Do you tend to worry unnecessarily all day? Do you feel anxious or tense excessively? Although some anxiety can be healthy, Generalized Anxiety Disorder (GAD) can severely affect your life and mental health.
What Is Generalized Anxiety Disorder (GAD)?
It is an anxiety disorder which involves irrational, uncontrollable and extreme worrying about actions, events and experiences. GAD can significantly affect a person’s ability to function in daily life as they keep worrying excessively about relationships, career, finances, family, and health problems. It is often characterized by extreme worrying, insomnia, muscle tension, restlessness, difficulty concentrating, irritability and fatigue. “Generalized anxiety disorder typically involves intense and repeated worry that impairs the ability of the patient to function normally in daily life,” explains Mind Help.
GAD is a chronic state of extreme worry, fear and anxiety that must persist for at least 6 months in order to be formally diagnosed, according to the National Institute of Mental Health (NIMH 1 ). The anxiety caused by this disorder can often adversely affect different aspects of the sufferer’s life like education, career, social and interpersonal relationships. People with this mental health condition are usually unable to control their worry and anxiety. As they tend to anticipate disaster, they worry about things more than necessary and expect the worst possible outcomes without any apparent reason.
GAD At A Glance
- Generalized Anxiety Disorder (GAD) is an anxiety disorder which involves irrational, uncontrollable and extreme worrying about actions, events and experiences.
- Around 6.8 million U.S. adults are affected by generalized anxiety disorder each year.
- It is often characterized by extreme worrying, insomnia, muscle tension, restlessness, difficulty concentrating, irritability and fatigue.
- People can develop this condition either as a child or as an adult.
- Psychotherapy and medication, along with a healthy lifestyle can greatly help the sufferer to combat generalized anxiety disorder.
Prevalence Of GAD
Nearly 20% of people 2 across the globe experience anxiety disorders. The Anxiety and Depression Association of America (ADAA) shows that around 3.1% of the American population or 6.8 million U.S. adults are affected by generalized anxiety disorder each year. Women are more likely to have this condition than men. Reports reveal that 3.4% of women were affected by GAD during 2001-03, whereas only 1.9% of men had this disorder. Moreover, around 5.7% of adults in the U.S. experience GAD once in their lifetime.
One report from Harvard Health states that “prevalence of this disorder increases with age. Generalized anxiety disorder usually first appears from young adulthood through the mid-50s – a later onset than seen with other psychiatric disorders.” According to the Harvard Health report, GAD can often develop along with other mental disorders. Around 66% of patients with GAD suffer from major depression, while 25% of sufferers experience panic disorder. Moreover, alcohol and substance use are also common among people with generalized anxiety disorder.
How GAD Affects Us?
Generalized anxiety disorder is different from general feelings of anxiety. All of us feel anxious and worried at times. Anxiety and fear protects us and keeps us safe in dangerous situations. Worrying about the future enables us to prepare for unforeseen circumstances and ensure our survival. However, sometimes such feelings can become overwhelming and people can start to worry about anything and everything constantly. “If fears and anxiety overshadow everything else and don’t go away, the person may have developed generalized anxiety disorder (GAD),” explains a 2008 study 3 . It adds “People with generalized anxiety disorder usually realize that their fears are exaggerated, but they aren’t able to control them.”
Most of the time, sufferers start worrying without any provocation which makes it difficult for them to get through the day. Even though sufferers may realize that their concerns are unnecessary and unwarranted, people suffering from GAD can find it hard to shake off their worries and relax. Moreover, severe worries often lead to certain physical symptoms like headaches, sweating, lightheadedness, trembling and shortness of breath. They are also prone to experience nausea, depression and substance use. It also affects their performance in school and work which results in further anxiety. Their overwhelming and frightening feelings can also interfere with relationships as well.
GAD is physically, mentally and emotionally exhausting. It wears the mind and drains the sufferer’s energy. Although they may worry about normal things, their anxiety and worry is exaggerated to such high levels that they become unable to break free from the cycle of chronic worrying. Moreover, it can also increase the risk of depression, heart diseases and other physical health conditions. People can develop this condition either as a child or as an adult. Overcoming generalized anxiety disorder can be a long and challenging process, but treatment can help you learn helpful coping skills and relieve symptoms.
Distinguishing Generalized Anxiety Disorder From Other Conditions
As anxiety is one of the most common symptoms for a number of mental health conditions, GAD can often be confused with other disorders, like –
- Panic disorder
- Obsessive-compulsive disorder
- Other phobia-related disorders
However, all these conditions are separate and should be diagnosed and treated differently. People with GAD feel anxious about various things for more than 6 months. Although they may be unable to recognize the source of their anxiety, they can be aware that it is irrational. However, they may not be able to control thoughts and emotions.
