Generalized Anxiety Disorder

Table of Contents

  • What is Generalized Anxiety Disorder?

  • When Does Anxiety Become a Disorder?

  • Types of Anxiety Disorders

  • Common Symptoms of GAD

  • Diagnosing Generalized Anxiety Disorders

  • What Causes Anxiety?

  • Everyday Influences and Triggers for Generalized Anxiety Disorder

  • Biological and Genetic Contributors to Generalized Anxiety Disorder

  • Approaches to Managing and Treating Generalized Anxiety Disorder

  • Telehealth: Getting Help from Home

  • References

What is Generalized Anxiety Disorder?

Generalized Anxiety Disorder (GAD) is characterized by persistent, excessive, and often uncontrollable worry about various aspects of daily life. These worries are typically disproportionate to the actual situation and can interfere with daily functioning, relationships, and overall well-being. GAD is diagnosed when these symptoms are present on most days for at least six months.

Individuals with GAD often worry about health, finances, family, work, or minor matters. The disorder can begin in childhood, adolescence, or adulthood and is more common in women. GAD frequently co-occurs with other mental health conditions, such as depression.

When Does Anxiety Become a Disorder?

Feeling anxious sometimes is normal. But if anxiety is strong, happens often, or lasts a long time—even when there is no real danger—it may be an anxiety disorder. These disorders can make it hard to enjoy life and do everyday things.

Formal Types of Anxiety

Anxiety is not a one-size-fits-all experience. In fact, anxiety disorders are the most common mental health conditions in the United States, affecting an estimated 19.1% of adults each year (National Institute of Mental Health, 2019). The main types include:

  • Generalized Anxiety Disorder (GAD) [Lifetime risk: 5.7%]: Characterized by chronic, excessive worry about various aspects of daily life. Approximately 2.7% of U.S. adults experience GAD in a given year, with women being more likely to be affected than men (National Institute of Mental Health, 2017; Anxiety and Depression Association of America, n.d.).

  • Panic Disorder [Lifetime risk:4.7%]: Involves recurrent, unexpected panic attacks and ongoing concern about having more attacks. Panic disorder affects about 2.7% of U.S. adults annually (Anxiety and Depression Association of America, n.d.).

  • Social Anxiety Disorder [Lifetime risk:12.1%]: Marked by intense fear of social situations or being judged by others. Social anxiety disorder affects roughly 7.1% of U.S. adults each year (National Institute of Mental Health, 2017).

  • Specific Phobias [Lifetime risk: ~12.5%]: Involve extreme fear of a particular object or situation (such as heights or flying). Specific phobias are the most common anxiety disorder, affecting about 9.1% of U.S. adults annually (National Institute of Mental Health, 2017).

  • Obsessive-Compulsive Disorder (OCD) [Lifetime risk: 2.3%]: OCD is defined by unwanted, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) performed to reduce anxiety.

  • Agoraphobia: Characterized by fear of situations where escape may be difficult, such as crowds or public transportation. Agoraphobia affects about 0.9% of U.S. adults each year (National Institute of Mental Health, 2017).

  • Illness Anxiety Disorder (formerly Hypochondriasis) [Lifetime risk: ~5.7%]:
    Previously known as hypochondriasis, this disorder involves a preoccupation with having or acquiring a serious illness, often without significant physical symptoms.

  • Post-Traumatic Stress Disorder (PTSD) [Lifetime risk: ~6.8–8%]:
    PTSD develops after exposure to a traumatic or life-threatening event and is characterized by intrusive memories, avoidance, negative changes in mood, and heightened arousal.

  • Complex PTSD [Lifetime risk: varies; higher in populations exposed to chronic trauma]: Complex PTSD involves symptoms from prolonged or repeated trauma, often affecting emotional regulation, self-identity, and relationships. Exact lifetime risk is not well established, but it is recognized as significant in populations exposed to ongoing trauma.

According to the CDC, about 18.2% of adults in the U.S. experienced symptoms of anxiety in the past two weeks in 2022, with higher rates among younger adults and women. The prevalence of symptoms has increased from 15.6% in 2019 to 18.2% in 2022, highlighting the growing impact of anxiety disorders on public health (CDC, 2024; National Institute of Mental Health, 2019).

