Generalized Anxiety Disorder (or GAD) is a common mental health condition affecting 3.2 million people in the United States. People with GAD experience regular, excessive anxiety that gets in the way of their 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 usually treated with therapy or medication, or a combination of both. The most common therapeutic treatment of GAD is Cognitive Behavioral Therapy (CBT), which often lasts for twelve to twenty sessions when treating GAD symptoms.
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. Unlike other anxiety disorders where fears are easily identified, people with GAD have several fears or may be unable to identify specific causes during times when they are anxious. GAD, like all mental health conditions, causes changes in the way a person thinks, feels and behaves.
Changes in Feelings, Thoughts, and 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.
Some people with GAD experience panic attacks, which are intense symptoms of anxiety that come on suddenly and typically last for several minutes. People having panic attacks often describe 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.
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.
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 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.
GAD Symptoms in Children vs Teens vs Adults
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. 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.
Teens with GAD are sometimes aware of their anxiety symptoms but 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.
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 symptomology.1
Symptoms of Generalized Anxiety Disorder
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 (DSM).
The symptoms of GAD are:2
- Excessive anxiety and worry about a number of events or activities, occurring more days than not for at least 6 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
- Muscle tension
- Difficulty falling asleep, 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
Causes and Triggers for Generalized Anxiety Disorder
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,3 as are people diagnosed with other medical or mental health conditions (like depression). 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.
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 to 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.4
While not causal, some people may be at higher risk for developing GAD than others. According to the research, females are more likely to be affected. Unmarried adults are also impacted at higher rates, as are people who have low levels of education, are under stress, or are in poor health.3
Treatment of GAD
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 GAD include psychotherapy, medication, or a combination of both.
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, or CBT.5
Cognitive Behavioral Therapy
CBT is a form of therapy that helps to address symptoms of anxiety by helping people make specific changes to the way they think and behave during times when they experience symptoms. Certain thought patterns are closely linked to anxiety. For example, people with anxiety disorders commonly describe ruminating on thoughts about (unlikely) bad things that could happen in the future. CBT therapy would help a person rethink these thoughts in more rational, helpful ways, like listing evidence that suggests that this outcome is unlikely. As a result, CBT therapy can help people change their anxious thoughts, which tends to reduce anxiety. CBT is usually offered in weekly sessions lasting about an hour and while treatment length can vary, twelve to twenty sessions is standard.
Many people with anxiety avoid situations that trigger anxiety, which is thought to provide short term relief but worsens anxiety in the long term. For this reason, a CBT therapist might encourage this person to intentionally place themselves in these situations to help them become desensitized. Called exposure therapy, this form of CBT can be helpful in challenging irrational fears people have that drive their avoidant behaviors. It tends to be more effective for people with specific identifiable fears who have a lot of avoidant behaviors. It is typically provided during weekly sessions lasting 60-90 minutes for eight to twelve sessions.
Acceptance and Commitment Therapy
A newer type of therapy called Acceptance and Commitment Therapy (ACT) is gaining popularity and is sometimes used to treat GAD. ACT is a form of therapy that encourages acceptance of anxious thoughts and feelings, as opposed to trying to stop or change them. Using mindfulness skills, clients are taught to experience their thoughts and feelings without letting them guide unhelpful reactions. Instead, clients are encouraged to make decisions that align with their personal values, which ACT therapists believe will lead to improvements in a person’s overall quality of life. ACT is typically provided during ten to fifteen weekly sessions lasting about an hour each time.
Sometimes, 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.
The most common medications used to treat GAD are:
SSRI’s and SNRI’s
These medications are often prescribed to treat depression but are also used to treat anxiety disorders. They work to balance specific aspects of brain chemistry involved in mood and mental health (serotonin and norepinephrine). They are considered a first-line medication option for those with GAD because they tend to be well-tolerated and have less serious side effects than certain other anti-anxiety medications.
Benzodiazepines decrease anxiety by stimulating the release of a sedating chemical called GABA in the brain. They are sometimes prescribed on an as-needed basis for those with acute anxiety and can be effective in reducing symptoms temporarily. Because of the risk for abuse and dependence with these drugs, they are typically not recommended for long term use.5 People who do become dependent on these medications may be unable to stop using the medications without medical supervision because of the risk for dangerous (and potentially fatal) withdrawal symptoms.
Typically prescribed to those with high blood pressure, these medications are sometimes prescribed for anxiety disorders, although there is only weak support for their efficacy at this time.6 These medications block certain nervous system functions that become activated during times when people experience anxiety. They are more commonly prescribed on a PRN (as needed) basis for people with GAD who experience panic attacks.
This unique anti-anxiety medication works on specific receptors in the brain thought to be related to anxiety. It has been found to effectively treat a range of anxiety disorders, including GAD.7 Unlike some other anti-anxiety medications, it does not carry a risk for abuse and dependence and is typically considered safe for longer term use.
How to Get Help for GAD
If you or someone you care about is struggling with symptoms of GAD, consider seeking formal treatment. While anxiety disorders can worsen over time, treatment can prevent and even reverse this progression, providing lasting symptom relief. Usually, treatment for GAD will be a covered service under most health insurance plans. This includes therapy and psychiatric medication.
For those looking to use their health insurance to find treatment, calling the insurance company or using the insurance company’s online search tool is the best way to find in-network treatment options. Online therapist directories can also help you find a local therapist or psychiatrist who specializes in the treatment of GAD.
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 statistics about GAD:8
- Women are twice as likely to be affected by GAD as men
- 3.1% of the US population is affected by GAD
- 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
- Only half of people diagnosed with GAD receive treatment
- Research has found that therapy is just as effective or more effective than medication in treatment of GAD
Living with GAD and Coping with 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. These include:
- Maintaining and 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 natural 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.
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 vs Normal Stress
Everyone experiences anxiety on occasion, often in response to stressful life situations. During times of stress, people’s brains and nervous systems respond in characteristic ways that result in symptoms of anxiety, including a racing heart, increased respiration, and feeling restless or jittery. During times of stress, a person might be able to identify that they have most of the symptoms of GAD or another anxiety disorder, but this does not mean they have GAD. GAD is only diagnosed when symptoms of anxiety persist over a long period of time (6 months or more) and when they are not directly caused by an external stressful situation. People without GAD find that their symptoms go away when their stress subsides but people with GAD report symptoms even during times when their stress levels are low.
GAD Tests, Quizzes, and Self-Diagnosis 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, consider using these tools:
GAD-7 scale: This short screening tool is often used by professionals as one part of the assessment process for diagnosing GAD
APA emerging measures: These free screening tools were developed by the American Psychiatric Association and are being validated for diagnostic use. Assessments exist for adults, teens, and children.
Additional Resources on GAD
For people wanting more information on GAD, consider these resources: