Generalized Anxiety Disorder

Do you tend to worry unnecessarily all day? Do you feel anxious or tense excessively? Although some anxiety can be healthy, Generalized Anxiety Disorder (GAD) can severely affect your life and mental health.

What Is Generalized Anxiety Disorder (GAD)?

It is an anxiety disorder which involves irrational, uncontrollable and extreme worrying about actions, events and experiences. GAD can significantly affect a person’s ability to function in daily life as they keep worrying excessively about relationships, career, finances, family, and health problems. It is often characterized by extreme worrying, insomnia, muscle tension, restlessness, difficulty concentrating, irritability and fatigue. “Generalized anxiety disorder typically involves intense and repeated worry that impairs the ability of the patient to function normally in daily life,” explains MindJournal.

GAD is a chronic state of extreme worry, fear and anxiety that must persist for at least 6 months in order to be formally diagnosed, according to the National Institute of Mental Health (NIMH). The anxiety caused by this disorder can often adversely affect different aspects of the sufferer’s life like education, career, social and interpersonal relationships. People with this mental health condition are usually unable to control their worry and anxiety. As they tend to anticipate disaster, they worry about things more than necessary and expect the worst possible outcomes without any apparent reason.

Prevalence Of GAD

Nearly 20% of people 1 across the globe experience anxiety disorders. The Anxiety and Depression Association of America (ADAA) shows that around 3.1% of the American population or 6.8 million U.S. adults are affected by generalized anxiety disorder each year. Women are more likely to have this condition than men. Reports 2 reveal that 3.4% of women were affected by GAD during 2001-03, whereas only 1.9% of men had this disorder. Moreover, around 5.7% of adults in the U.S. experience GAD once in their lifetime.

One report from Harvard Health states that “prevalence of this disorder increases with age. Generalized anxiety disorder usually first appears from young adulthood through the mid-50s – a later onset than seen with other psychiatric disorders.” According to the Harvard Health report, GAD can often develop along with other mental disorders. Around 66% of patients with GAD suffer from major depression, while 25% of sufferers experience panic disorder. Moreover, alcohol and substance use is also common among people with generalized anxiety disorder.

How GAD Affects Us

Generalized anxiety disorder is different from general feelings of anxiety. All of us feel anxious and worried at times. Anxiety and fear protect us and keeps us safe in dangerous situations. Worrying about the future enables us to prepare for unforeseen circumstances and ensure our survival. However, sometimes such feelings can become overwhelming and people can start to worry about anything and everything constantly. “If fears and anxiety overshadow everything else and don’t go away, the person may have developed generalized anxiety disorder (GAD),” explains a 2008 study 3. It adds “People with generalized anxiety disorder usually realize that their fears are exaggerated, but they aren’t able to control them.”

Most of the time, sufferers start worrying without any provocation which makes it difficult for them to get through the day. Even though sufferers may realize that their concerns are unnecessary and unwarranted, people suffering from GAD can find it hard to shake off their worries and relax. Moreover, severe worries often lead to certain physical symptoms like headaches, sweating, lightheadedness, trembling and shortness of breath. They are also prone to experience nausea, depression and substance use. It also affects their performance in school and work which results in further anxiety. Their overwhelming and frightening feelings can also interfere with relationships as well.

GAD is physically, mentally and emotionally exhausting. It wears the mind and drains the sufferer’s energy. Although they may worry about normal things, their anxiety and worry are exaggerated to such high levels that they become unable to break free from the cycle of chronic worrying. Moreover, it can also increase the risk of depression, heart diseases and other physical health conditions. People can develop this condition either as a child or as an adult. Overcoming generalized anxiety disorder can be a long and challenging process, but treatment can help you learn helpful coping skills and relieve symptoms.

Distinguishing Generalized Anxiety Disorder From Other Conditions

As anxiety is one of the most common symptoms for a number of mental health conditions, GAD can often be confused with other disorders, like –

  • Depression
  • Panic disorder
  • Obsessive-compulsive disorder
  • Other phobia-related disorders


However, all these conditions are separate and should be diagnosed and treated differently. People with GAD feel anxious about various things for more than 6 months. Although they may be unable to recognize the source of their anxiety, they can be aware that it is irrational. However, they may not be able to control thoughts and emotions.

