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Principles of Health: Anxiety and Stress

Conditions In-Depth: Generalized Anxiety Disorder

by Michael Woods, Adrian Preda

Generalized anxiety disorder (GAD) is characterized by 6 months or more of chronic, exaggerated worry and tension that is unfounded or much more severe than the normal anxiety most people experience. People with this disorder usually expect the worst; they worry excessively about money, health, family, or work, even when there are no signs of trouble. They are unable to relax and often suffer from insomnia and an inability to concentrate. Many people with GAD also have physical symptoms, such as fatigue, trembling, muscle tension, headaches, irritability, or hot flashes.

Approximately 6.8 million American adults develop GAD during the course of a given year. It most often begins during childhood or adolescence, but can begin in adulthood, too. It affects women more often than men. Some research suggests that GAD may run in families, and it may also worsen during stressful times.

Research shows that GAD often coexists with depression, substance abuse, or other anxiety disorders. Other conditions associated with stress, such as irritable bowel syndrome, often accompany GAD. Tell your doctor if you have physical symptoms, such as insomnia or headaches, or emotional symptoms, such as constant feelings of worry and tension. This information will help your doctor determine if you are suffering from GAD.

What are the risk factors for generalized anxiety disorder? What are the symptoms of generalized anxiety disorder? How is generalized anxiety disorder diagnosed? What are the treatments for generalized anxiety disorder? Are there screening tests for generalized anxiety disorder? How can I reduce my risk of generalized anxiety disorder? What questions should I ask my doctor? What is it like to live with generalized anxiety disorder? Where can I get more information about generalized anxiety disorder?

Screening

The purpose of screening is early diagnosis and treatment. Screening tests are administered to people without current symptoms, but who may be at high risk for certain diseases or conditions.

There are questionnaires, such as the GAD-7, that doctors use for screening and assessing the severity of GAD.

Diagnosis

Diagnosis of generalized anxiety disorder (GAD) can be difficult, since the distinction between normal anxiety and GAD is not always apparent. Diagnosis is based on a physical exam, psychological evaluation, and the criteria outlined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The symptoms of GAD must be present for at least 6 months and cause impairment in your ability to function. Initial Assessment

After obtaining your medical history, you may be asked about worries, anxiety, “nerves,” stress, and other symptoms. Your doctor may ask whether your anxiety is acute (brief or intermittent) or chronic (persistent).

Acute anxiety lasts from hours to weeks and usually occurs in response to a particular stressor. Persistent anxiety lasts from months to years and may be considered a part of your temperament. Persistent anxiety does not normally occur in response to stress. In susceptible people, though, stress may increase levels of persistent anxiety.

Evaluation of Medical Disorders

Before generalized anxiety disorder can be diagnosed, your doctor will look for and rule out other medical disorders that could cause your symptoms. Medical conditions commonly associated with anxiety include:

  • Hypoglycemia

  • Irritable bowel syndrome

  • Chronic pain conditions

  • Hyperthyroidism

  • Cushing disease

  • Mitral valve prolapse

  • Carcinoid syndrome

  • Hypocalcemia

  • Chronic obstructive pulmonary disease (COPD)

  • Heart failure

  • Tourette syndrome

  • Pheochromocytoma

Your doctor should also ask what medications, herbal supplements, and vitamins you take. You may be asked to stop taking certain medications or supplements so that your doctor can more accurately pinpoint the cause of your symptoms. Medications that can contribute to or worsen anxiety include:

  • Steroids

  • Over-the-counter cold remedies and diet pills

  • Antidepressants

  • Angiotensin-converting enzyme (ACE) inhibitors

  • Digoxin

  • Thyroxine

  • Theophylline

Evaluation for Substance Abuse

Use or withdrawal from addictive substances can cause anxiety. Your healthcare provider may ask about your use of alcohol, caffeine, nicotine, addictive medications (particularly sedatives), illegal drugs, and other substances.

