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Generalized Anxiety Disorder

(GAD)

Definition

Generalized anxiety disorder (GAD) is an anxiety disorder marked by chronic, exaggerated worrying and anxiety about everyday life. Everyone worries at times. But people with GAD can never relax and usually anticipate the worst. They 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 it can also start in early adulthood.

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

Factors that may increase the risk of GAD include:
  • Sex: female
  • Family member with an anxiety disorder
  • Increase in stress
  • Exposure to physical or emotional trauma
  • Unemployment, poverty
  • Drug abuse
  • Medical condition or disability

Symptoms

Symptoms of GAD usually develop 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"
Physical symptoms include:
  • Muscle tension
  • Lightheadedness
  • Trembling
  • Difficulty sleeping
  • Restlessness
  • Shortness of breath
  • Sweating
  • Heart palpitations
  • Choking sensation
  • Abdominal discomfort
  • Diarrhea
  • Nausea
Symptoms of Anxiety
Physiological effects of anxiety
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People with GAD often have other anxiety disorders, depression , and/or alcohol abuse or drug abuse

Diagnosis

Your doctor will ask you about your symptoms and medical history. A physical exam will be done. Your doctor will also look for other medical conditions that may be causing your symptoms (eg, hyperthyroidism ).
You will be asked about any medicines that you are taking, including over-the-counter products, herbs, and supplements. Some medicines can cause side effects similar to the symptoms of GAD. Your doctor will also ask about any other substances that you may be using (eg, nicotine, caffeine, illegal drugs, prescription medicines, alcohol).
To make a diagnosis of GAD, symptoms must:
  • Be present more days than not
  • Be present for at least six months
  • Interfere with your life (eg, causing you to miss work or school)

Treatment

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

Cognitive Behavioral Therapy

During cognitive-behavioral therapy (CBT) , 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 situations that cause worry and tension. This can allow you to reduce your anxiety in a safe environment.

Support Groups

Joining a support group or self-help group is often helpful. This form of support allows you to share your experiences 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

Medicine can be prescribed for symptoms that are severe and make it difficult to function. Medicines can help relieve symptoms so you can concentrate on getting better. It is important to note that many medicines cannot be stopped abruptly but need to be tapered off. Check with your doctor before discontinuing any medicine.
Medicines may include:
  • Benzodiazepines —to relax your body and keep it from tensing in response to anxious thoughts
    • Note: These medicines need to be monitored closely because they may cause dependence.
  • Buspirone (BuSpar)—an anti-anxiety medicine that does not cause dependence
  • Antidepressant medicines (most commonly selective serotonin re-uptake inhibitors [SSRIs])—to help control anxious thoughts

Lifestyle Changes

  • Learn relaxation techniques (eg, deep breathing, meditation, yoga).
  • Avoid tobacco, caffeine, and drugs. These can worsen anxiety.
  • Exercise on a regular basis.
  • Get an appropriate amount of sleep each night.
  • Identify stressful situations. Avoid them when possible.
  • If you drink alcohol, do so in moderation.

Prevention

There are no guidelines for preventing GAD.

RESOURCES

Anxiety Disorders Association of America http://www.adaa.org/

Mental Health America http://www.nmha.org/

CANADIAN RESOURCES

Canadian Psychiatric Association http://www.cpa-apc.org/

Canadian Psychological Association http://www.cpa.ca/

References

Antidepressant use in children, adolescents, and adults. US Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273 . Published May 22, 2009. Accessed August 27, 2012.

Factsheet: generalized anxiety disorder (GAD). Mental Health America website. Available at: http://www.nmha.org/index.cfm?objectid=C7DF9194-1372-4D20-C83F9C0D95A6265C . Accessed August 27, 2012.

Generalized anxiety disorder. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated May 23, 2012. Accessed August 27, 2012.

Generalized anxiety disorder. FamilyDoctor.org website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/generalized-anxiety-disorder/treatment.html . Updated November 2010. Accessed August 27, 2012.

Generalized anxiety disorder (GAD). National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/health/publications/anxiety-disorders/generalized-anxiety-disorder-gad.shtml . Updated July 2009. Accessed August 27, 2012.

Gliatto MF. Generalized anxiety disorder. American Academy of Family Physicians website. Available at: http://www.aafp.org/afp/20001001/1591.html . Published October 2000. Accessed August 27, 2012.

9/12/2012 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Li AW, Goldsmith CA. The effects of yoga on anxiety and stress. Altern Med Rev. 2012;17(1):21-35.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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