Worrying is a part of life. It’s natural to worry about the stressful things in our lives. But what happens when that worry becomes invasive and persistent? For people with generalized anxiety disorder (GAD), worrying can take over their lives, becoming excessive and exaggerated.
A person with GAD doesn’t simply have rational worries based on actual risk—they worry regardless of outside stressors, exaggerate the perceived level of risk, and cannot rationalize away the worry.
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What Is Generalized Anxiety Disorder?
Affecting about 6.8 million adults—or 3.1% of the U.S. population—in any given year, GAD is a common mental illness that is characterized by an excessive, chronic worry that interferes with a person’s ability to function normally.
People with GAD do not have a focused fear of a specific nature, such as found with a phobia, but rather their anxiety is spread out or changes from one thing to another repeatedly.
For example, someone without GAD may notice that a friend has not answered their text and make a mental note to follow up with them. Someone with GAD may see this unanswered text and picture their friend hurt or even dead from an accident. They may wonder if their friend is angry with them, or does not want to continue their friendship. They are likely to check and recheck their phone constantly until that friend answers the text.
Often times, a person with GAD is aware that their fear is irrational or disproportionate to the situation, but cannot turn off the worry. Because the anxiety is not based in reality, confronting it with logic or reassurance is not enough to quell it.
Is My Worrying Normal?
A person with GAD may be worried about the same things as a person without GAD, but they take that worry to the extreme.
Paradoxically, for many people with GAD, worrying feels productive. Though they usually recognize it as magical thinking, people with GAD can feel like worrying wards off bad things from happening, and that if they stop worrying about it, their fears will come true.
GAD is exhausting mentally and physically. It impacts nearly every aspect of a person’s life, and can be very overwhelming.
Symptoms
To meet the DSM-5’s criteria for GAD, the following must be met:
- Excessive anxiety and worry about a number of activities or events, occurring more days than not for at least 6 months
- Difficulty controlling your worry
- Three (or more) of the following six symptoms (one or more for children), with at least some symptoms having been present for more days than not for the past 6 months:
- Restlessness, feeling keyed up or on edge
- Being easily fatigued
- Difficulty concentrating or mind going blank
- Irritability
- Muscle tension
- Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep)
- Significant distress or impairment in social, occupational, or other important areas of functioning, caused by worry or anxiety
- Symptoms are not caused by a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism)
- Symptoms are not better explained by another mental illness or disorder
Some other symptoms of GAD include:
- Nervousness or irritability
- Feeling a sense of impending danger, panic, or doom
- Increased heart rate
- Hyperventilation (rapid breathing)
- Sweating
- Trembling
- Feeling weak or tired
- Difficulty concentrating
- Gastrointestinal (GI) problems
- Muscle tension, headaches, and other unexplained pains
It’s important to note the differences between typical worrying with the disordered worrying that comes with GAD.
Anxiety Triggers Are Not Universal
Both children and adults can experience excessive worry about any area, activity, or concept—or they may experience feelings of anxiety not attached to anything specific. These triggers also do not have to be logical or make sense to other people.
People with GAD may engage in behaviors to try to control their excessive worrying, such as:
- Avoiding news on TV, online, or in newspapers
- Limiting or skipping out on participation in activities that cause them worry
- Seeking excessive reassurance or approval (particularly in children).
- Over-planning or preparing
- “Rehearsing” or replaying scenarios in their mind
Diagnosis
GAD is more often diagnosed and treated by family physicians and primary care providers than by psychiatrists.
To determine a diagnosis of GAD, your health care provider may:
- Do a physical exam to look for signs that your anxiety might be linked to medications or an underlying medical condition
- Order blood tests, urine tests, or other tests, if another medical condition is suspected
- Ask detailed questions about your symptoms and medical history
- Use psychological questionnaires to help determine a diagnosis
- Use the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association
Is It GAD, Or Something Else?
Generalized anxiety disorder can mimic other psychiatric disorders and vice versa. As well, GAD often occurs at the same time as other psychiatric disorders (this is called comorbidity). It’s important to get a comprehensive diagnosis in order to make a treatment plan that addresses your unique needs.
Causes
Scientists are not yet sure of the specific causes of GAD, but they believe it arises from a combination of biological and environmental factors. These might include:
- Differences in brain chemistry and function
- Genetics
- Differences in the way threats are perceived
- Development and personality
Risk Factors
- Gender: Women are diagnosed with GAD more often than men.
- Age: GAD can develop at any time, but the risk is highest between childhood and middle age.
- Personality: Those who are timid or have a negative temperament, or those who are very cautious/danger averse may be more prone to generalized anxiety disorder.
- Genetics: GAD appears to run in families.
- Experiences: A history of significant life changes, traumatic or negative experiences during childhood, or a recent traumatic or negative event may increase the risk of developing GAD. Chronic medical illnesses or other mental health disorders may also increase risk.
Treatment
As with any psychiatric disorder, finding a successful treatment for GAD can take some trial and error. What works for one person with GAD may not work as well as another treatment for someone else with GAD. If the first treatment you try is not successful or has side effects you can’t tolerate, don’t assume your GAD is untreatable—go back to your health care provider with your concerns and work together to try a new plan.
GAD is primarily treated with either therapy, medication, or a combination of both.
Therapy
The most common form of therapy used to treat generalized anxiety disorder is cognitive-behavioral therapy (CBT). CBT helps analyze the way we think in order to recognize and correct distortions. Using CBT, people with GAD can change their automatic thinking processes that lead to anxiety and replace them with healthier ways of thinking.