Evaluation of Other Psychiatric Disorders

You may be tested for:

  • Depression

  • Panic disorder

  • Posttraumatic stress disorder

  • Social phobia

  • Obsessive-compulsive disorder

  • Social anxiety disorder

  • Other psychiatric disorders that often occur with generalized anxiety disorder

Symptoms

Generalized anxiety disorder (GAD) can affect both adults and children. People with GAD often have psychological and physical symptoms. They may visit the doctor many times before they are diagnosed. They often ask the doctor to help them with the problems related to GAD, such as headaches or trouble falling asleep. Reluctance to discuss emotional problems and worries may lead to a delay in the diagnosis.

Psychological symptoms of GAD include:

  • Excessive ongoing worrying, even when there are no signs of trouble

  • Inability to relax

  • Difficulty concentrating, mind going “blank”

  • Feeling tense, edgy, or jumpy

  • Irritability or restlessness

  • Difficulty sleeping

Physical symptoms of generalized anxiety disorder include:

  • Headaches

  • Fatigue

  • Trembling

  • Muscle tension

  • Sweating

  • Lightheadedness

  • Shortness of breath

  • Nausea

  • Chest pain

  • Numbness or tingling

  • Frequent urination in adults and bedwetting in children

  • Aches and pains

  • Gastrointestinal discomfort, including diarrhea, heartburn, and flatulence

  • Dry mouth

  • Cold, clammy hands

  • Difficulty swallowing

  • Racing heart

Risk Factors

A risk factor is something that increases your likeli-hood of getting a disease or condition.

It is possible to develop generalized anxiety disorder (GAD) with or without the risk factors listed below. However, the more risk factors you have, the greater your likelihood of developing GAD. If you have a number of risk factors, ask your doctor what you can do to reduce your risk.

Risk factors for developing GAD include:

Sex

Women are diagnosed with GAD twice as often as men. Reasons for this include hormonal factors, cultural expectations, and more willingness to visit doctors and talk about their anxiety.

Family History

Anxiety disorders tend to run in families. This may be due to family dynamics, such as the failure to learn effective coping skills, overprotective behaviors, abuse, and violence.

Genetic Factor

Approximately one-fourth of first-degree relatives will be affected.

Substance Abuse

Smoking, alcohol, and drug use can increase the risk of GAD.

Medical Conditions

People with chronic illnesses have a greater risk of GAD.

Socioeconomic and Ethnic Factors

Members of poor minority groups, particularly immigrants, tend to be at greater risk for developing GAD. This may be due to problems adjusting to a new culture, feelings of inferiority, alienation, and loss of strong family ties.

Depression

Generalized anxiety disorder often occurs with depression, particularly major depression or chronic mild depression. Adolescents with depression seem particularly at risk for developing GAD in adulthood.

Cultural Factors

Anxiety rates among children and adolescents have increased significantly since the 1950s. Two studies suggested that anxiety was related to lack of social connections and a sense of increased environmental threat.

Stressful Events in Susceptible People

The initial appearance of GAD often follows a highly stressful event, such as the loss of a loved one, the loss of an important relationship, the loss of a job, or being the victim of a crime.

History of Self-Harm

Adolescents who engage in self-harm by age 16 (with or without intent of suicide) are at a higher risk for a diagnosis of anxiety by young adulthood. Those with suicidal intent had a higher risk than those who did not.

Reducing Your Risk

Currently, there are no guidelines for reducing your risk of generalized anxiety disorder (GAD).

As scientists learn more about the condition, your doctor may have more information regarding steps for reducing your risk of GAD.

Medications

The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.

Generalized anxiety disorder (GAD) has a biological component. Abnormal amounts of certain brain chemicals may play a role in its development. The condition often responds to medication. Anxiolytics (antianxiety medications) and antidepressants help ease the symptoms of anxiety. They are often used in combination with counseling, such as cognitive-behavioral therapy.

