An Overview of Generalized Anxiety Disorder

Anxiety disorders are a class of mental disorders that distinguish themselves from other problems with two key features: fear and anxiety. Fear is an emotion experienced in response to an imminent threat (real or imagined). Anxiety, on the other hand, is an emotional state experienced in anticipation of a potential future threat.

Generalized anxiety disorder (GAD)—despite its name—is a specific type of anxiety disorder.

The hallmark feature of GAD is persistent, excessive, and intrusive worry.

Signs and Symptoms

To meet formalized criteria for GAD, excessive anxiety and worry must be present most of the day more days than not for at least six months.

Features of excessive worry include:

  • worry even when there is nothing wrong
  • worry about a perceived threat in a manner that is disproportionate to actual risk
  • worrying about something for the majority of your waking hours
  • asking others for reassurance about your specific concern, but continuing to worry anyways
  • worry that shifts from one topic to another

Worries may manifest differently in adults versus children, but in both cases they tend to be about typical life circumstances or stressors (e.g., health issues, financial matters, starting a new school or job).

For people with GAD, the worry is very difficult to control and is associated with multiple physical or cognitive symptoms such as:

  • restlessness or edginess
  • fatigue
  • poor concentration (sometimes with memory problems)
  • irritability (sometimes observable to others)
  • muscle tension or soreness
  • impaired sleep

Many people with GAD also experience other uncomfortable markers of prolonged anxiety, including sweating, stomach upset, or migraine headaches.

Children and teens with GAD may experience fewer physical or cognitive symptoms than adults.

Diagnosis

GAD can be challenging to accurately identify because anxiety is an emotional state that everyone experiences from time to time in response to the stresses of everyday life. In fact, moderate anxiety can be quite helpful in a range of ways—for example, providing us with motivation to get things done or to respond to actual threats to our safety if they occur.

The diagnosis of GAD occurs, however, when anxiety crosses a threshold of excessiveness and stays there for extended periods of time. The anxiety, worry, or other symptoms make it extremely challenging for an individual to fulfill responsibilities on a daily basis. This can result in a strain in personal relationships or problems at work or school.

GAD is typically diagnosed by a mental health professional or a physician. During an evaluation, the clinician will ask you about your symptoms and may use clinical judgment or standardized assessment tools to make a diagnosis.

You may be asked to undergo or provide records from a physical exam by a medical doctor to ensure that physical and cognitive symptoms are unrelated to other medical problems.

As part of a thorough evaluation, your clinician will ask a range of questions about symptoms or behaviors that may or may not apply to you. This might include questions about your mood, eating behavior, substance use, or history of trauma. Your answers will help your healthcare provider to rule out other psychiatric problems or decide that your symptoms are better explained by a different diagnosis. Speaking openly with your provider is critical—it’s simply the best and fastest way to arrive at an appropriate treatment plan and get some relief from your symptoms.

Who Gets GAD?

Women are about twice as likely to develop GAD in their lifetime as men. Though the average age of onset is 31 years, later than that of other anxiety disorders, GAD can occur at any point in the life cycle.

GAD is among the three most common psychiatric problems in youngsters (alongside separation anxiety and social anxiety disorders). Early onset anxiety disorders can put children and teens at greater risk for a range of other psychological issues in adulthood. However, early detection and intervention can result in significant or full remission of symptoms and may protect against the development of other problems later in life.

Learn more about the signs and symptoms of GAD in children and teens and how this condition is treated in young people.

GAD is also the most commonly occurring anxiety disorder in older adults. New onset GAD in older adults is commonly related to co-occurring depression. In this age group, GAD has historically likely been underdiagnosed and undertreated for a number of reasons. However, as the field of geriatric psychiatry grows, so too does research about GAD in older adults and its treatment (including ways to overcome typical barriers to mental health care).

What Causes GAD?

Like many other psychiatric disorders, GAD is thought to emerge in the context of particular biological and environmental factors.

A key biological factor is genetic vulnerability. It is estimated that one-third of the risk of experiencing GAD is genetic, but genetic factors may overlap with other anxiety and mood disorders (particularly major depression).

Temperament is another associated factor with GAD. Temperament refers to personality traits that are often regarded as innate (and therefore might be biologically mediated). Temperamental characteristics known to be associated with GAD include harm avoidance, neuroticism (or the tendency to be in a negative emotional state), and behavioral inhibition.