Symptoms Of GAD

According to a recent research paper 4, excessive worry is one of the most prominent symptoms of generalized anxiety disorder. But it can also be “accompanied by many non-specific psychological and physical symptoms.” Anxiety and fear are the most common emotional symptoms of GAD, while insomnia, rapid breathing and muscle tension are common physical symptoms. As sufferers often feel fear, worry and anxiety about anything and as these emotions are not tied to any specific situations, it is known as “generalized” anxiety. It should be noted that if you feel anxious only in specific situations, then it may not be GAD. Contrary to popular belief, panic attacks and sudden fear are not signs of GAD, although a sufferer may experience such symptoms.

Generalized anxiety disorder often develops gradually and may have the following physical and emotional signs and symptoms:

1. Physical symptoms

  • Difficulty sleeping or staying asleep
  • Exhaustion & fatigue
  • Shaking & trembling
  • Muscle tension
  • Frequent stomach aches or unexplained pains
  • Heart palpitations
  • Sweating or sweaty palms
  • Headaches
  • Hot flashes
  • Nausea, dizziness, vomiting & diarrhoea
  • Difficulty swallowing
  • Going to the bathroom repeatedly
  • Changes in appetite
  • Neurological symptoms like tingling or numbness in the body

2. Emotional symptoms

  • Excessive, constant worry & tension about everyday things
  • Feelings of nervousness
  • Restlessness
  • Irritability
  • Difficulty concentrating
  • Unrealistic perspective on issues
  • Being startled easily
  • Feelings of dread & doom
  • Trouble controlling emotions
  • Difficulty relaxing

Children, teens and adults suffering from generalized anxiety disorder tend to worry excessively about normal daily situations, like –

  • Family problems
  • Money
  • Job security
  • Health
  • Household responsibilities & chores
  • Academic/work performance
  • Punctuality or being late
  • Natural disasters like storms or earthquakes


The severity of the symptoms may vary depending on the situations and circumstances. NIMH explains “Symptoms may get better or worse at different times, and they are often worse during times of stress, such as with a physical illness, during exams at school, or during a family or relationship conflict.”

Causes Of GAD

The exact cause of generalized anxiety disorder is not fully known or understood. However, like many other mental health disorders, GAD may develop from a complex combination of genetic, environmental, behavioural and other factors. The NIMH explains “GAD sometimes runs in families, but no one knows for sure why some family members have it while others don’t. Researchers have found that several parts of the brain, as well as biological processes, play a key role in fear and anxiety.” Apart from these, stress and other environmental factors may also play a crucial role in the development of this condition.

Some of the common factors that influence the development of GAD include:

1. Genetics

The development of generalized anxiety disorder may be influenced by family history as you are more likely to have GAD if it runs in your family. One 2008 study 5 suggests that “individuals with generalized anxiety disorder have a higher occurrence of anxiety problems among their relatives than do individuals without the disorder.” This goes to show that this disorder may be passed on in families with a history of GAD or other mental conditions. You are 5 times more likely to have GAD if a family member is affected by the condition.

Another 2017 study 6 revealed that “GAD is a heritable condition with a moderate genetic risk (heritability of approximately 30%).” However, researchers are yet to identify any specific genes associated with anxiety.

2. Brain chemistry and function

Although the process through which generalized anxiety disorder is activated remains unknown, it has been found that brain circuitry related to anxiety and fear can contribute to someone having GAD. According to the National Health Service (NHS), UK, “overactivity in areas of the brain involved in emotions and behaviour” may significantly contribute to the development of GAD. When there is an imbalance in certain brain chemicals, like noradrenaline and serotonin, it can lead to the development of such anxiety disorders 7 as these chemicals help to regulate and control mood.

Moreover, problems with particular nerve cell pathways associated with certain areas of the brain related to thoughts and emotions can also influence the onset of this disorder. NIMH explains “Researchers have found that several parts of the brain, as well as biological processes 8, play a key role in fear and anxiety.

3. Environment

Traumatic and stressful experiences can also be a significant factor in the development of GAD. Significant life events, like parental overprotection, abuse, loss of a loved one, divorce, long term illness, unemployment and other negative experiences may contribute to this condition. According to the NHS, “having a history of stressful or traumatic experiences, such as domestic violence, child abuse or bullying” or “having a painful long-term health condition” are common environmental factors according to research.

