Generalized Anxiety Disorder (GAD) is an anxiety disorder marked by regular, excessive anxiety that gets in the way of someone’s quality of life or ability to function. GAD symptoms arise in response to several different situations, and sometimes even when there is no identifiable cause. GAD is relatively common, affecting about 3% of the American population.1
What Is Generalized Anxiety Disorder?
People with generalized anxiety disorder (GAD) worry excessively about many different situations, and sometimes without being able to identify what they are anxious about. In addition to excessive worrying, people with GAD often also experience restlessness, fatigue, tension, and irritability, and many have trouble sleeping and concentrating.2
How Common Is GAD?
Generalized anxiety disorder is a type of anxiety that affects 5.7% of adults in the US at some point in their lives.1
GAD vs. Normal Stress
Stress and anxiety are often experienced together, with many overlapping symptoms including a racing heart, muscle tension, irritability, and worried thoughts. While these symptoms are normal in unfamiliar, stressful, or scary situations, people with GAD experience anxiety that is excessive and frequent. Their symptoms occur most days of the week and persist for at least six months, as opposed to only being experienced during times of stress. Still, people with the disorder often find their symptoms worsen during times of stress.
Generalized Anxiety Disorder Symptoms
Only a licensed and trained health or mental health professional can diagnose GAD. All mental health conditions, including GAD, are diagnosed using a standardized set of criteria drawn from the Diagnostic and Statistical Manual of Mental Disorders
Symptoms of generalized anxiety disorder include:2
- Excessive anxiety and worry about a number of events or activities, occurring more days than not for at least six months
- The individual finds it difficult to control the worry
- The anxiety and worry are associated with three or more of the following symptoms (only one required in children):
- Restlessness, feeling keyed up or on edge
- Becoming easily fatigued
- Difficulty concentrating or mind going blank
- Irritability
- Muscle tension
- Difficulty falling asleep or staying asleep, or feeling tired after sleep
- The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
- The disturbance is not attributable to the psychological effects of a substance or another medical condition
- The disturbance is not better explained by another mental disorder
GAD Symptoms in Children & Teens
GAD signs and symptoms in children and adolescents are relatively the same as adults; what changes is what they worry about and how the symptoms may present. Kids with GAD tend to worry about things typical for their age—however, their worries and apprehensions are recurrent, intense, and hard to shake off, affecting their ability to focus, relax, and enjoy activities.2
Common signs and symptoms of GAD in children/teens include:2
- Getting easily irritable or unhappy for no apparent reason
- Having difficulty coping with uncertainty or indecisiveness
- Expecting the worst without a valid explanation; tendency to overly worry about catastrophic events, like earthquakes or nuclear war
- Seeking constant reassurance
- Feelings of insecurity regarding performance which may manifest in perfectionistic tendencies like having to redo tasks, obsessing about punctuality, etc.
- Becoming easily tired, particularly at the end of the day
- Inability to concentrate or feeling like their mind is “going blank”
- Restlessness, feeling keyed up or on edge
- Trouble sleeping
- Experiencing physical issues like headaches, upset stomach, muscle soreness, trembling, twitching, etc.
Signs of Generalized Anxiety Disorder
GAD is a disorder within the category of anxiety disorders. Like all anxiety disorders, the condition causes people to experience excessive anxiety. Anxiety describes a collection of symptoms that include changes in the way a person feels, thinks and behaves.
Changes in Feelings, Thoughts, & Behaviors
While all people experience occasional anxiety in specific stressful situations (referred to as situational anxiety), people with GAD experience anxiety that is frequent and disproportionate. People with GAD often experience more intense anxiety in situations where there is a lot of uncertainty or when they aren’t in control. They may not be able to identify a specific fear during these times and might instead describe just feeling a general sense of dread. Some people also describe feeling more irritable or snappy during times when they are anxious.