The five components of CBT for anxiety are:
- Education: Before re-training your thinking processes, it’s important to learn both how anxiety works and how the process of CBT works. In this stage, you will focus on gaining an understanding of GAD and how it affects your thinking and your behavior. You will also learn what to expect from CBT treatment.
- Monitoring: You will be taught ways to monitor your anxiety. What triggers it? What specific things do you worry about? How intense are your episodes and for how long do they last? Monitoring your anxiety gives you an overall view of what GAD looks like for you. Being aware of how your anxiety manifests and what triggers it will help you implement ways to change it. It may help to keep a diary for this part of therapy.
- Physical control strategies: Anxiety elicits a “fight or flight” response. In this stage of CBT, you will learn techniques to combat this physical over-arousal.
- Cognitive control strategies: This is where the “thinking about thinking” comes in. These strategies help you to realistically examine and evaluate the thinking patterns that contribute to GAD, and alter them to be more productive. Challenging these negative thoughts helps to lower your anxiety.
- Behavioral strategies: Avoidance is a common reaction to anxiety, but not usually a productive one. This stage focuses on learning to tackle your anxiety and face your fears head-on instead of avoiding the things that make you anxious.
Medication
The medications prescribed for generalized anxiety disorder are often the same ones prescribed for other mental illnesses or medical conditions.
Be Careful of Interactions
Medications used to treat anxiety can have negative effects when taken with some other medications. This includes some herbal and “natural” treatments. Always tell your health care provider and your pharmacist what other medications—prescription or not—you are taking.
These medications can also interact with alcohol. Check with your health care provider or pharmacist about whether or not it is safe to drink alcohol while taking your medication.
Antidepressant drugs
These drugs act on neurotransmitters involved in many regions of the brain that affect anxiety, mood, and arousal.
Selective serotonin reuptake inhibitors (SSRIs) prescribed for anxiety include:
- Fluoxetine (Prozac)
- Sertraline (Zoloft)
- Citalopram (Celexa)
Serotonin-norepinephrine reuptake Inhibitors (SNRIs) may also be prescribed. They include:
- Venlafaxine (Effexor)
- Duloxetine (Cymbalta)
Sometimes an antidepressant works well for GAD symptoms but has side effects. Common side effects of antidepressants might include, but are not limited to:
- Sexual problems
- Weight gain
- Insomnia
Buspirone
Buspirone (BuSpar) is an anti-anxiety medication that works using a different mechanism than SSRIs and SNRIs.
Buspirone may not be effective at a low dose. Higher (therapeutic) doses may be more effective, but can also cause more side effects.
Some common side effects of buspirone include:
- Nausea
- Headache
- Changes in dreams
- Feeling dizzy
- Drowsiness
- Lightheadedness
Tricyclic antidepressants
Some people with GAD find tricyclic antidepressants work better for them than other medications.
These medications may be prescribed:
- Imipramine (Tofranil)
- Nortriptyline (Pamelor)
- Desipramine (Norpramin)
- Clomipramine (Anafranil)
For some people, tricyclic antidepressants have unpleasant side effects like:
- Dizziness
- Constipation
- Blurred vision
- Trouble urinating
Others find they tolerate the side effects of tricyclic antidepressants better than other types of medication.
Never Stop Treatment “Cold Turkey”
Many medications used to treat mental illness, including ones for GAD, can have side effects when stopped abruptly. Some of these side effects can be serious. Always consult your health care provider before stopping your medication. Your provider can help you make a plan to taper off.
Over time, generalized anxiety is associated with an increased risk of developing or worsening:
- Digestive or bowel problems, such as irritable bowel syndrome or ulcers
- Headaches and migraines
- Chronic pain and illness
- Sleep problems and insomnia
- Heart-health issues
GAD often occurs alongside other mental illnesses, including:
- Phobias
- Panic disorder
- Post-traumatic stress disorder (PTSD)
- Obsessive-compulsive disorder (OCD)
- Depression
- Suicidal thoughts or suicide
- Substance abuse
These coexisting conditions can make treatment more difficult, but not impossible.
Help Is Available
If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor.
If you or a loved one are in immediate danger, call 911.
For more mental health resources, see our National Helpline Database.
Treatment success varies by person and both therapy and medication can take a while to become effective. If you don’t notice an improvement right away, give it a little bit. Your health care provider can give you an idea of how long to wait before trying something else. Your provider is likely to want you to come in for regular follow-ups when you begin a new medication until you reach a type and dose that works well for you.
If at any time you feel your treatments are no longer as effective, talk to your health care provider to see if adjustments can be made.
Coping
While treatment such as therapy and/or medication is often needed to manage GAD, there are lifestyle changes you can make to help ease some of your anxiety and support your treatment plan.
- Make connections with others: Reach out to friends or join a support group. Having the company and support of others can ease anxiety.
- Learn how to self-soothe: When you are in a moment of high anxiety, engaging your senses can help ground you. These senses include look, listen, smell, taste, tough, and move.
- Relaxation techniques: Practicing things like deep breathing, progressive muscle relaxation, and meditation. helps to fight the physical responses your body has to anxiety.
- Health body habits: Eat healthy foods, get enough sleep, and avoid or limit substances that may aggravate your anxiety.
- Get organized: Seek help early, keep a journal or diary, and prioritize your needs.
A Word From Verywell
GAD can be difficult and frightening to live with. If you are feeling the effects of GAD, see your health care provider right away. While finding the right treatment might take a bit of work and experimentation with the help of your health care provider, GAD can be managed, and living a life free of excessive and intrusive anxiety is possible.
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