Generalized anxiety disorder

• 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.

Review Date: 1/15/2009

Reviewed By: Christos Ballas, MD, Attending Psychiatrist, Hospital of the University of Pennsylvania, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.