Apart from this, alcohol or drug abuse and excessive caffeine or tobacco consumption can also worsen the condition. Moreover, other mental health disorders or medical illnesses may also increase risk.

Diagnosis Of GAD

According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), the diagnostic criteria of GAD includes the following:

A. Excessive worry and anxiety for more than 6 months.
B. Unable to manage worry and anxiety.
C. Anxiety is related to 3 or more of the following symptoms for at least 6 months-

  1. Getting fatigued or exhausted easily
  2. Restlessness or feeling on edge
  3. Problems concentrating
  4. Muscle tension
  5. Sleep disturbance or insomnia
  6. Irritability

D. Symptoms lead to significant impairment or distress in daily functioning in important areas.
E. Symptoms are not a result of other psychiatric disorders, physical health conditions or drugs or medications.

A research paper published in JAMA network states that a doctor may check the patient’s medical history and perform physical examinations and tests to make sure the symptoms are not caused by other medical problems. It adds “Mental health professionals (psychiatrists, psychologists, and licensed therapists) ask questions and use specific testing methods to examine an individual’s symptoms to see if he/she has one of the anxiety disorders or another mental health issue, such as depression or bipolar disorder.”

Treatment Of GAD

Generalized anxiety disorder is usually treated with psychotherapy, medication or a combination of both to alleviate the symptoms and reduce feelings of anxiety. The treatment process may take some time depending on the severity of the condition and the individual.

1. Psychotherapy

Cognitive Behavioral Therapy (CBT) 9 is a type of psychotherapy that can be especially effective in treating GAD. CBT involves psychoeducation, changing maladaptive behaviour and thought patterns and cautious exposure to anxiety-inducing circumstances. Through gradual exposure, it helps the patient to manage their reactions to stressful situations and control their feelings of fear, worry and anxiety.

CBT can also help the sufferer develop helpful coping mechanisms and learn new strategies to overcome their anxiety. Cognitive Behavioral Therapy can be extremely beneficial when used along with medication.

2. Medications

Although medications cannot cure the disorder, it can substantially help in relieving the symptoms of GAD. Different types of antidepressants and anti-anxiety medicines can be prescribed by the doctor for generalized anxiety disorder. According to a 2018 study 10, SSRIs (selective serotonin reuptake inhibitors) and SNRIs (selective norepinephrine reuptake inhibitors) along with azapirones, benzodiazepines, anti-adrenergic medications, second-generation antipsychotics, melatonin analogues, lavender oil and kava can prove to be effective in treating GAD. However, it may take 2 to 6 weeks for SSRIs 11 to effectively reduce anxiety.

The study states “SSRIs and SNRIs represent the first-line psychopharmacologic treatment while second-line pharmacotherapies may include buspirone, benzodiazepines, SGAs and pregabalin,” in adult patients. However, the patient’s age, medical history and co-morbidity should be considered during psychopharmacologic treatment.

It should be noted that these medications may cause certain side effects like sleeping problems, nausea and headaches. It is recommended that the patient consults the doctor regarding any side effects they may experience. Moreover, “medications are powerfully effective in rapidly decreasing anxiety, but they can cause tolerance and dependence if you use them continuously. Therefore, your doctor will only prescribe them for brief periods of time if you need them,” adds NIMH.

3. Relaxation techniques

Relaxation techniques like deep breathing, progressive muscle relaxation 12 and autogenic training 13, can enable the sufferer to cope with stress and anxiety better. Moreover, certain lifestyle habits can also help in coping with GAD, such as:

  • Yoga
  • Meditation
  • Exercise
  • A nutritious, healthy diet
  • Biofeedback
  • A healthy sleeping routine
  • Avoiding smoking, caffeine, alcohol and drugs


These practices can not only help to elevate mood but also improve the patient’s overall mental, emotional and physical well being. In fact, one 2015 study 14 found that Kundalini Yoga can greatly help in coping with GAD. Another 2013 study 15 found that mindfulness meditation or Mindfulness-Based Stress Reduction (MBSR) techniques “have a beneficial effect on anxiety symptoms in GAD and may also improve stress reactivity.” Moreover, biofeedback intervention has proved to be “effective in significantly reducing the levels of stress, anxiety, and depression” over a 4-week period, as per a recent study 16.

