Definition

Generalized anxiety disorder (GAD) causes chronic, exaggerated worrying and anxiety about everyday life. Everyone worries at times, but people with GAD can never relax and usually anticipate the worst. The intensity and pervasiveness of their worry interferes with normal functioning at school, work, and in their relationships. The worrying is often not related to anything in particular. Instead, each day provokes tension and anxiety.

People with GAD often worry excessively about health, family, work, or money. The worry is so severe that it interferes with their ability to live their lives. The anxiety can also progress to the point where people "worry about worrying." GAD usually starts in childhood or adolescence, but can also start in early adulthood. It is not unusual for GAD to start after age 20.

Causes

The exact cause of GAD is unknown. Researchers believe it is caused by a combination of genetic, environmental, developmental, and psychological factors.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors for GAD include:

  • Sex: female
  • Family member with an anxiety disorder
  • Long-term exposure to abuse, poverty, or violence
  • Low-self esteem
  • Poor coping skills
  • Smoking or other substance abuse
  • Increase in stress

Symptoms

Symptoms of GAD usually build up 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, mind going "blank"
  • Stress

Physical symptoms include:

  • Fatigue
  • Muscle tension
  • Headaches
  • Trembling
  • Difficulty sleeping
  • Restlessness
  • Shortness of breath
  • Sweating
  • Stomach ache (abdominal pain)
  • Heart palpitations
  • Choking sensation
  • Diarrhea
  • Nausea

Physical Reactions of Anxiety

Physical reaction anxiety
© 2009 Nucleus Medical Art, Inc.

People with GAD often have other anxiety disorders, depression , and/or problems with abusing alcohol or drugs.

Diagnosis

Your doctor will ask you about your symptoms and medical history, and perform a physical exam. Your doctor will also look for other medical conditions that may be causing your symptoms (eg, an overactive thyroid).

You will be asked about any medications you are taking, including over-the-counter and herbal medications. Some medications can cause side effects similar to the symptoms of GAD. Your doctor will also ask about addictive substances you may be using. These can include nicotine, caffeine, street drugs, prescription medications, and alcohol.

To make a diagnosis of GAD, symptoms must be:

  • Present more days than not
  • Present for at least six months
  • Interfering with your life (causing you to miss work or school, for example)

Treatment

If you have a mild form of GAD, your doctor will probably first have you try therapy to learn to manage anxious thoughts.

Therapies include:

Cognitive Behavioral Therapy

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.

Behavioral Therapy

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 situation that is causing the worry and tension. This can allow you to reduce your anxiety in a safe environment.

Support Groups

Joining a support or self-help group is often helpful. This form of support allows you to share your experience and learn how others have coped with GAD.

Biofeedback

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

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 can not be stopped abruptly, but need to be tapered off. Check with your doctor before discontinuing any medication.

Medications may include:

  • Benzodiazepines—to relax your body and keep it from tensing in response to anxious thoughts
    • These medications need to be monitored closely because they may cause dependence.
  • Anti-anxiety drugs—to decrease anxiety
    • Buspirone (BuSpar)—an antianxiety medicine that does not cause dependence
    • Alprazolam (Xanax)—may be prescribed for short period of time
  • Antidepressant medications (most commonly selective serotonin re-uptake inhibitors, “SSRIs”)—to help control anxious thoughts
  • Beta-blockers—may be used to help with physical symptoms of anxiety

***Please note FDA Public Health Advisory for Antidepressants:

The FDA advises that people taking antidepressants should be closely observed. For some, the medications have been linked to worsening symptoms and suicidal thoughts. These adverse effects are most common in young adults. The effects tend to occur at the beginning of treatment or when there is an increase or decrease in the dose. Although the warning is for all antidepressants, of most concern are the SSRI class such as:

For more information, please visit: http://www.fda.gov/cder/drug/antidepressants/

Prevention

There are no guidelines for preventing GAD. Early diagnosis and treatment can help symptoms from becoming debilitating. Some evidence suggests that exercise can help reduce symptoms. To further reduce anxiety symptoms, avoid caffeine, nicotine, and over-the-counter cold medications.