What Is Generalized Anxiety Disorder (GAD)?

How Does GAD Look Different From “Normal” Worrying?
“Normal” Worrying	Generalized Anxiety Disorder
Doesn’t get in the way of responsibilities or daily functioning.	Significantly interferes with functioning, including relationships, job, and activities.
You can control your worrying.	You cannot control your worrying.
Worries are unpleasant, but not significantly distressing.	Your worries are very upsetting and cause great distress.
Your worries are realistic, and limited to a small number of specific concerns.	Your worry extends to a wide variety of things, and you tend to focus on worst case scenarios.
Your worries last for short bouts of time.	You’ve been worrying almost every day for at least six months.

People with GAD may engage in behaviors to try to control their excessive worrying, such as:

• Avoiding news on TV, online, or in newspapers
• Limiting or skipping out on participation in activities that cause them worry
• Seeking excessive reassurance or approval (particularly in children).
• Over-planning or preparing
• “Rehearsing” or replaying scenarios in their mind

Diagnosis

GAD is more often diagnosed and treated by family physicians and primary care providers than by psychiatrists.

To determine a diagnosis of GAD, your healthcare provider may:

• Do a physical exam to look for signs that your anxiety might be linked to medications or an underlying medical condition
• Order blood tests, urine tests, or other tests, if another medical condition is suspected
• Ask detailed questions about your symptoms and medical history
• Use psychological questionnaires to help determine a diagnosis
• Use the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

Causes

Scientists are not yet sure of the specific causes of GAD, but they believe it arises from a combination of biological and environmental factors. These might include:

• Differences in brain chemistry and function
• Genetics
• Differences in the way threats are perceived
• Development and personality

Risk Factors

• Gender: Women are diagnosed with GAD more often than men.
• Age: GAD can develop at any time, but the risk is highest between childhood and middle age, with the median age being 30.
• Personality: Those who are timid, have negative affectivity and harm avoidance may be more prone to generalized anxiety disorder.
• Genetics: GAD appears to run in families and one-third of the risk of GAD is thought to be due to genetics.
• Experiences: A history of significant life changes, traumatic or negative experiences during childhood, or a recent traumatic or negative event may increase the risk of developing GAD. Chronic medical illnesses or other mental health disorders may also increase risk.

Treatment

As with any psychiatric disorder, finding a successful treatment for GAD can take some trial and error. What works for one person with GAD may not work as well as another treatment for someone else with GAD. If the first treatment you try is not successful or has side effects you can’t tolerate, don’t assume your GAD is untreatable—go back to your healthcare provider with your concerns and work together to try a new plan.

GAD is primarily treated with either therapy, medication, or a combination of both.

Therapy

The most common form of therapy used to treat generalized anxiety disorder is cognitive-behavioral therapy (CBT). CBT helps analyze the way we think in order to recognize and correct distortions. Using CBT, people with GAD can change their automatic thinking processes that lead to anxiety and replace them with healthier ways of thinking.

The five components of CBT for anxiety are:

• Education: Before re-training your thinking processes, it’s important to learn both how anxiety works and how the process of CBT works. In this stage, you will focus on gaining an understanding of GAD and how it affects your thinking and your behavior. You will also learn what to expect from CBT treatment.
• Monitoring: You will be taught ways to monitor your anxiety. What triggers it? What specific things do you worry about? How intense are your episodes and for how long do they last? Monitoring your anxiety gives you an overall view of what GAD looks like for you. Being aware of how your anxiety manifests and what triggers it will help you implement ways to change it. It may help to keep a diary for this part of therapy.
• Physical control strategies: Anxiety elicits a “fight or flight” response. In this stage of CBT, you will learn techniques to combat this physical over-arousal.
• Cognitive control strategies: This is where the “thinking about thinking” comes in. These strategies help you to realistically examine and evaluate the thinking patterns that contribute to GAD, and alter them to be more productive. Challenging these negative thoughts helps to lower your anxiety.
• Behavioral strategies: Avoidance is a common reaction to anxiety, but not usually a productive one. This stage focuses on learning to tackle your anxiety and face your fears head-on instead of avoiding the things that make you anxious.

Medication

The medications prescribed for generalized anxiety disorder are often the same ones prescribed for other mental illnesses or medical conditions.

Antidepressant drugs

These drugs act on neurotransmitters involved in many regions of the brain that affect anxiety, mood, and arousal.

Selective serotonin reuptake inhibitors (SSRIs) prescribed for anxiety include:

• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Citalopram (Celexa)

Serotonin-norepinephrine reuptake Inhibitors (SNRIs) may also be prescribed. They include:

• Venlafaxine (Effexor)
• Duloxetine (Cymbalta)

Sometimes an antidepressant works well for GAD symptoms but has side effects. Common side effects of antidepressants might include, but are not limited to:

• Sexual problems
• Drowsiness
• Insomnia
• Gastrointestinal issues

Buspirone

Buspirone (BuSpar) is an anti-anxiety medication that works using a different mechanism than SSRIs and SNRIs.

Buspirone takes some time and dosage adjustments to be effective.

Some common side effects of buspirone include:

• Nausea
• Headache
• Changes in dreams
• Feeling dizzy
• Drowsiness
• Lightheadedness

Tricyclic antidepressants

Some people with GAD find tricyclic antidepressants work better for them than other medications.

These medications may be prescribed:

• Imipramine (Tofranil)
• Nortriptyline (Pamelor)
• Desipramine (Norpramin)
• Clomipramine (Anafranil)

For some people, tricyclic antidepressants have unpleasant side effects like:

• Dizziness
• Constipation
• Blurred vision
• Trouble urinating

Over time, generalized anxiety is associated with an increased risk of developing or worsening:

• Digestive or bowel problems, such as irritable bowel syndrome or peptic ulcers
• Headaches and migraines
• Chronic pain
• Sleep problems and insomnia
• Heart-health issues

GAD often occurs alongside other mental illnesses, including:

• Phobias
• Panic disorder
• Post-traumatic stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)
• Depression
• Suicidal thoughts
• Substance abuse

These coexisting conditions can make treatment more difficult, but not impossible.

Treatment success varies by person and both therapy and medication can take a while to become effective. If you don’t notice an improvement right away, give it a little bit of time. Your healthcare provider can give you an idea of how long to wait before trying something else. Your provider is likely to want you to come in for regular follow-ups when you begin a new medication until you reach a type and dose that works well for you.

If at any time you feel your treatments are no longer as effective, talk to your healthcare provider to see if adjustments can be made.

Coping

While treatment such as therapy and/or medication is often needed to manage GAD, there are lifestyle changes you can make to help ease some of your anxiety and support your treatment plan.

• Make connections with others: Reach out to friends or join a support group. Having the company and support of others can ease anxiety.
• Learn how to self-soothe: When you are in a moment of high anxiety, engaging your senses can help ground you. These senses include look, listen, smell, taste, touch, and move.
• Relaxation techniques: Practicing things like deep breathing, progressive muscle relaxation, and meditation. helps to fight the physical responses your body has to anxiety.
• Health body habits: Eat healthy foods, get enough sleep, and avoid or limit substances that may aggravate your anxiety.
• Get organized: Seek help early, keep a journal or diary, and prioritize your needs.

A Word From Verywell

GAD can be difficult and frightening to live with. If you are feeling the effects of GAD, see your healthcare provider right away. While finding the right treatment might take a bit of work and experimentation with the help of your healthcare provider, GAD can be managed, and living a life free of excessive and intrusive anxiety is possible.