Common Symptoms of Anxiety

According to the DSM-5, Generalized Anxiety Disorder (GAD) requires excessive anxiety and worry occurring more days than not for at least six months, about a number of events or activities. For a diagnosis in adults, the anxiety and worry must be associated with at least three of the following six symptoms:

  • Restlessness or feeling keyed up or on edge

  • Fatigue or feeling easily tired

  • Trouble concentrating or feeling like the mind goes blank

  • Irritability or increased grouchiness

  • Muscle tension, aches, or twitching

  • Sleep disturbances, such as trouble falling or staying asleep, or unsatisfying sleep

Other common physical manifestations:

  • Persistent and excessive worry about everyday matters

  • Difficulty controlling the worry or nervousness

  • Overthinking plans, solutions, or worst-case scenarios

  • Viewing situations as threatening even when they are not

  • Headaches

  • Trembling, shaking, or feeling twitchy

  • Sweating or hot flashes

  • Nausea, upset stomach, diarrhea, or irritable bowel syndrome

  • Lightheadedness or dizziness

  • Trouble breathing or shortness of breath

  • Increased heart rate or feeling easily startled

  • Frequent urination or feeling a lump in the throat

  • Inability to relax or feeling unable to set aside worries

  • Being easily startled

  • Difficulty making decisions or handling uncertainty

Symptoms must be present for at least six months and cause significant distress or impairment in social, work, or other important areas of functioning for a formal diagnosis.

GAD often co-occurs with other anxiety disorders, depression, or physical health problems, and can fluctuate in severity over time, often worsening during periods of stress.

Diagnosing Anxiety Disorders

Diagnosis is based on a clinical evaluation, including a detailed history and standardized assessment tools. Key steps include:

  • Clinical Interview: Open-ended questions about symptoms, duration, and impact.

  • Standardized Questionnaires: Tools like the GAD-7 can help assess severity.

  • Exclusion of Other Causes: Symptoms must not be due to another medical condition, substance use, or another mental disorder.

DSM-5 Criteria: Clinicians use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for formal diagnosis.

What Causes Generalized Anxiety Disorder?

The exact cause of GAD is unknown, but it is believed to result from a complex interplay of genetic, biological, psychological, and environmental factors:

  • Genetics: Family history increases risk, suggesting a hereditary component.

  • Brain Chemistry: Imbalances in neurotransmitters (e.g., GABA, serotonin) and altered brain function (especially in the amygdala) are implicated.

  • Personality Traits: Perfectionism, high responsibility, shyness, or emotional sensitivity may increase vulnerability.

  • Environmental Stress: Chronic stress, trauma, or adverse life events can trigger or worsen symptoms.

Everyday Influences and Triggers for Generalized Anxiety Disorder

Environmental and lifestyle factors play a significant role in the development and persistence of GAD:

  • Stressful Life Events: Trauma, abuse, loss, or chronic stress (financial, job, relationship issues).

  • Family Environment: Overprotective or anxious parenting, learned behaviors, and negative role models.

  • Early Life Experiences: Childhood adversity or instability.

  • Chronic Illness: Ongoing health problems can contribute to anxiety.

Biological and Genetic Contributors to Generalized Anxiety Disorder

Biological underpinnings of GAD include:

  • Genetic Predisposition: Multiple genes may contribute to risk.

  • Neurotransmitter Imbalance: Dysregulation of brain chemicals involved in mood and anxiety.

  • Brain Structure and Function: Changes in the amygdala and prefrontal cortex, areas that regulate fear and anxiety.

  • Hormonal Factors: Conditions like hyperthyroidism can exacerbate anxiety symptoms.

Approaches to Managing and Treating Generalized Anxiety Disorder

Effective treatment for GAD often combines psychotherapy, medication, and lifestyle changes:

  • Cognitive Behavioral Therapy (CBT): The most evidence-based psychotherapy for GAD, focusing on changing negative thought patterns and behaviors.

  • Medications:

    • Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs) are first-line options.

    • Buspirone: An anti-anxiety medication sometimes used.

    • Benzodiazepines: Used short-term due to risk of dependence.