Symptoms Of GAD
According to a 2007 study 4 , a person experiencing GAD for at least 6 months will mainly struggle with feelings of apprehension, worry and tension. The researchers identified the following common symptoms of generalized anxiety disorder:
- General symptoms (cold chills or hot flushes, tingling sensations or numbness, muscle tension, body aches, inability to relax, restlessness, difficulty swallowing etc).
- Autonomic arousal symptoms (heart palpitations or faster heart rate, shaking, trembling, sweating & dry mouth).
- Chest and abdomen symptoms (breathing difficulties, chest pain, abdominal distress, nausea, stomach churning, discomfort, feeling choked etc).
- Psychological symptoms (derealisation, depersonalisation, intense fear, feeling of losing control, light-headedness, dizziness, passing out etc).
- Other nonspecific symptoms (being startled or exaggerated responses, difficulty concentrating, difficulty sleeping & persistent irritability)
However, the symptoms must exclude conditions like obsessive-compulsive disorder, phobic anxiety disorder, hypochondria and panic disorder. Moreover, the symptoms must not be caused by any physical conditions or substance use issues. The severity of the symptoms may vary depending on the situations and circumstances.
Read More About Symptoms Of Generalized Anxiety Disorder Here.
Causes Of GAD
Experts are yet to identify the exact causes of generalized anxiety disorder. Here are some other factors that may influence the onset of GAD in someone:
Like many other mental health disorders, GAD can be caused by genetic predisposition. Research 5 shows that it can be hereditary and runs in families.
2. Brain structure
When certain brain areas 6 that regulate emotion & behavior become overactivated, it can lead to GAD. An imbalance in brain chemicals, like noradrenaline & serotonin, and a functional amygdala dysconnectivity 7 can also be prominent factors.
3. Environmental factors
Traumatic and stressful life experiences 8 , like bullying, abuse and loss of a loved one, whether in childhood or adulthood, can also increase the likelihood of developing GAD.
4. Lifestyle factors
Moreover, certain unhealthy habits, like drug and alcohol abuse 9 , can also lead to the onset of this anxiety disorder. However, GAD can often develop without any clear reason as well.
Read More About Causes Of Generalized Anxiety Disorder Here.
Diagnosis Of GAD
According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), the diagnostic criteria of GAD includes the following:
- A. Excessive worry and anxiety for more than 6 months
- B. Unable to manage worry and anxiety
- C. Anxiety is related to 3 or more of the following symptoms for at least 6 months-
- Getting fatigued or exhausted easily
- Restlessness or feeling on edge
- Problems concentrating
- Muscle tension
- Sleep disturbance or insomnia
- D. Symptoms lead to significant impairment or distress in daily functioning in important areas
- E. Symptoms are not a result of other psychiatric disorders, physical health conditions or drugs or medications
A research paper published in JAMA network states that a doctor may check the patient’s medical history and perform physical examinations and tests to make sure the symptoms are not caused by other medical problems. It adds “Mental health professionals (psychiatrists, psychologists, and licensed therapists) ask questions and use specific testing methods to examine an individual’s symptoms to see if he/she has one of the anxiety disorders or another mental health issue, such as depression or bipolar disorder.”
Treatment Of Generalized Anxiety Disorder
Although generalized anxiety disorder is a long term disorder, there are different treatments available that can effectively relieve symptoms. A doctor or mental health professional may recommend psychotherapy or medication or a combination of both to eliminate feelings of anxiety. According to a 2015 study, “Treatment often includes medications such as selective serotonin reuptake inhibitors and/or psychotherapy, both of which are highly effective.” However, as the treatment process may take some time depending on the intensity of symptoms, it is crucial to follow the instructions of the doctor. Here are the treatment options for GAD:
A doctor may suggest psychotherapy before prescribing medications to someone suffering from this condition. Cognitive behavioral therapy (CBT), a form of talk therapy, is perhaps one of the most effective psychotherapy techniques for GAD, according to research 10 . “CBT appears to be both efficacious and effective in the treatment of anxiety disorders,” explains a 2015 study 11 . This form of therapy helps the patient identify and change their own negative & distorted thought patterns, overcome avoidance behavior, and focus on doing things that can help them gain better emotional control when anxious thoughts arise.