Depending on your situation, medication may be advised for the short-term or for a lengthy period of time. In general, people who are treated for a longer period of time usually have a lower relapse rate. Medication will likely be recommended if anxiety impairs your ability to function.

Prescription Medications

Azapirones

Common name: Buspirone

Buspirone is a relatively new anxiolytic drug that is believed to enhance the activity of serotonin, a neurotransmitter involved in regulating anxiety and mood. It takes within 2 weeks to take effect. For that reason, it is not useful for treating acute anxiety and insomnia. The primary advantages of buspirone are that it is not sedating and it does not result in physical dependence or tolerance as compared with benzodiazepines.

Do not take buspirone with monoamine oxidase (MAO) inhibitors. Do not take with alcohol or other sedating drugs. Use with caution if you have liver or kidney disease.

Possible side effects include:

  • Excitability, nervousness

  • Headache

  • Nausea

  • Lightheadedness

Benzodiazepines

Common names include:

  • Lorazepam

  • Clonazepam

  • Chlordiazepoxide

  • Oxazepam

  • Clorazepate

  • Diazepam

  • Alprazolam

Benzodiazepines reduce symptoms of anxiety by enhancing the function of gamma aminobutyric acid (GABA), a neurotransmitter thought to be abnormal in people with GAD. These drugs produce a sedative effect, reduce physical symptoms, such as muscle tension, and often cause drowsiness and lethargy.

Benzodiazepines are fast acting and useful for treating acute anxiety and insomnia. These drugs can be habit-forming when used long-term or in excess. They may cause withdrawal symptoms, such as anxiety, irritability, and insomnia when discontinued. In such cases, you should taper off the medication slowly, over a period of weeks or months under a doctor’s supervision.

Withdrawal from benzodiazepines can be severe at times. It can include restlessness, tremors, delirium tremens, and seizures that can be life-threatening. Dangerously high fever, confusion, hallucinations, and dehydration may also occur. Benzodiazepines should not be used for more than 4 weeks. GAD may return after stopping the drug, but that is often true of any medication or treatment. Talk to your doctor before changing how you take this medication.

Do not take with alcohol or other sedating drugs. Do not take if you must drive a vehicle or operate machinery. Benzodiazepines should not be taken in combination with certain oral antifungal medications or by people with certain types of glaucoma.

Possible side effects include:

  • Drowsiness or lethargy

  • Confusion

  • Lightheadedness, particularly in elderly persons

  • Slow reaction time, impaired coordination

  • Memory changes

Selective Serotonin Reuptake Inhibitors (SSRIs)

Common names include:

  • Citalopram

  • Fluvoxamine

  • Paroxetine

  • Fluoxetine

  • Sertraline

  • Escitalopram

Selective serotonin reuptake inhibitors (SSRIs) affect the concentration of the neurotransmitter serotonin, which plays a role in anxiety. Although they are considered antidepressants, SSRIs have been used effectively for the treatment of anxiety disorders. Improvement is usually seen in 4 to 6 weeks after beginning treatment. You should not drink alcohol while taking an SSRI. Do not take SSRIs if you are taking MAO inhibitors, thioridazine, or pimozide. Use with caution if you have liver or kidney disease.

Possible side effects include:

  • Nausea or vomiting

  • Abdominal pain

  • Rash

  • Sweating, anxiety

  • Headaches

  • Dry mouth

  • Tremor

  • Diarrhea

  • Loss of appetite or weight loss

  • Weight gain

  • Nervousness

  • Insomnia

  • Lightheadedness

  • Sexual dysfunction—ranges from decreased arousal, to erectile dysfunction, and/or delayed time to orgasm

  • Risk of severe mood and behavior changes, including suicidal thoughts in some patients—young adults may be at a higher risk for this side effect

Tricyclic Antidepressants

Common names include:

  • Imipramine

  • Nortriptyline

Tricyclic antidepressants are thought to regulate serotonin and norepinephrine in the brain. They have been used effectively for the treatment of depression. Improvement is usually seen in 3 to 6 weeks after beginning treatment. These drugs are highly toxic if taken in large doses therefore, they are often not prescribed for suicidal patients. Tricyclic antide-pressants are not addictive.

