Generalized anxiety disorder (or GAD) is characterized by excessive, exaggerated anxiety and worry about everyday life events with no obvious reasons for worry. People with symptoms of generalized anxiety disorder tend to always expect disaster and can't stop worrying about health, money, family, work, or school. 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, the anxiety so dominates the person's thinking that it interferes with daily functioning, including work, school, social activities, and relationships.
What Are the Symptoms of GAD?
GAD affects the way a person thinks, but the anxiety can lead to physical symptoms, as well. Symptoms of GAD can include:
- Excessive, ongoing worry and tension
- An unrealistic view of problems
- Restlessness or a feeling of being "edgy"
- Muscle tension
- Difficulty concentrating
- The need to go to the bathroom frequently
- Trouble falling or staying asleep
- Being easily startled
In addition, people with GAD often have other anxiety disorders (such as panic disorder or phobias), obsessive-compulsive disorder, clinical depression, or additional problems with drug or alcohol misuse.
What Causes GAD?
The exact cause of GAD is not fully known, but a number of factors -- including genetics, brain chemistry, and environmental stresses -- appear to contribute to its development.
- Genetics: Some research suggests that family history plays a part in increasing the likelihood that a person will develop GAD. This means that the tendency to develop GAD may be passed on in families.
- Brain chemistry: GAD has been associated with abnormal functioning of certain nerve cell pathways that connect particular brain regions involved in thinking and emotion. These nerve cell connections depend on chemicals called neurotransmitters that transmit information from one nerve cell to the next. If the pathways that connect particular brain regions do not run efficiently, problems related to mood or anxiety may result. Medicines, psychotherapies, or other treatments that are thought to "tweak" 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, changing jobs or schools, may contribute to GAD. GAD also may become worse during periods of stress. The use of and withdrawal from addictive substances, including alcohol, caffeine, and nicotine, can also worsen anxiety.
How Common Is GAD?
About 4 million adult Americans suffer from 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.
How Is GAD Diagnosed?
If symptoms of GAD are present, the doctor will begin an evaluation by asking questions about your medical and psychiatric history and may perform a physical exam. Although there are no lab tests to specifically diagnose anxiety disorders, the doctor may use various tests to look for physical illness as the cause of symptoms.
The doctor bases his or her diagnosis of GAD on reports of the intensity and duration of symptoms -- including any problems with functioning caused by the symptoms. The doctor then determines if the symptoms and degree of dysfunction indicate a specific anxiety disorder. GAD is diagnosed if symptoms are present for more days than not during a period of at least six months. The symptoms also must interfere with daily living, such as causing you to miss work or school.
How Is GAD Treated?
If no other medical condition is found, you may be referred to a psychiatrist or psychologist, mental health professionals who are specially trained to diagnose and treat mental illnesses like GAD. Treatment for GAD most often includes a combination of medication and cognitive-behavioral therapy.
- Medication: Drugs are available to treat GAD and may be especially helpful for people whose anxiety is interfering with daily functioning. The drugs most often used to treat GAD in the short-term (since they can be addictive, are sedating, and can interfere with memory and attention) are from a class of drugs called benzodiazepines. These medications are sometimes also referred to as sedative-hypnotics or "minor tranquilizers" because they can temporarily remove intense feelings of acute anxiety. They work by decreasing the physical symptoms of anxiety, such as muscle tension and restlessness. Common benzodiazepines include alprazolam (Xanax), chlordiazepoxide Hcl (Librium), diazepam (Valium), and lorazapam (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. These antidepressants may take a few weeks to start working, but they're safer and more appropriate for long-term treatment of GAD.
- Cognitive-behavioral therapy: People suffering from anxiety disorders often participate 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.
In addition, relaxation techniques, such as deep breathing and biofeedback, may help control the muscle tension that often accompanies GAD.
Are There Side Effects of GAD Treatment?
Dependency on sedative-hypnotic medications (benzodiazepines) is a potential complication of treatment 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.
What Is the Outlook for People With GAD?
Although many people with GAD cannot be cured and symptoms can return from time to time, most people gain substantial relief from their symptoms with proper treatment.
Can GAD Be Prevented?
Anxiety disorders like GAD cannot be prevented. However, there are some things that you can do to control or lessen symptoms, including:
- Stop or reduce your consumption of products that contain caffeine, such as coffee, tea, cola, and chocolate.
- Ask your doctor or pharmacist before taking any over-the-counter drugs or herbal remedies. Many contain chemicals that can increase anxiety symptoms.
- Exercise daily and eat a healthy, balanced diet.
- Seek counseling and support after a traumatic or disturbing experience.
- Practice stress management techniques like yoga or meditation.