Generalized Anxiety Disorder

Medically Reviewed by Jennifer Casarella, MD on September 14, 2021
6 min read

Generalized anxiety disorder (or GAD) is marked by excessive, exaggerated anxiety and worry about everyday life events for no obvious reason. People with symptoms of generalized anxiety disorder tend to always expect disaster and can't stop worrying about health, money, family, work, or school.

Everyone feels anxiety now and then -- and there can be good reasons why. But in people with GAD, the worry is often unrealistic or out of proportion for the situation. Daily life becomes a constant state of worry, fear, and dread. Eventually, anxiety can even dominate a person's thinking so much that they find it hard to do routine things at work or school, socially, and in their relationships. But there are treatments to ease anxiety so it’s not running your life.

Nearly 4 million adult Americans, or about 2%, have GAD during the course of a year. It most often begins in childhood or adolescence but can begin in adulthood. It is more common in women than in men.

GAD affects the way a person thinks, and it can lead to physical symptoms. Mental health professionals use a standard set of criteria to diagnose GAD.  Those symptoms can’t be caused by a medical problem or other condition and last at least 6 months.  Those criteria include:

  • Excessive, ongoing worry and tension
  • Unrealistic view of problems
  • Restlessness or a feeling of being "edgy"
  • Trouble concentrating
  • Tiring easily or being fatigued
  • Increased crankiness or irritability
  • Trouble sleeping
  • Muscle tension or muscle aches and soreness

People with generalized anxiety disorder often also have other anxiety disorders such as panic disorder or phobias, obsessive compulsive disorder, clinical depression, or problems with drug or alcohol misuse.

Experts don’t know the exact causes of generalized anxiety disorder. Several things -- including genetics, brain chemistry, and environmental stresses -- appear to contribute to its development.

  • Genetics. Some research suggests that family history plays a part in making it more likely that a person will have GAD. This means that the tendency to develop GAD may be passed on in families. But no anxiety genes have been identified, and families may also pass down the tendency through lifestyle or environment.
  • Brain chemistry. This is complex. GAD has been linked to problems with certain nerve cell pathways that connect particular brain regions involved in thinking and emotion. These nerve cell connections depend on chemicals called neurotransmitters that send information from one nerve cell to the next. If the pathways that connect particular brain regions don’t work well, problems related to mood or anxiety may result. Medicines, psychotherapies, or other treatments that are thought to work on these neurotransmitters may improve the signaling between circuits and help to improve symptoms related to anxiety or depression.
  • Environmental factors. Trauma and stressful events such as abuse, the death of a loved one, divorce, and changing jobs or schools may contribute to GAD. The condition can also worsen when stress feels out of hand. The use of and withdrawal from addictive substances (including alcohol, caffeine, and nicotine) can also worsen anxiety.

If you have symptoms of GAD, your doctor will begin an evaluation by asking questions about your medical and psychiatric history. You may also get a physical exam. Lab tests don’t diagnose anxiety disorders, but some can help doctors check for any physical illness that might be causing the symptoms.

The doctor bases their diagnosis of GAD on reports of how intense and long-lasting the symptoms are, including any problems with daily life caused by the symptoms. The doctor then determines whether the person has a specific anxiety disorder or generalized anxiety disorder.

For someone to be diagnosed with GAD, symptoms must interfere with daily living and be present for more days than not for at least 6 months.

If no other medical condition is found, you may be referred to a psychiatrist or psychologist. These are mental health professionals who are trained to diagnose and treat conditions including GAD. Treatment for GAD most often includes a combination of medication and cognitive behavioral therapy. And your daily habits can make a difference.

  • Cognitive behavioral therapy. People being treated for anxiety disorders often take part in this type of therapy, in which you learn to recognize and change thought patterns and behaviors that lead to anxious feelings. This type of therapy helps limit distorted thinking by looking at worries more realistically. You may want to look into joining a support group.
  • Medications. These aren’t a cure, but they can help ease symptoms. Your doctor may recommend drugs called benzodiazepines, often used to treat GAD in the short term. These are prescribed less often than in the past because they may be addictive or sedating and can interfere with memory and attention. They work by curbing the physical symptoms of anxiety, such as muscle tension and restlessness. Common benzodiazepines include alprazolam (Xanax), chlordiazepoxide Hcl (Librium), diazepam (Valium), and lorazepam (Ativan). These drugs can exaggerate sedation effects when combined with many other medicines, and they are also dangerous if mixed with alcohol.
    Certain antidepressants, such as duloxetine (Cymbalta), escitalopram oxalate (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and venlafaxine (Effexor) are also used to treat GAD for longer periods of time. They may take a few weeks to start working, but they're safer and more appropriate for long-term treatment of GAD.
  • Home remedies. These lifestyle habits also help:

It’s possible to become dependent upon sedative-hypnotic medications (benzodiazepines) if those medications are used on an ongoing basis.

Side effects of antidepressants that treat GAD vary by specific drug and the person taking them. Common side effects can include sleepiness, weight gain, nausea, and sexual problems.

There are no negative side effects from therapy or healthy lifestyle measures. Whether those are enough to handle an anxiety disorder, or if medications are also needed, is a decision to make with your health care provider.

Most people gain substantial relief from their symptoms with proper treatment. Symptoms can come and go, such as during stressful times. So it’s important to stick to your treatment plan, which may include therapy, lifestyle habits, and medication. If anxiety symptoms flare up, reach out to your support team, including your doctor or therapist.

Anxiety disorders like GAD can’t always be prevented. But there are some things that you can do to control or lessen symptoms, including:

  • Seek counseling and support after a traumatic or disturbing experience, or if you’ve noticed that you’re feeling more anxious than usual. It’s better to address a problem, not avoid it.
  • Lead a healthy, active lifestyle.
  • Stay connected to others. Don’t get isolated.
  • Take breaks when you start to worry. Try to let go of concerns about the past.
  • If you have an anxiety treatment plan, stick with it.
  • Ask your doctor or pharmacist before taking any over-the-counter drugs or herbal remedies. Many contain chemicals that can increase anxiety symptoms.
  • Practice stress management techniques.
  • Consider joining a support group for people dealing with anxiety.

Show Sources


American Psychiatric Association: “What Are Anxiety Disorders?”

Anxiety and Depression Association of America: “Generalized Anxiety Disorder (GAD).”

National Institute of Mental Health.

Anxiety Disorder Causes from MedicineNet.

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