These drugs are infrequently used for the treatment of GAD because of the many side effects, plus the overdose potential.

Possible side effects include:

  • Lightheadedness

  • Dry mouth

  • Constipation

  • Difficulty urinating

  • Weight gain

  • Low blood pressure

  • Sexual dysfunction

  • Risk of severe mood and behavior changes, including suicidal thoughts in some patients—young adults may be at a higher risk for this side effect

Atypical Antidepressants

Common names include:

  • Trazodone

  • Venlafaxine

  • Nefazodone

Atypical antidepressants affect the concentration of serotonin and can be effective in treating GAD. Improvement is usually seen in 4 to 6 weeks after beginning treatment.

Possible side effects include:

  • Nausea

  • Nervousness

  • Diminished sex drive

  • Risk of severe mood and behavior changes, including suicidal thoughts in some patients—young adults may be at a higher risk for this side effect

Special Considerations

Consultation with a specially trained mental health professional is recommended if you do not respond to treatment with medications. A mental health professional can help clarify the diagnosis and determine if another psychiatric disorder is present. They can also make recommendations about psychotherapy and changes in medications.

If you are taking medications, follow these general guidelines:

  • Take the medication as directed. Do not change the amount or the schedule.

  • Ask what side effects could occur. Report them to your doctor.

  • Talk to your doctor before you stop taking any prescription medication.

  • Plan ahead for refills if you need them.

  • Do not share your prescription medication with anyone.

  • Medications can be dangerous when mixed. Talk to your doctor if you are taking more than one medication, including over-the-counter products and supplements.

When to Contact Your Doctor

Contact your doctor if you have any side effects that are troublesome and persistent or your symptoms are not improving.

Other Treatments

Counseling

The following types of counseling are often effective for generalized anxiety disorder (GAD), as well as other anxiety disorders. During counseling with a mental health professional, you can learn ways to reduce anxiety and psychological stress in your daily life.

Behavioral Therapy

Behavioral therapy can help you modify and gain control over your behavior. It helps you learn how to cope with anxiety-provoking situations through controlled exposure to them. Examples include stress management (coping techniques), relaxation exercises, assertiveness training, and desensitization (gradual exposure to a stressful situation). This type of therapy can help you gain a better sense of control over your life.

Cognitive Therapy

Cognitive therapy helps you to change patterns of thinking that are unproductive and harmful. This kind of therapy helps you examine your feelings and separate realistic from unrealistic thoughts and helpful from unhelpful thoughts. Changing the way you respond helps you control the anxiety you may feel. As with behavioral therapy, it helps you gain a better sense of control over your life.

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy is a combination of cognitive and behavioral therapies. This involves:

  • Cognitive restructuring—change false self-concepts, such as low self-esteem

  • Anxiety monitoring—record thoughts and feelings every day

  • Education—identify the basis of your symptoms followed by specific educational plan to deal with them effectively

With this type of therapy, you examine your feelings and thought patterns, learn to interpret them in a more realistic way, and apply coping techniques to various situations. These skills will be useful for a lifetime.

Other Treatments

Relaxation Techniques

A variety of relaxation techniques can help you cope more effectively with stressors that contribute to GAD. Examples include meditation, deep breathing, progressive relaxation, yoga, and biofeedback. These techniques help you recognize tension in your body and release it with exercises that help quiet your mind and relax your muscles.

Exercise

Regular physical activity may also help to reduce anxiety. Some good options include brisk walking, swimming, and strength training. Before starting an exercise program, check with your doctor about any possible medical problems you may have that would limit your exercise program.

Talking to Your Doctor

You have a unique medical history. Therefore, it is essential to talk with your doctor about your personal risk factors and/or experience with generalized anxiety disorder (GAD). By talking openly and regularly with your doctor, you can take an active role in your care.