Although medications cannot cure the disorder, it can substantially help in relieving the symptoms of GAD. Different types of antidepressants and anti-anxiety medicines can be prescribed by the doctor for generalized anxiety disorder. According to a 2018 study 12 , SSRIs (selective serotonin reuptake inhibitors) and SNRIs (selective norepinephrine reuptake inhibitors) along with azapirones, benzodiazepines, anti-adrenergic medications, second-generation antipsychotics, melatonin analogues, lavender oil and kava can prove to be effective in treating GAD.
However, it may take 2 to 6 weeks for SSRIs 13 to effectively reduce anxiety. The study states “SSRIs and SNRIs represent the first-line psychopharmacologic treatment while second-line pharmacotherapies may include buspirone, benzodiazepines, SGAs and pregabalin,” in adult patients. However, the patient’s age, medical history and co-morbidity should be considered during psychopharmacologic treatment.
3. Relaxation techniques
In addition to medical treatment, guided and applied relaxation techniques, like progressive muscle relaxation 14 , deep breathing and autogenic training 15 can also help. Applied relaxation helps us to relax our muscles during stressful situations that make us feel anxious. Apart from these, other techniques like yoga 16 , meditation 17 and biofeedback 18 can also be helpful in managing GAD.
Read More About Generalized Anxiety Disorder Treatment Here.
Coping Strategies For GAD
Apart from therapy, medication and relaxation techniques, certain self-help and coping techniques can also help the sufferer to control their symptoms and deal with generalized anxiety disorder. Here are some helpful coping tips and lifestyle changes:
1. Staying physically active
Studies 19 have shown that regular exercise can effectively reduce anxiety and symptoms of anxiety disorders. Follow a daily exercise routine involving at least 30 minutes of high intensity physical activity for around 3-4 days a week. Exercise is highly effective in reducing stress and anxiety and improving mood.
2. Get enough sleep
Sleep deprivation 20 is closely associated with GAD. Practicing good sleep hygiene and getting at least 7-8 hours of sleep every day can help you relieve anxiety, feel relaxed and experience stable moods.
3. Eat nutritious food
Evidence 21 suggests that poor diet is often linked with low moods and mental health problems. Having a healthy diet involving whole grains, fish, vegetables & fruits can help to reduce anxiety and increase the happy hormone serotonin to stabilize mood.
4. Avoid substances
Stimulants and substances like nicotine 22 , caffeine 23 , alcohol 24 and recreational drugs often worsen GAD symptoms. Avoiding or limiting consumption of tobacco, coffee, cola, energy drinks, and alcohol can greatly help in coping with chronic anxiety. Moreover, avoiding drugs may be necessary to make sure treatment is effective.
5. Build a support system
Talk to trusted loved ones about your thoughts, emotions and experiences. Build a strong network of people you can rely on when you need help. Having a support system can be highly valuable in your recovery journey.
Although the treatment process can be challenging and time-consuming, it is crucial that the patient follows the instructions of their doctor and continues treatment, instead of giving up.
Read More About Coping With Generalized Anxiety Disorder Here.
Recovery Is Possible
Psychotherapy and medication, along with a healthy lifestyle can greatly help the sufferer to combat generalized anxiety disorder. Moreover, the support of friends and family can also help significantly in overcoming the condition. With time, patience, determination and proper treatment, a person with GAD can fully recover and live a normal, healthy life.References:
- NIMH » anxiety disorders. (n.d.). NIMH » Home. https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml
- Torpy JM, Burke AE, Golub RM. Generalized Anxiety Disorder. JAMA. 2011;305(5):522. doi:10.1001/jama.305.5.522
- InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Generalized anxiety disorder: Overview. 2008 Feb 14 [Updated 2017 Oct 19]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279595/
- Gale, C., & Davidson, O. (2007). Generalised anxiety disorder. BMJ (Clinical research ed.), 334(7593), 579–581. https://doi.org/10.1136/bmj.39133.559282.BE
- McLaughlin, K. A., Behar, E., & Borkovec, T. D. (2008). Family history of psychological problems in generalized anxiety disorder. Journal of clinical psychology, 64(7), 905–918. https://doi.org/10.1002/jclp.20497
- Nuss P. (2015). Anxiety disorders and GABA neurotransmission: a disturbance of modulation. Neuropsychiatric disease and treatment, 11, 165–175. https://doi.org/10.2147/NDT.S58841
- Makovac, E., Watson, D. R., Meeten, F., Garfinkel, S. N., Cercignani, M., Critchley, H. D., & Ottaviani, C. (2016). Amygdala functional connectivity as a longitudinal biomarker of symptom changes in generalized anxiety. Social cognitive and affective neuroscience, 11(11), 1719–1728. https://doi.org/10.1093/scan/nsw091
- Hettema JM, Prescott CA, Myers JM, Neale MC, Kendler KS. The structure of genetic and environmental risk factors for anxiety disorders in men and women. Arch Gen Psychiatry. 2005 Feb;62(2):182-9. doi: 10.1001/archpsyc.62.2.182. PMID: 15699295.
