty sleeping
  • Restlessness
  • Shortness of breath
  • Sweating
  • Heart palpitations
  • Chest pain
  • Choking sensation
  • Abdominal discomfort
  • Diarrhea
  • Nausea
  • Numbness or tingling

Symptoms of Anxiety
Physiological effects of anxiety

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People with GAD often have other anxiety disorders, depression, and/or substance use disorders.

Diagnosis

You will be asked about your symptoms and medical history. A physical and psychiatric exam will be done. Conditions with similar symptoms will be evaluated. Blood and urine tests may 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 6 months
  • Interfere with your life such as causing you to miss work or school

You may be referred to a psychotherapist for further evaluation.

Treatment

Counseling with or without medicine can help to manage GAD symptoms. It can ease impact on day-to-day life.

Counseling

There are many types of treatment for GAD. The choice will be based on specific needs by may include one or more of the following:

  • Cognitive-behavioral therapy(CBT)—works to change patterns of thinking. This will allow you to notice what is causing anxiety and how to change reaction to it. This can decrease the symptoms of anxiety.
  • Psychodynamic therapy—talk therapy to address negative feelings and buried emotions that affect daily life.
  • Mindfulness meditation—tool that helps to slow racing thoughts and calm mind and body. Regular practice can ease tension. It may also help during events that cause anxiety.
  • Relaxation therapy—steps such as deep breathing, muscle relaxation, and visualization that can ease tension. Learning ways to relax can help you gain control over anxiety. Instead of reacting with worry and tension, you can learn to remain calm.
  • Acceptance-based therapy—action-based therapy. It starts with acceptance of issues and commitment to make changes in behavior.

Medicine

Medicine may be recommended if symptoms are debilitating. It may help with work in counseling. The length of time on medicine will depend on how severe symptoms are. Medicine choices may include:

  • Antidepressant, such as selective serotonin reuptake inhibitors (SSRIs)
  • Buspirone
  • Benzodiazepines

The risks and benefits of medicine will be weighed when making treatment plan. Some types may cause dependence.

Other Steps

Some habits may help to ease tension. They may be used as part of overall treatment.

  • Regular exercise
  • Getting enough sleep every night
  • Staying away from tobacco, caffeine, and drugs which can increase anxiety
  • Progressive muscle relaxation
  • Yoga

Strong social support may also help or be an important part of therapy.

Prevention

There are no current guidelines to prevent GAD because the cause is unknown.

RESOURCES:

Anxiety and Depression Association of America
https://adaa.org

Mental Health America
http://www.mentalhealthamerica.net

CANADIAN RESOURCES:

Canadian Psychiatric Association
https://www.cpa-apc.org

Canadian Psychological Association
https://cpa.ca

REFERENCES:

Anxiety disorders. National Institute of Mental Health website. Available at: https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml. Updated July 2018. Accessed May 8, 2020.

Anxiety Treatment. Anxiety and Depression Association of America website. Available at: https://adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad/treatments. Accessed May 8, 2020.

DeMartini J, Patel G, Fancher TL. Generalized Anxiety Disorder. Ann Intern Med. 2019 Apr 2;170(7):ITC49-ITC64.

Generalized anxiety disorder. EBSCO DynaMed Plus website. Available at: https://www.dynamed.com/condition/generalized-anxiety-disorder/. Updated November 13, 2020. Accessed May 8, 2020.

Locke AB, Kirst N, Shultz CG. Diagnosis and management of generalized anxiety disorder and panic disorder in adults. Am Fam Physician. 2015 May 1;91(9):617-24

11/6/2014 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T114697/Generalized-anxiety-disorder: Mars B, Heron J, Crane C, et al. Clinical and social outcomes of adolescent self harm: population based birth cohort study. BMJ. 2014;349:g5954.

Last reviewed November 2019 by EBSCO Medical Review Board Adrian Preda, MD  Last Updated: 5/8/2020