Panic Attacks
Some people with GAD experience anxiety as panic attacks, which are intense symptoms of anxiety that come on suddenly and typically last for several minutes. Someone having a panic attack often describes that their heart is racing or that they have chest pain and experience shortness of breath. Some people might experience dizziness or even pass out during a panic attack. Many times, people confuse panic attacks with heart attacks or other medication emergencies and end up seeking emergency care.
Worry & Trouble Concentrating
People with GAD may spend a lot of time worrying about bad things that could happen, even when these are highly unlikely to occur. Because of these changes in thinking, people with GAD often describe having trouble focusing and concentrating. Worried thoughts might keep them up at night, and insomnia is frequently reported.
Avoidance
Because anxiety is uncomfortable, people with GAD may avoid certain situations that cause them more anxiety. As a result, they might become more socially isolated, less active, and give up activities they used to enjoy. Because anxiety tends to be more intense in unfamiliar or uncertain situations, people with GAD might have set routines that they are hesitant to deviate from. While avoidance of tasks and situations is common, there are some people who cope with GAD symptoms by staying very active and busy, distracting themselves from anxious thoughts or feelings.
What Causes Generalized Anxiety Disorder?
A number of different brain chemicals are thought to play a role in anxiety, and people with GAD may have imbalances that help to explain some of their symptoms. Serotonin and norepinephrine are two primary chemicals that tend to be imbalanced in people with GAD.
It is believed that anxiety disorders, including GAD, are largely a result of an overactive amygdala (a region of the brain that helps detect danger). When the amygdala is overactive, it triggers the release of certain chemicals and activates the nervous system in ways that cause an increase in heart rate and respiration, along with other changes that make up the “fight or flight” response.3
Risk Factors for Developing GAD
All mental health conditions are caused by a complex interaction of genetic, biological, social, psychological, and environmental factors. People who have a family member with the disorder are 25% more likely to develop GAD, as are people diagnosed with other medical or mental health conditions (like depression).4 People who abuse substances are also at higher risk, as are those who experience something stressful or traumatic at some point in their lives, especially during childhood.
While not causal, some people may be at higher risk for developing GAD than others. Those who are more likely to develop GAD include:1,4
- Females
- Unmarried adults
- People who have low levels of education
- People under greater levels of stress
- People who are in poor physical health
Complications of Living With GAD
GAD can be extremely debilitating and is usually linked to a variety of negative life outcomes. When left untreated, complications can lead to or aggravate other mental and/or physical health conditions, impacting important areas of functioning.2,4
Complications of untreated GAD include:2,4
- Poor job performance and increased absenteeism
- Inability to efficiently tend to personal responsibilities
- Sleep issues like insomnia
- Increased used of medical resources
- Chronic depression
- Substance or alcohol misuse
- Health problems such as irritable bowel syndrome, heart disease, ongoing headaches, and more
- Social withdrawal
- Increased suicidal thoughts and behaviors
When Should I See My Doctor?
If any of the symptoms and/or complications discussed resonate with you, it’s a good idea to talk with your doctor about how you’re feeling. Your PCP can evaluate you for any underlying medical conditions that may account for your symptoms or refer you to a mental health specialist. The earlier you get treatment for GAD the better, because when left untreated your overall wellness may be at risk.4
How Is GAD Treated?
GAD symptoms can get in the way of living a full, happy, and productive life. Luckily, GAD is highly treatable and many people who receive treatment can significantly reduce, and in some cases even resolve, their symptoms. Treatment options for anxiety include psychotherapy, medication, or a combination of both.
Therapy
There are several different types of therapy that counselors may use to treat anxiety disorders. Some types of therapy have been more extensively researched than others, resulting in more evidence supporting their efficacy. Currently, the “gold standard” in treating anxiety disorders is cognitive behavioral therapy (CBT). Other therapy options for GAD include exposure therapy and acceptance and commitment therapy (ACT).6,7
Medication
Sometimes, anxiety medication is recommended for people with GAD as a part of their treatment. Medication is usually provided by a psychiatrist, psychiatric nurse practitioner, or physician’s assistant who specializes in behavioral health. On occasion, general practitioners may also prescribe anxiety medications for their patients. Some of the more common medications used to treat anxiety include benzodiazepines and beta blockers, which both work to reverse certain stress-related nervous system functions.6,7
How to Get Help for GAD
If you or someone you care about is struggling with anxiety related to GAD, the good news is that there are many effective treatment options that can help people reduce their symptoms and improve their overall quality of life. Often, anxiety disorders respond very well to therapy, so finding a counselor is a good first step to take. There are many ways to find a certified therapist, but an online therapist directory is a great place to start.