No specific environmental factors have been identified as specific or necessary to cause GAD. However, environmental features associated with GAD include (but are not limited to):

  • observation of constant worrying by family members
  • overprotective parents
  • modeling of dealing with stress in an anxious manner
  • exposure to an unsafe setting (including trauma)
  • periods of prolonged stress

Again, no one factor—biological or environmental—is understood to cause GAD. Rather, the disorder is thought to result from a "perfect storm of environmental stressors that occur in an individual with a genetic predisposition for anxiety.

Course of Illness

People with GAD will often describe themselves as feeling anxious or on edge for most of their lives. The expression of symptoms appears consistent across age groups. However, the content of the worry does tend to change across the lifespan. Younger individuals may worry more about school and performance, while older people focus more on physical health, finances, and family’s well-being.

For those meeting the threshold of the formal diagnosis, symptoms tend to be chronic, but to wax and wane—between full- and sub-threshold forms of the disorder—across the lifespan. Though remission rates are low overall, GAD symptoms are known to improve substantially when treated either with psychotherapy or medication. Treatment can provide the tools necessary to help individuals with GAD successfully navigate subsequent periods of high stress and transition.

Co-Occurring Conditions

It is not uncommon for individuals with GAD to meet criteria for another psychiatric diagnosis in the course of their lifetime. If multiple disorders occur simultaneously they are referred to as comorbid conditions. The most commonly co-occurring disorder is depression. However, a substantial subset of individuals struggle with co-occurring GAD and anxiety disorders.

Treatment

Treatment for GAD typically falls into one of three categories: medication, psychotherapy, and self-help. The goals of any treatment are to help people with the disorder feel better physically and mentally, and to make it more possible to fully engage in relationships, at work or school, or in other situations for which the worry previously seemed paralyzing. Treatment research is ongoing and encouraging, particularly with regards to the helpfulness of approaches like yoga and mindfulness. Because anxiety is a natural part of the human experience and treatments for GAD appear to offer far-reaching benefits on day-to-day functioning, even people with low-grade anxiety may benefit from treatment.

If You Have Recently Been Diagnosed with GAD

Receiving a diagnosis of GAD—or any psychiatric disorder—is an important step towards feeling better because diagnoses are used to guide treatment recommendations. Participate actively in a discussion with the diagnosing clinician to understand your treatment options and evaluate the best place to start.

If you are considering psychotherapy as a first-line treatment, educate yourself about evidence-based approaches such as cognitive behavioral therapy and acceptance and commitment therapy and about what you can (and cannot) expect from the talk therapy process overall. 

If you are interested in a trial of a medication to treat your GAD symptoms, talk with your prescriber to decide about the options. He or she will help you to evaluate the relative risks and benefits of taking a new medicine in light of your particular medical and psychiatric history.

If Your Loved One Has GAD

Living with someone living with anxiety has its challenges, but there are several ways that you can help including learning about the problem, discouraging avoidance, limiting reassurance-seeking behavior, and championing successes large and small. If you have an anxious child or teen, review some of the unique aspects of helping youngsters with GAD.

There will, of course, be limits to the ways in which you can be helpful to your loved one with GAD. This is when it is especially useful for your loved one to use the treatment resources (i.e., clinicians) available to them. If your loved one is reluctant to seek treatment for anxiety, or unaware of the severity of the problem, look for a quiet moment to have a ​​nonjudgmental conversation about how treatment might be a way to feel better, faster.

A Word From Verywell

The challenge of GAD is that anxiety is a ubiquitous (and often helpful) emotion, and so it can be difficult to know when the worry has crossed the line to “too much.” However, if worry is persistent, uncontrollable, and associated with physical symptoms of anxiety, it is worth seeking consultation with a mental health professional to see what’s what, and to learn new ways of coping with stressors of any magnitude.

Sources:

American Psychiatric Association. Diagnostic and statistical manual of mental disorders (Fifth edition). Washington, D.C.: American Psychiatric Association; 2013.

Craske MG, Barlow, DH. Mastery of Your Anxiety and Worry Workbook (2nd Edition). In DH Barlow (Ed.) Treatments That Work. New York: Oxford University Press, 2006.

Kahl KG, Winter L, Schweiger U. The third wave of cognitive behavioural therapies: what is new and what is effective? Curr. Opin. Psychiatry. 2012;25, 522–528.

Mackenzie CS, Reynolds K, Cho, KL, Pagura J, Sareen, J. Prevalence and correlates of generalized anxiety disorder in a national sample of older adultsAmerican Journal of Geriatric Psychiatry 2011; 19: 305-315.

Mohatt J, Bennett SM, Walkup JT. (2014). Treatment of separation, generalized, and social anxiety disorders in youthsAm J Psychiatry, 171:741-748.

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