Generalized anxiety disorder

Definition

Generalized anxiety disorder (GAD) is a pattern of frequent, constant worry and anxiety over many different activities and events.

Alternative Names

GAD; Anxiety disorder

Causes, incidence, and risk factors

Generalized anxiety disorder (GAD) is a common condition. The cause of GAD is not known, but biological and psychological factors play a role. Stressful life situations or behavior developed through learning may also contribute to GAD.

The disorder may start at any time in life, including childhood. Most people with the disorder report that they have been anxious for as long as they can remember. GAD occurs somewhat more often in women than in men.

Symptoms

Generalized anxiety disorder has the following symptoms:

• Difficulty concentrating
• Difficulty controlling worry
• Excess anxiety and worry that is out of proportion to the situation most of the time
• Excessive sweating, palpitations, shortness of breath, and stomach/intestinal symptoms
• Fatigue
• Irritability
• Muscle tension -- shakiness, headaches
• Restlessness or feeling keyed up or "on the edge"
• Sleep disturbance (difficulty falling or staying asleep; or restless, unsatisfying sleep)

Depression and substance abuse may occur with an anxiety disorder.

Signs and tests

A physical examination and psychological evaluation can rule out other causes of anxiety. The health care provider should rule out physical disorders that may mimic anxiety, as well as symptoms caused by drugs. This process may include different tests.

Treatment

The goal of treatment is to help the person function well. The success of treatment usually depends on the severity of the generalized anxiety disorder.

Cognitive-behavioral therapy (CBT) and medications are the mainstays of treatment.

Selective serotonin reuptake inhibitors (SSRIs) are usually the first choice in medications. Serotonin-norepinephrine reuptake inhibitors (SNRIs) are another choice. Other antidepressants and some antiseizure drugs may be used for severe cases.

Other anti-anxiety medications may also be prescribed. Benzodiazepines may be recommended if antidepressants don't help.

Behavioral therapies that may be used with drug therapy include:

• Cognitive behavioral therapy to change distorted and possibly harmful perceptions of severe anxiety
• Pleasant mental imagery
• Relaxation techniques

Other counseling and therapy techniques may help people gain an understanding of the illness and the factors that protect against or trigger it.

A healthy lifestyle that includes exercise, enough rest, and good nutrition can help reduce the impact of anxiety.

Support Groups

Support groups may be helpful for some patients with GAD. Patients have the opportunity to learn that they are not unique in experiencing excessive worry and anxiety.

Support groups are not a substitute for effective treatment, but can be a helpful addition to it.

Expectations (prognosis)

The disorder may continue and be difficult to treat, but most patients see great improvement with medications or behavioral therapy.

Complications

People with GAD may develop other psychiatric disorders, such as panic disorder or depression. Substance abuse or dependence may become a problem if you try to self-medicate with drugs or alcohol to relieve anxiety.

Calling your health care provider

Call your health care provider if:

• You are experiencing the signs and symptoms of generalized anxiety disorder
• You have been experiencing symptoms for 6 months or longer
• Your symptoms interfere with your daily functioning

References

Ebell MH. Diagnosis of anxiety disorders in primary care. Am Fam Physician. 2008;78:501-502.

Gale C, Davidson O. Generalised anxiety disorder. BMJ. 2007;334:579-581.

Schneier FR. Clinical practice: social anxiety disorder. New Engl J Med. 2006;355:1029-1036.

Katon WJ. Clinical practice: panic disorder. New Engl J Med. 2006;354:2360-2367.

Connolly SD, Bernstein GA, Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with anxiety disorders. J Am Acad Child Adolesc Psychiatry. 2007;46:267-283.

• Generalized Anxiety Disorder

  Generalized anxiety disorder (GAD) is a pattern of frequent, constant worry and anxiety over many different activities and events.
  Generalized anxiety disorder (GAD) is a common condition. The cause of GAD is not known, but biological and psychological factors play a role. Stressful life situations or behavior developed through learning may also contribute to GAD.

• Separation Anxiety

  Separation anxiety is a developmental stage during which the child experiences anxiety when separated from the primary caregiver (usually the mother).
  Young children with symptoms that improve after age 2 are normal, even if some anxiety comes back later during stress. When separation anxiety occurs in adolescence, it may signal the development of an anxiety disorder.

• Stress Vs Anxiety

  What is the difference between feeling stressed and having an anxiety disorder?
  
  Stress can come from any situation or thought that makes you feel frustrated, angry, nervous, worried, or even anxious. What is stressful to one person may not be stressful to another.
  Anxiety is a feeling of apprehension or fear. You may not know the source of this uneasiness, which can add to the distress you feel.
  Anxiety disorders are a group of psychiatric conditions that cause excessive anxiety. They include generalized anxiety disorder, specific phobias, obsessive-compulsive disorder, and social phobia. People with these disorders have symptoms every day or nearly every day that cause them to have difficulty with daily activities and relationships. Panic disorder is another type of anxiety disorder. Symptoms tend to come and go.

• Grief

  Grief may be triggered by the death of a loved one. People also can experience grief if they have an illness for which there is no cure, or a chronic condition that affects their quality of life. The end of a significant relationship may also cause a grieving process.
  Everyone feels grief in their own way. However, there are certain stages to the process of mourning. It starts with recognizing a loss and continues until a person eventually accepts that loss. People's responses to grief will be different, depending on the circumstances of the death.
  For example, if the person who died had a chronic illness, the death may have been expected. The end of the person's suffering might even have come as a relief. If the death was accidental or violent, coming to a stage of acceptance could take longer.

• Obsessive compulsive disorder

  Obsessive-compulsive disorder is an anxiety disorder in which people have thoughts, feelings, ideas, sensations (obsessions), or behaviors that make them feel driven to do something (compulsions). A person may have both obsessions and compulsions.
  There are several theories about the cause of OCD, but none have been confirmed. Some reports have linked OCD to head injury and infections. Several studies have shown that there are brain abnormalities in patients with OCD, but more research is needed.