- Munir S, Takov V. Generalized Anxiety Disorder. [Updated 2020 Nov 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441870/
- Borza L. (2017). Cognitive-behavioral therapy for generalized anxiety. Dialogues in clinical neuroscience, 19(2), 203–208. https://doi.org/10.31887/DCNS.2017.19.2/lborza
- Kaczkurkin, A. N., & Foa, E. B. (2015). Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues in clinical neuroscience, 17(3), 337–346. https://doi.org/10.31887/DCNS.2015.17.3/akaczkurkin
- Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2018). Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review. Expert opinion on pharmacotherapy, 19(10), 1057–1070. https://doi.org/10.1080/14656566.2018.1491966
- InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Treatment options for generalized anxiety disorder. 2008 Feb 14 [Updated 2017 Oct 19]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279594/
- Li, Y., Wang, R., Tang, J., Chen, C., Tan, L., Wu, Z., Yu, F., & Wang, X. (2015). Progressive muscle relaxation improves anxiety and depression of pulmonary arterial hypertension patients. Evidence-based complementary and alternative medicine : eCAM, 2015, 792895. https://doi.org/10.1155/2015/792895
- Kanji N, Ernst E. Autogenic training for stress and anxiety: a systematic review. 2000. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK68303/
- Hofmann, S. G., Curtiss, J., Khalsa, S., Hoge, E., Rosenfield, D., Bui, E., Keshaviah, A., & Simon, N. (2015). Yoga for generalized anxiety disorder: design of a randomized controlled clinical trial. Contemporary clinical trials, 44, 70–76. https://doi.org/10.1016/j.cct.2015.08.003
- Hoge, E. A., Bui, E., Marques, L., Metcalf, C. A., Morris, L. K., Robinaugh, D. J., Worthington, J. J., Pollack, M. H., & Simon, N. M. (2013). Randomized controlled trial of mindfulness meditation for generalized anxiety disorder: effects on anxiety and stress reactivity. The Journal of clinical psychiatry, 74(8), 786–792. https://doi.org/10.4088/JCP.12m08083
- Ratanasiripong, P., Kaewboonchoo, O., Ratanasiripong, N., Hanklang, S., & Chumchai, P. (2015). Biofeedback Intervention for Stress, Anxiety, and Depression among Graduate Students in Public Health Nursing. Nursing research and practice, 2015, 160746. https://doi.org/10.1155/2015/160746
- Stonerock, G. L., Hoffman, B. M., Smith, P. J., & Blumenthal, J. A. (2015). Exercise as Treatment for Anxiety: Systematic Review and Analysis. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 49(4), 542–556. https://doi.org/10.1007/s12160-014-9685-9
- Mellman TA. Sleep and anxiety disorders. Psychiatr Clin North Am. 2006 Dec;29(4):1047-58; abstract x. doi: 10.1016/j.psc.2006.08.005. PMID: 17118281.
- Weng TT, Hao JH, Qian QW, Cao H, Fu JL, Sun Y, Huang L, Tao FB. Is there any relationship between dietary patterns and depression and anxiety in Chinese adolescents? Public Health Nutr. 2012 Apr;15(4):673-82. doi: 10.1017/S1368980011003077. Epub 2011 Nov 25. PMID: 22115495.
- Picciotto MR, Brunzell DH, Caldarone BJ. Effect of nicotine and nicotinic receptors on anxiety and depression. Neuroreport. 2002 Jul 2;13(9):1097-106. doi: 10.1097/00001756-200207020-00006. PMID: 12151749.
- Richards, G., & Smith, A. (2015). Caffeine consumption and self-assessed stress, anxiety, and depression in secondary school children. Journal of psychopharmacology (Oxford, England), 29(12), 1236–1247. https://doi.org/10.1177/0269881115612404
- Gibson-Smith D, Bot M, Brouwer IA, Visser M, Giltay EJ, Penninx BWJH. Association of food groups with depression and anxiety disorders. Eur J Nutr. 2020 Mar;59(2):767-778. doi: 10.1007/s00394-019-01943-4. Epub 2019 Apr 3. PMID: 30945032; PMCID: PMC7058560.