Some people also choose to talk to a doctor or psychiatrist about medication in addition to therapy. Both therapy and medication consultations with doctors are usually covered by most health insurance plans, which make it easier and more affordable for people to get help for their anxiety.
5 Ways to Cope With GAD Symptoms
Anxiety is uncomfortable and living with symptoms of GAD can make it hard to function normally. Those suffering from GAD should consider seeking formal treatment, which can help reduce symptoms and teach skills for improved coping. In addition to treatment, there are also some lifestyle changes and skills that could help to manage and reduce GAD symptoms.
Here are five ways to cope with GAD symptoms:
- Maintaining an active lifestyle: An active lifestyle which includes regular exercise can help to balance brain chemicals and stress hormones linked to anxiety.
- Establishing a meditation practice: Meditation practices can help anxious people focus their attention on the present moment, getting unhooked from unhelpful thoughts that feed into their anxiety.
- Developing more self-compassion: Self-kindness, forgiveness, and acceptance is key to mental health, and exercises focused on building self-compassion can help to reduce stress and anxiety.
- Managing stress levels: Managing stress requires basic self-care and healthy lifestyle choices like eating well and sleeping enough, and involves working to directly address sources of stress.
- Relying on social supports: Having a support system, even if it is a small one, is key to mental wellness. Fostering and maintaining close relationships with other people can help to minimize stress and provide comfort during times when GAD symptoms are most intense.
Can GAD Be Prevented?
Because there isn’t a specific cause for GAD, it’s difficult to prevent. Nonetheless, if you think you’re at risk of developing GAD or feel you’re getting more nervous than usual, there are things you can do to diminish the anxiety. You can begin by leading a healthy lifestyle and avoiding/limiting the consumption of caffeinated and alcoholic beverages. You can also address any emerging symptoms with therapy sooner rather than later which can prevent GAD from worsening. Professional treatment is known to have favorable outcomes and enhance quality of life for people living with an anxiety disorder like GAD.4
What GAD Looks Like in Different Age Groups
People of any age can be diagnosed with GAD but adult onset is most common. While the same set of criteria is used to diagnose children, teens, and adults, people of different ages may display slight differences in their symptoms.
How GAD Presents in Children
Children may not understand or have the language to describe feelings of anxiety, and it is not uncommon for children to describe more physical symptoms like headaches or stomach aches. Children with GAD might have trouble separating from caregivers or might have habits of asking questions or seeking reassurance from parents to reduce their anxiety.
How GAD Presents in Teens
Teens with anxiety are sometimes aware of their anxiety symptoms but might choose not to talk about it with their parents. Instead, they might withdraw or become more moody or irritable. Some teens with high levels of anxiety might change their routines in ways that avoid certain people or situations. Teens with GAD may experience a lot of social anxiety, and sometimes make up excuses to not attend social activities, and in some cases, to not attend school. Parents of teens with GAD might notice that their teen is doing poorly in school, which could be a result of missing classes or having trouble focusing due to GAD symptoms.
