Generalized Anxiety Disorder, Adult

Generalized anxiety disorder (GAD) is a mental health condition. Unlike normal worries, anxiety related to GAD is not triggered by a specific event. These worries do not fade or get better with time. GAD interferes with relationships, work, and school.

GAD symptoms can vary from mild to severe. People with severe GAD can have intense waves of anxiety with physical symptoms that are similar to panic attacks.

What are the causes?

• Differences in natural brain chemicals.
• Genes passed down from parents to children.
• Differences in the way threats are perceived.
• Development and stress during childhood.
• Personality.

What increases the risk?

• Being female.
• Having a family history of anxiety disorders.
• Being very shy.
• Experiencing very stressful life events, such as the death of a loved one.
• Having a very stressful family environment.

What are the signs or symptoms?

• Mental and emotional symptoms:
  • Worrying excessively about natural disasters.
  • Fear of being late.
  • Difficulty concentrating.
  • Fears that others are judging your performance.
• Physical symptoms:
  • Fatigue.
  • Headaches, muscle tension, muscle twitches, trembling, or feeling shaky.
  • Feeling like your heart is pounding or beating very fast.
  • Feeling out of breath or like you cannot take a deep breath.
  • Having trouble falling asleep or staying asleep, or experiencing restlessness.
  • Sweating.
  • Nausea, diarrhea, or irritable bowel syndrome (IBS).
• Behavioral symptoms:
  • Experiencing erratic moods or irritability.
  • Avoidance of new situations.
  • Avoidance of people.
  • Extreme difficulty making decisions.

How is this diagnosed?

This condition is diagnosed based on your symptoms and medical history. You will also have a physical exam. Your health care provider may perform tests to rule out other possible causes of your symptoms.

• Is out of his or her control.
• Affects several different aspects of his or her life, such as work and relationships.
• Causes distress that makes him or her unable to take part in normal activities.
• Includes at least three symptoms of GAD, such as restlessness, fatigue, trouble concentrating, irritability, muscle tension, or sleep problems.

Before your health care provider can confirm a diagnosis of GAD, these symptoms must be present more days than they are not, and they must last for 6 months or longer.

How is this treated?

• Medicine. Antidepressant medicine is usually prescribed for long-term daily control. Anti-anxiety medicines may be added in severe cases, especially when panic attacks occur.
• Talk therapy (psychotherapy). Certain types of talk therapy can be helpful in treating GAD by providing support, education, and guidance. Options include:
  • Cognitive behavioral therapy (CBT). People learn coping skills and self-calming techniques to ease their physical symptoms. They learn to identify unrealistic thoughts and behaviors and to replace them with more appropriate thoughts and behaviors.
  • Acceptance and commitment therapy (ACT). This treatment teaches people how to be mindful as a way to cope with unwanted thoughts and feelings.
  • Biofeedback. This process trains you to manage your body's response (physiological response) through breathing techniques and relaxation methods. You will work with a therapist while machines are used to monitor your physical symptoms.
• Stress management techniques. These include yoga, meditation, and exercise.

A mental health specialist can help determine which treatment is best for you. Some people see improvement with one type of therapy. However, other people require a combination of therapies.

Follow these instructions at home:

Lifestyle

• Maintain a consistent routine and schedule.
• Anticipate stressful situations. Create a plan and allow extra time to work with your plan.
• Practice stress management or self-calming techniques that you have learned from your therapist or your health care provider.
• Exercise regularly and spend time outdoors.
• Eat a healthy diet that includes plenty of vegetables, fruits, whole grains, low-fat dairy products, and lean protein.
  • Do not eat a lot of foods that are high in fat, added sugar, or salt (sodium).
  • Drink plenty of water.
• Avoid alcohol. Alcohol can increase anxiety.
• Avoid caffeine and certain over-the-counter cold medicines. These may make you feel worse. Ask your pharmacist which medicines to avoid.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Understand that you are likely to have setbacks. Accept this and be kind to yourself as you persist to take better care of yourself.
• Anticipate stressful situations. Create a plan and allow extra time to work with your plan.
• Recognize and accept your accomplishments, even if you judge them as small.
• Spend time with people who care about you.
• Keep all follow-up visits. This is important.

Where to find more information

National Institute of Mental Health: www.nimh.nih.gov

Substance Abuse and Mental Health Services: www.samhsa.gov

Contact a health care provider if:

• Your symptoms do not get better.
• Your symptoms get worse.
• You have signs of depression, such as:
  • A persistently sad or irritable mood.
  • Loss of enjoyment in activities that used to bring you joy.
  • Change in weight or eating.
  • Changes in sleeping habits.

Get help right away if:

• You have thoughts about hurting yourself or others.

• Call your local emergency services (911 in the U.S.).
• Call a suicide crisis helpline, such as the National Suicide Prevention Lifeline at 1-800-273-8255 or 988 in the U.S. This is open 24 hours a day in the U.S.
• If you’re a Veteran:
  • Call 988 and press 1. This is open 24 hours a day.
  • Text the Veterans Crisis Line at 838255.

Summary

• Generalized anxiety disorder (GAD) is a mental health condition that involves worry that is not triggered by a specific event.
• People with GAD often worry excessively about many things in their lives, such as their health and family.
• GAD may cause symptoms such as restlessness, trouble concentrating, sleep problems, frequent sweating, nausea, diarrhea, headaches, and trembling or muscle twitching.
• A mental health specialist can help determine which treatment is best for you. Some people see improvement with one type of therapy. However, other people require a combination of therapies.