Generalized anxiety disorder, or GAD, is a type of anxiety disorder that causes excessive worry and anxiety about many different things. Some anxiety is normal, but with GAD it is difficult to control and occurs out of proportion with a given situation. GAD causes serious dysfunction in many areas of a person’s life, such as work, school, and relationships. Treatment for this anxiety disorder includes behavioral therapies, medications, and ongoing self-care and healthy coping strategies. With dedicated treatment, it is possible to improve symptoms of generalized anxiety and improve function.
What Is Generalized Anxiety Disorder?
Generalized anxiety disorder, or GAD, is a mental illness that causes excessive worrying about a variety of situations. While it is normal for a person to experience anxiety or to worry in stressful situations, someone struggling with GAD experience anxiety to a degree that is out of proportion with circumstances. The level of anxiety a person may experience can be extreme and difficult or impossible to manage or reduce.
The symptoms of GAD can cause significant impairment, interfering with everything from social activities to academic performance, but they can also be managed with good treatment.
Following an accurate diagnosis, a person with GAD needs to go through long-term treatment that may include medications, therapy, alternative therapies, lifestyle changes, and healthy coping strategies. Ongoing care is also important, as this is a chronic illness that can relapse even after successful treatment.
Types of Anxiety Disorders
Generalized anxiety disorder is just one of several types of mental illnesses classified as anxiety disorders. While GAD is characterized by excessive worrying about anything, and often everything, the other anxiety disorders are more specific:
- Separation anxiety disorder. This is a strong fear of being separated from people or from home. It can occur in children and adults.
- Selective mutism. Most often seen in children, selective mutism causes someone to not talk when they should, such as at school or in the home. It is not related to the physical or developmental ability to speak.
- Phobias. A phobia is an irrational but intense fear of something specific, like spiders or leaving the house.
- Social anxiety disorder. Social anxiety causes severe worry and fear about socializing and fears of being embarrassed or made fun of by other people.
- Panic Disorder. Panic disorder causes panic attacks—frightening and sudden episodes that cause dread, anxiety, fear, and physical symptoms.
Facts and Statistics
Anxiety disorders are the most common type of mental disorders that affect adults in the U.S. Nearly 40 million people every year struggle with some type of anxiety disorder, including GAD. While other anxiety disorders trigger specific fears and worries, GAD causes a range of worries about many different things.
- Approximately three percent of American adults, or 6.8 million people, have GAD.
- Only about 43 percent of people with GAD actually get treatment.
- The risk of being diagnosed with GAD is twice as high for women as men.
- Prevalence of GAD is highest in adults between the ages of 30 and 44.
- Over 32 percent of adults with GAD experience serious impairment as a result.
- Just over two percent of adolescents struggle with generalized anxiety.
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Symptoms and Diagnosis of Generalized Anxiety Disorder
Getting a diagnosis for GAD is important, because it will lead to necessary and appropriate treatment. A mental health professional can evaluate a patient and use the criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to make an accurate diagnosis. To make this diagnosis a patient must meet the following requirements:
- Out-of-proportion, excessive worry and anxiety on most days for six months or more, with respect to multiple situations or factors, such as school performance or social activities
- An inability to manage or reduce anxiety
- Significant distress or impairment in any area of normal functioning because of anxiety
- Excessive, uncontrollable worry and impairment that cannot be explained by other conditions, either medical or mental, or by substance use or a developmental phase
In addition to the above criteria, a person’s excessive anxiety must be characterized by three or more of these symptoms of GAD:
- Getting fatigued easily
- Feeling on edge or restless
- Being unable to concentrate or finding that one’s mind goes blank
- Muscle tension
- Difficulty falling or staying asleep, or experiencing poor quality sleep
These are the diagnostic symptoms of GAD, but there are many other signs that a person may exhibit when struggling with this type of anxiety disorder:
- Overthinking situations and making detailed plans to consider worst-case scenarios
- Being unable to handle uncertainty
- Being indecisive because of worry over making the wrong decision
- Being unable to stop worrying or obsessing over something
- Being unable to relax
- Physical signs, like sweating, nausea, diarrhea, starling easy, or tremors
It is important to remember that GAD causes a person to worry about several things, not just one or two specific concerns. With GAD, someone may have anxiety about doing well in school or at work, about relationships, over social situations, and also over things that are often less rational, like natural disasters or being a victim of a crime.
Causes and Risk Factors
No one knows exactly what causes GAD, but there are likely to be several factors that trigger it in individuals. These include genetics, changes in the structure or chemistry of the brain, and developmental and environmental factors. Known risk factors for GAD include family history of anxiety disorders and traumatic or very stressful experiences, especially in childhood. There is also some evidence that certain personality traits predispose someone to GAD, like timidity or cynicism.
More evidence is being uncovered relating to anxiety disorders and how the brain functions, or dysfunctions. Very recent research used laboratory mice to look for areas in the brain responsible for the feeling of anxiety. The researchers discovered specific types of brain cells located in the hippocampus that fire when the mice were put in anxiety-inducing situations. When those cells fired they triggered anxious behaviors, like hiding. The finding is important, because it is the first time that cells that seem to be dedicated to a state of anxiety have been found. This may help point to a brain structural or chemical cause of anxiety disorder, but it may also help researchers develop better treatments.
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It is common for someone with generalized anxiety disorder to also struggle with other mental illnesses or substance use disorders. GAD is one of the most common conditions to co-occur with others. Some of the conditions that someone with GAD is at a greater risk of also being diagnosed for include major depression, persistent depressive disorder, and other anxiety disorders, most commonly panic disorder.
Substance use disorders are also more common in people with GAD than those without any mental illness. Of all the anxiety disorders, substance abuse most commonly co-occurs with GAD and panic disorder. All anxiety disorders are also more likely to co-occur with dependence on substances.
There are a few possible explanations for these co-occurrences: someone with GAD may use alcohol or drugs to self-medicate and cope with negative feelings; substance abuse may trigger anxiety symptoms in someone already predisposed to it; they may also co-occur because substance use disorders and anxiety disorders have similar risk factors.
Treatment and Prognosis of Generalized Anxiety Disorder
The typical course of treatment for GAD is a combination of medications and therapy, followed by ongoing self-care and treatment as needed. GAD can be debilitating and cause a lot of dysfunction, so treating it initially in residential care is a good way to allow a patient to focus on getting better in a safe and dedicated environment. In residential treatment a patient does not need to be concerned with other responsibilities.
In treatment, a patient with GAD is likely to be treated mostly with therapy but also with medications. GAD responds well to SSRIs, a category of antidepressants that target the brain chemical called serotonin. These drugs can take several weeks to work, so patients may also be given anti-anxiety medications for more immediate relief from symptoms.
Therapy styles may vary for treating GAD, but the most common approach is to use behavioral therapies, like cognitive behavioral therapy. This is a type of therapy that guides patients to become more aware of mood and symptoms and to take active steps to change negative thoughts and behaviors. In addition to therapy and medication, treatment in a residential facility is supplemented with alternative therapies, group support, family involvement, nutrition, and exercise.
After treatment in a facility, patients with GAD are encouraged to maintain treatment with therapy as needed, with continuing use of medication, and with lifestyle changes and self-care. The latter may include changing things that cause a lot of stress, like work, and using stress management techniques and positive coping skills learned in therapy.
GAD can be a devastating condition that causes severe anxiety over nearly everything. It can cause a person to be unable to function normally in several areas of his or her life. With commitment to treatment, however, and dedication to ongoing self-care for this chronic illness, the prognosis for most patients is very good and recovery is likely.