Generalized Anxiety Disorder

Anxiety disorders are the most common emotional disorder and affect more than 25 million Americans.

Generalized anxiety disorder (GAD) is a mental health condition in which a person is often worried or anxious about many things and finds it hard to control this anxiety.

Fear and anxiety are part of life, but GAD involves more than temporary worry or fear. For people with GAD, the anxiety does not go away and it gets worse over time. People may have chest pains or nightmares, or they may even be afraid to leave home. In many cases, GAD occurs along with other anxiety or mood disorders. GAD has symptoms that are similar to panic disorder, obsessive-compulsive disorder, and other types of anxiety, but they are all different conditions.

People with GAD have ongoing, severe tension that interferes with daily functioning. They worry constantly and feel helpless to control these worries. The worries often focus on job responsibilities, family health, or minor matters such as chores, car repairs, or appointments. They may have problems sleeping, muscle aches or tension, feel shaky and weak, and have headaches. People with GAD can be irritable and often have problems concentrating and working effectively.

In most cases, GAD improves with medications or talk therapy (psychotherapy). Making lifestyle changes, learning coping skills and using relaxation techniques also can help.

GAD symptoms can vary. The main symptom is frequent worry or tension for at least 6 months, even when there is little or no clear cause. Worries seem to float from one problem to another. Problems may involve family, other relationships, work, school, money, and health. Even when aware that worries or fears are stronger than appropriate for the situation, a person with GAD still has difficulty controlling them.

Other symptoms of GAD include:

• Persistent worrying or obsession about small or large concerns that's out of proportion to the impact of the event
• Inability to set aside or let go of a worry
• Inability to relax, restlessness, and feeling keyed up or on edge
• Difficulty concentrating, or the feeling that your mind "goes blank"
• Worrying about excessively worrying
• Distress about making decisions for fear of making the wrong decision
• Carrying every option in a situation all the way out to its possible negative conclusion
• Difficulty handling uncertainty or indecisiveness
• Physical signs and symptoms may include:
• Fatigue
• Irritability
• Muscle tension or muscle aches
• Trembling, feeling twitchy
• Being easily startled
• Trouble sleeping
• Sweating
• Nausea, diarrhea or irritable bowel syndrome
• Headaches

Symptoms in children and teenagers can differ from those in adults. In addition to the symptoms above, children and teenagers who have GAD may have excessive worries about:

• Performance at school or sporting events
• Being on time (punctuality)
• Earthquakes, nuclear wa,r or other catastrophic events

A child or teen with GAD may also:

• Feel overly anxious to fit in
• Be a perfectionist
• Redo tasks because they are not perfect the first time
• Spend excessive time doing homework
• Lack confidence
• Strive for approval
• Require a lot of reassurance about performance

GAD can also lead to or worsen other mental and physical health conditions, such as:

• Depression (which often occurs with generalized anxiety disorder)
• Substance abuse
• Trouble sleeping (insomnia)
• Digestive or bowel problems
• Headaches
• Heart-health issues

The exact cause of GAD is unknown, but areas of the brain that control fear responses may have a role in some anxiety disorders. Anxiety disorders can run in families, which suggests that a combination of genes and environmental stresses can contribute to anxiety disorders, including GAD.

There is no test that can diagnose GAD. The diagnosis is based on your answers to questions about the symptoms of GAD. Your health care provider will ask about these symptoms and will likely ask you about other aspects of your mental and physical health. GAD is diagnosed when a person worries excessively about a variety of everyday problems for at least 6 months.

A physical exam or laboratory tests may be done to rule out other conditions that cause similar symptoms.

With proper treatment, many people with GAD lead normal, fulfilling lives. The goal of treatment is to help you feel better and function well in daily life. In less severe cases, talk therapy or medication alone can be helpful. In more severe cases, a combination of these may work best.

You should feel comfortable talking with the mental health professional you choose. If you do not, you should seek help elsewhere. Once you find a clinician with whom you are comfortable, you will work together to create an individualized treatment plan for your anxiety disorder.

Some people with GAD might benefit from joining a self-help or support group and sharing their problems and achievements with others. Talking with a trusted friend or family member can also provide support, but it is not necessarily a sufficient alternative to care from an expert clinician.

Self-care is also important in GAD, and other than taking medicine and going to therapy, you can help yourself by:

• Reducing caffeine intake
• Not using illegal drugs
• Exercising, getting enough rest, and eating healthy foods

GAD is treatable and most people respond well to GAD is generally treated with psychotherapy, medication, or both.

Treatment can provide significant relief from symptoms, but it does not always provide a complete cure.

Medications that reduce the symptoms of GAD include:

• antidepressants such as buspirone (Wellbutrin), duloxetine (Cymbalta), escitalopram (Lexapro), paroxetine (Paxil), protriptyline (Vivactil), and venlafaxine (Effexor XR)
• anti-anxiety drugs such as alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan)

Psychotherapy involves talking with a trained clinician, such as a psychiatrist, psychologist, social worker, or counselor, to understand the symptoms and triggers of an anxiety disorder and how to manage it. It can be useful in treating anxiety disorders by helping people change the thinking patterns that support the fears and anxieties and changing the way they react to anxiety-provoking situations.