How GAD Presents in Adults
Adults with GAD tend to have more straight-forward symptoms, but also may have been living with the disorder for so long that they have become used to their symptoms, assuming they are normal. Adults with GAD might discount symptoms by assuming that their symptoms are a part of their personality; they may describe themselves as “worriers,” “busybodies,” or as “high strung” or “type A,” not realizing that these are actually symptoms of GAD. Adults who have both GAD and depression might also be more likely to have their anxiety go undetected because of conflicting symptoms.5
How GAD Presents in Older Adults
In older adults, anxiety disorders commonly co-occur with depression and/or another medical illness. Sometimes, an injury, accident or medical illness triggers symptoms of GAD in older adults. Associations between GAD symptoms and cognitive decline have also been observed by researchers studying anxiety in older adults. These co-occurring disorders can make it more difficult to detect symptoms of anxiety, as they are often attributed to the other condition.8
GAD vs. Other Anxiety Disorders
Symptoms of GAD can sometimes be confused with those of other anxiety disorders, making detection more challenging. Adding to these challenges is the high rate of people with GAD who also experience other mental health conditions, including mood disorders and other anxiety disorders. Still, there are some defining features of GAD that help to differentiate it from these other disorders.
GAD vs. Specific Phobias
People with GAD experience symptoms of anxiety in response to a broad range of triggers and situations. People with specific phobias, however, experience anxiety in response to very specific triggers. People with specific phobias are aware of their triggers and have a predictable response when they encounter them, while people with GAD may have less awareness or less predictable responses to triggers. For example, a person with GAD might find that they are only sometimes nervous about getting their blood drawn, whereas someone with a phobia would be consistently nervous in this situation.
GAD vs. Social Anxiety Disorder
People with GAD may experience anxiety in social settings, but when anxiety is exclusive to these settings, social anxiety disorder is sometimes suspected. People with social anxiety disorder tend to be preoccupied with specific fears of being negatively evaluated or judged by other people. People with GAD might have symptoms of anxiety in social settings but usually would have anxiety in other settings as well. Typically, people with GAD either have a broad range of fear triggers or may be unable to identify fear triggers and just describe generally feeling a sense of dread or anxiety.
GAD vs. Panic Disorder
Some people with GAD will experience panic attacks, which are episodes of intense anxiety usually lasting several minutes. Having panic attacks does not mean a person has panic disorder, which only develops when a person has frequent panic attacks and develops a subsequent fear of having another attack. When this happens, people spend a lot of time worrying about having a panic attack, paying too close attention to their body to watch for panic symptoms, or might avoid places or situations where they feel they may have another attack. With panic disorder, the anxiety has become centralized around having another panic attack but with GAD, panic attacks are usually occasional and do not become a focal trigger for anxiety.
GAD Tests & Self-Assessment Tools
Only a licensed health or mental health professional with appropriate training can diagnose conditions like GAD. Usually, this diagnosis is made during an initial appointment with a licensed counselor, psychologist, or psychiatrist. However, some people with symptoms of GAD might be curious about screening tools or tests for GAD that can help them determine if they should seek professional help.
For those interested in screening for generalized anxiety, consider using these tools:
GAD Statistics
Anxiety disorders are the most common type of disorder affecting American adults. In their lifetime, one out of three people will experience an anxiety disorder. GAD is one of the most common types of anxiety disorders affecting Americans.
Additional facts and statistics about GAD:1,3,9
- Women are twice as likely to be affected by GAD as men
- 5-6% of Americans will experience GAD within their lifetime
- GAD is the most common type of anxiety disorder affecting older adults in the US
- People living in high-income countries like the US, Australia and countries in Europe are more likely to experience GAD
- 81.9% of people with GAD are diagnosed with another mental health condition
- Mood disorders like Major Depressive Disorder affect 63% of people with GAD
- Less than half of people with GAD receive treatment
- Research has found that therapy is just as effective or more effective than medication in treatment of GAD
Final Thoughts on Generalized Anxiety Disorder
People struggling with GAD experience frequent worry and anxiety which can make it difficult to function, and also to enjoy life. Anxiety can be overwhelming, but treatments like therapy, sometimes in combination with medication, can really help reduce symptoms. People who seek counseling for GAD can also learn more effective methods of coping to help them feel more in control of their anxiety, greatly improving their quality of life.
For Further Reading
Generalized Anxiety Disorder Infographics