  • Lifestyle Modifications:

    • Regular exercise

    • Stress management techniques (mindfulness, relaxation)

    • Adequate sleep and nutrition

    • Reducing caffeine and substance use

  • Supportive Measures: Social support, self-care, and psychoeducation are crucial for long-term management.

Telehealth: Getting Help from Home

Telehealth has made it easier than ever to get help for anxiety. With telehealth, you can talk to a therapist or psychiatrist through video calls, phone calls, or online messages. This is especially helpful for people who feel too anxious to leave home or who live far from mental health providers.

Benefits of Telehealth for Anxiety

  • Convenience: Attend sessions from your home, saving time and travel.

  • Accessibility: Get care even if you live in a rural area or have a busy schedule.

  • Comfort: Many people feel more at ease talking about their worries in a familiar setting.

Effectiveness: Studies show that telehealth is just as effective as in-person therapy for treating anxiety.

References

  1. Centers for Disease Control and Prevention. (2024, November 7). Symptoms of anxiety and depression among adults: United States, 2019 and 2022 (National Health Statistics Reports No. 213). https://www.cdc.gov/nchs/data/nhsr/nhsr213.pdf

  2. Centers for Disease Control and Prevention. (2020, March). Symptoms of generalized anxiety disorder among adults: United States, 2019. https://www.cdc.gov/nchs/products/databriefs/db378.htm

  3. National Institute of Mental Health. (2019). Any anxiety disorder. https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder

  4. National Institute of Mental Health. (2017). Generalized anxiety disorder. https://www.nimh.nih.gov/health/statistics/generalized-anxiety-disorder

  5. Anxiety and Depression Association of America. (n.d.). Anxiety disorders: Facts & statistics. https://adaa.org/understanding-anxiety/facts-statistics

  6. Johns Hopkins Medicine. (n.d.). Generalized Anxiety Disorder (GAD). https://www.hopkinsmedicine.org/health/conditions-and-diseases/generalized-anxiety-disorder

  7. WebMD. (2024, May 6). Anxiety Disorders: Types, Causes, Symptoms, Diagnosis, Treatment. https://www.webmd.com/anxiety-panic/anxiety-disorders

  8. Verywell Mind. (2014, November 3). Generalized Anxiety Disorder: Symptoms and DSM-5 Diagnosis. https://www.verywellmind.com/dsm-5-criteria-for-generalized-anxiety-disorder-1393147

  9. Better Health Channel. (n.d.). Generalised anxiety disorder (GAD). https://www.betterhealth.vic.gov.au/health/healthyliving/Generalised-anxiety-disorder

  10. International Scholars Journals. (n.d.). The Impact of Lifestyle Factors on Generalized Anxiety Disorder Diagnosis and Treatment Approaches. https://www.internationalscholarsjournals.com/articles/the-impact-of-lifestyle-factors-on-generalized-anxiety-disorder-diagnosis-and-treatment-approaches.pdf

  11. CBS News. (2020). Acute Anxiety: Internet Searches For Key Words Spiked To All-Time High Early In COVID-19 Pandemic. https://www.cbsnews.com/baltimore/news/acute-anxiety-internet-searches-for-key-words-spiked-to-all-time-high-early-in-covid-19-pandemic/

  12. Medical News Today. (2024, August 27). Anxiety: Symptoms, types, causes, prevention, and treatment. https://www.medicalnewstoday.com/articles/323454

  13. AnxietyCentre.com. (n.d.). Anxiety FAQ. https://www.anxietycentre.com/faq/

  14. Zero To Finals. (2023, January 1). Generalised Anxiety Disorder. https://zerotofinals.com/moremedicine/psychiatry/generalisedanxietydisorder/

  15. Penninx, B. W. J. H., et al. (2021, February 11). Anxiety disorders. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC9248771/

  16. PMC. (2023, September 28). A Comprehensive Review of the Generalized Anxiety Disorder. https://pmc.ncbi.nlm.nih.gov/articles/PMC10612137/

  17. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

  18. MSD Manuals. (2023, August 9). Generalized Anxiety Disorder.https://www.msdmanuals.com/professional/psychiatric-disorders/anxiety-and-stressor-related-disorders/generalized-anxiety-disorder