Although the treatment process can be challenging and time-consuming, it is crucial that the patient follows the instructions of their doctor and continues treatment, instead of giving up.

Recovery Is Possible

Psychotherapy and medication, along with a healthy lifestyle can greatly help the sufferer to combat generalized anxiety disorder. Moreover, the support of friends and family can also help significantly in overcoming the condition. With time, patience, determination and proper treatment, a person with GAD can fully recover and live a normal, healthy life.

References:
  1. Torpy JM, Burke AE, Golub RM. Generalized Anxiety Disorder. JAMA. 2011;305(5):522. doi:10.1001/jama.305.5.522 []
  2. Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, Benjet C, Georgiades K, Swendsen J. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010 Oct;49(10):980-9. PMID: 20855043 []
  3. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Generalized anxiety disorder: Overview. 2008 Feb 14 [Updated 2017 Oct 19]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279595/ []
  4. Munir S, Takov V. Generalized Anxiety Disorder. [Updated 2020 Nov 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441870/ []
  5. McLaughlin, K. A., Behar, E., & Borkovec, T. D. (2008). Family history of psychological problems in generalized anxiety disorder. Journal of clinical psychology, 64(7), 905–918. https://doi.org/10.1002/jclp.20497 []
  6. Gottschalk, M. G., & Domschke, K. (2017). Genetics of generalized anxiety disorder and related traits. Dialogues in clinical neuroscience, 19(2), 159–168. https://doi.org/10.31887/DCNS.2017.19.2/kdomschke []
  7. Martin, E. I., Ressler, K. J., Binder, E., & Nemeroff, C. B. (2009). The neurobiology of anxiety disorders: brain imaging, genetics, and psychoneuroendocrinology. The Psychiatric clinics of North America, 32(3), 549–575. https://doi.org/10.1016/j.psc.2009.05.004 []
  8. Maron, E., & Nutt, D. (2017). Biological markers of generalized anxiety disorder. Dialogues in clinical neuroscience, 19(2), 147–158. https://doi.org/10.31887/DCNS.2017.19.2/dnutt []
  9. Borkovec TD, Ruscio AM. Psychotherapy for generalized anxiety disorder. J Clin Psychiatry. 2001;62 Suppl 11:37-42; discussion 43-5. PMID: 11414549. []
  10. Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2018). Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review. Expert opinion on pharmacotherapy, 19(10), 1057–1070. https://doi.org/10.1080/14656566.2018.1491966 []
  11. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Treatment options for generalized anxiety disorder. 2008 Feb 14 [Updated 2017 Oct 19]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279594/ []
  12. Li, Y., Wang, R., Tang, J., Chen, C., Tan, L., Wu, Z., Yu, F., & Wang, X. (2015). Progressive muscle relaxation improves anxiety and depression of pulmonary arterial hypertension patients. Evidence-based complementary and alternative medicine : eCAM, 2015, 792895. https://doi.org/10.1155/2015/792895 []
  13. Kanji N, Ernst E. Autogenic training for stress and anxiety: a systematic review. 2000. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK68303/ []
  14. Hofmann, S. G., Curtiss, J., Khalsa, S., Hoge, E., Rosenfield, D., Bui, E., Keshaviah, A., & Simon, N. (2015). Yoga for generalized anxiety disorder: design of a randomized controlled clinical trial. Contemporary clinical trials, 44, 70–76. https://doi.org/10.1016/j.cct.2015.08.003 []
  15. Hoge, E. A., Bui, E., Marques, L., Metcalf, C. A., Morris, L. K., Robinaugh, D. J., Worthington, J. J., Pollack, M. H., & Simon, N. M. (2013). Randomized controlled trial of mindfulness meditation for generalized anxiety disorder: effects on anxiety and stress reactivity. The Journal of clinical psychiatry, 74(8), 786–792. https://doi.org/10.4088/JCP.12m08083 []
  16. Ratanasiripong, P., Kaewboonchoo, O., Ratanasiripong, N., Hanklang, S., & Chumchai, P. (2015). Biofeedback Intervention for Stress, Anxiety, and Depression among Graduate Students in Public Health Nursing. Nursing research and practice, 2015, 160746. https://doi.org/10.1155/2015/160746 []
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