Generalized anxiety disorder (GAD): Symptoms, causes, and treatments

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Generalized anxiety disorder (GAD) causes feelings of intense anxiety, worry, or nervousness about everyday life. People with GAD struggle to control these feelings, and the condition tends to interfere with daily activities and personal relationships.

GAD, a type of anxiety disorder, is very common. It affects 3.1% of the population (or 6.8 million adults) in the United States in any given year. It is more common in women.

Living with anxiety can be challenging. However, like other anxiety disorders, GAD is highly treatable. Some of the most effective treatments include psychotherapy, medication, and making lifestyle changes.

In this article, we provide an overview of GAD, including its symptoms and causes. We also list some potential treatment options.

Symptoms

A person with GAD may experience uncontrollable and persistent worries, fears, and concerns.

The symptoms of GAD can vary from one individual to another.

Symptoms may get better or worse at different times. Periods of high stress or physical illness, for example, often cause symptoms to worsen for a while.

Emotional and cognitive symptoms of GAD include:

uncontrollable and persistent worries, fears, and concerns
an inability to deal with uncertainty about the future
intrusive thoughts
excessive planning and troubleshooting
difficulty making decisions
fear of making the “wrong” decision
problems concentrating
an inability to relax

Physical symptoms include:

tense or tight muscles
aches and pains
difficulty sleeping
fatigue
feeling restless, jumpy, or twitchy
digestive problems, such as nausea or diarrhea
being easily startled
excessive sweating
needing to urinate more frequently than usual

Behavioral symptoms include:

being unable to relax or spend “quiet” time alone
switching between tasks or not finishing tasks due to finding it difficult to concentrate
spending excessive amounts of time completing simple tasks
redoing tasks because they are not “perfect”
avoiding situations that trigger anxiety, including socializing with others and speaking in public
missing school or work due to fatigue, fear, or other symptoms
requiring reassurance and approval from others

The presence of other conditions

People with GAD often have co-occurring conditions. These may include:

other anxiety disorders, such as phobias, obsessive-compulsive disorder, or social anxiety
depression
drug or alcohol misuse

Diagnosis

A doctor may use a psychological questionnaire to diagnose GAD.

A doctor or mental health professional may diagnose GAD according to the criteria in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.

To receive a diagnosis of GAD, a person must have:

excessive anxiety and worry in several areas of their life on more days than not for at least 6 months
difficulty controlling these worries
at least three of the following symptoms (or just one symptom in the case of children):

restlessness
fatigue
difficulty concentrating
irritability
tense muscles
sleep problems

significant distress or problems functioning in social settings or at work

Also, these symptoms must not result from substance use or another medical condition.

To confirm a diagnosis or rule out physical conditions that may be causing symptoms, a doctor may:

perform a physical examination
take a detailed medical and family history
use a psychological questionnaire
order blood or urine tests

Causes and risk factors

The exact cause of GAD is unknown. However, it most likely occurs as a result of a combination of several factors, including:

Genetics

Having a family history of GAD increases the risk of developing it, according to some research. For example, children of people with GAD are more likely to develop the condition themselves than those whose parents do not have it.

Brain chemistry and structure

Differences in brain functioning may increase the risk of developing an anxiety disorder. People with GAD also show differences in brain structure on neuroimaging studies using functional MRI scans.

An imbalance of serotonin and other brain chemicals are also present in people with GAD and other anxiety disorders.

Personality

People who are timid or pessimistic may be more likely to develop GAD.

Some research also suggests a link between anxiety disorders and neuroticism, a personality trait wherein people view the world as unsafe and threatening.

Life experiences and environmental factors

Having a history of trauma, such as abuse or bereavement, may also contribute to GAD. In addition, having a chronic illness can increase the chance of developing an anxiety disorder, as can misusing addictive substances.

Sex

Estimates suggest that females are twice as likely as males to have GAD.

Age

GAD can affect anyone of any age. However, the chance of developing it seems to be highest “between childhood and middle age.”

Treatments

Treatment options for GAD depend on the severity of a person’s symptoms and the presence of any other conditions.

Many people require a combination of treatments, such as attending psychotherapy and making lifestyle changes. Medications may also be necessary.

Treatment options include:

Psychotherapy

Working with a therapist can help people effectively manage their symptoms. Doctors and mental health professionals with often recommend cognitive behavioral therapy (CBT) for anxiety, as it is both safe and effective.

Studies suggest that CBT reduces worry in people with GAD, with the effects being equal to those of medications and more effective 6 months after treatment completion.

Other types of therapy that show promise in treating GAD include mindfulness based therapies and acceptance and commitment therapy. This is a type of therapy that uses both acceptable and mindfulness techniques.

Medication

In some cases, a healthcare professional may recommend medication to help with the symptoms of GAD.

Several types of medication can treat GAD, including:

Antidepressants. Most commonly, doctors will prescribe selective serotonin reuptake inhibitors or serotonin and norepinephrine reuptake inhibitors for GAD. These drugs can take several weeks to work.
Buspirone. This is an antianxiety medication that reduces the physical symptoms of anxiety. Buspirone can take several weeks to take effect.
Benzodiazepines. Occasionally, doctors may prescribe a benzodiazepine for short term anxiety relief. These medications are fast acting, but they are highly addictive and may not be suitable for people with a history of addiction.

Lifestyle changes

Regular exercise may help a person keep their symptoms under control.

Making lifestyle modifications can help people keep their worries and concerns under better control. Some examples of helpful changes to make include:

exercising regularly
eating a healthful diet
reducing exposure to stressors
prioritizing issues and events
practicing mindfulness, meditation, or yoga
keeping a journal to help identify anxiety triggers and coping strategies
avoiding alcohol and drugs, and limiting or avoiding nicotine or caffeine
setting a sleep schedule to ensure 7–9 hours sleep per night

Summary

Anxiousness is a normal part of life, but excessive anxiety or worry — especially if it interferes with everyday functioning or relationships with others — can indicate an anxiety disorder.

GAD is common and highly treatable. Individuals who have concerns about their mental health should see a doctor or psychotherapist for treatment. The earlier a person seeks treatment, the better the outlook.

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