General Tips for Gathering Information

Here are some tips that will make it easier for you to talk to your doctor:

  • Bring someone else with you. It helps to have another person hear what is said and think of questions to ask.

  • Write out your questions ahead of time, so you don’t forget them.

  • Write down the answers you get, and make sure you understand what you are hearing. Ask for clarification, if necessary.

  • Don’t be afraid to ask your questions or ask where you can find more information about what you are discussing. You have a right to know.

Specific Questions to Ask Your Doctor

About GAD

  • Tell your doctor about your constant worry and tension, or any other signs of GAD, such as aches and pains for no reason, or trouble sleeping.

  • Tell your doctor if these problems keep you from doing everyday things and living your life.

  • Ask for a checkup to check for other illnesses.

  • Ask your doctor if they have helped other people with GAD. Special training helps doctors treat people with GAD. If your doctor doesn’t have special training, ask for the name of a doctor or counselor who does.

About Treatment Options

  • What treatment options are available for GAD?

  • If your doctor prescribes medicine, ask:

    • How long will it take to work?

    • What benefits can I expect?

    • What side effects should I watch for?

  • Can you recommend a counselor who treats people with GAD?

  • If you decide to try counseling, interview counselors and find one with whom you feel comfortable discussing your problems. You should ask the counselor about:

    • Their training and experience in treating anxiety disorders

    • Their basic approach to treatment

    • The length of treatment

    • The length and frequency of treatment sessions

    • What health insurance is accepted

    • Fee schedules and sliding scale fees to accompany various financial circumstances

About Lifestyle Changes

Ask your doctor or counselor about lifestyle changes that could help you reduce your anxiety and stress symptoms. Examples may include:

  • Diet

  • Caffeine and alcohol use

  • Getting adequate sleep

  • Relaxation and stress management techniques

  • Exercise

About Your Outlook

  • What are my chances of recovering from GAD with treatment? Without treatment?

  • Will I have a recurrence of GAD and related conditions? What can I do to prevent these?

Resource Guide

American Psychiatric Association

1000 Wilson Boulevard, Suite 1825

Arlington, VA 22209–3901

703-907-7300

www.psychiatry.org

This website provides information to the public and healthcare professionals on psychiatric disorders, as well as access to news releases, books, and journals.

ADAA—Anxiety and Depression Association of America

8701 Georgia Avenue, Suite 412

Silver Spring, MD 20910

240-485-1001

adaa.org

This website provides information on anxiety disorders for the public and healthcare professionals, including help finding a therapist, self-help groups, and anxiety screening tools.

National Institute of Mental Health

Science Writing, Press, and Dissemination Branch

6001 Executive Boulevard

Room 6200, MSC 9663

Bethesda, MD 20892–9663

866-615-6464

www.nimh.nih.gov

This website provides mental health information for the public, healthcare professionals, and researchers. This site covers news and events, as well as information on clinical trials, funding opportunities, and research.

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Citation Types

Type
Format
MLA 9th
Woods, Michael, and Adrian Preda. "Conditions In-Depth: Generalized Anxiety Disorder." Principles of Health: Anxiety and Stress, edited by Lindsey L. Wilner & Megan E. Shaal, Salem Press, 2020. Salem Online, online.salempress.com/articleDetails.do?articleName=POHAnxiety_0113.
APA 7th
Woods, M., & Preda, A. (2020). Conditions In-Depth: Generalized Anxiety Disorder. In L. L. Wilner & M. E. Shaal (Eds.), Principles of Health: Anxiety and Stress. Salem Press. online.salempress.com.
CMOS 17th
Woods, Michael and Preda, Adrian. "Conditions In-Depth: Generalized Anxiety Disorder." Edited by Lindsey L. Wilner & Megan E. Shaal. Principles of Health: Anxiety and Stress. Hackensack: Salem Press, 2020. Accessed October 22, 2025. online.salempress.com.