Generalized Anxiety Disorder: Criteria, Causes, And Treatment
Worry is a natural emotional reaction that arises when you are uncertain about the future. However, for some, this uncertainty does not subside and may compound. Excessive worry and a vague, unsettled feeling, among other symptoms, may indicate an anxiety disorder known as generalized anxiety disorder (GAD).
GAD is one of the most common mental disorders. Read on to learn more about it, how to identify its physical and psychological symptoms, the diagnostic criteria used to diagnose it, and what treatments are recommended to limit excessive anxiety and worry and promote mental health.
GAD is a mental health disorder that is characterized by worry, fear, and persistent overwhelm. A major component of generalized anxiety disorder is an excessive worry about ordinary situations in day-to-day life rather than being focused on a specific topic or problem. While anxiety and worry are typical human emotions, people with GAD experience them to the point of distress or functional impairment in multiple areas of their lives, such as work, health, or finances. GAD may often include physical symptoms but does not involve the presence of panic attacks.
According to the National Institute of Mental Health, “Generalized anxiety disorder usually involves persistent anxiety or dread, which can interfere with daily life. It is not the same as occasionally worrying about things or experiencing anxiety due to stressful life events.”
DSM-5 definition of generalized anxiety
When assessing someone for a GAD diagnosis, medical professionals look for the following criteria found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association Publishing:
- You experience excessive worry or anxiety about multiple events or activities, such as school, work, or performance, which occurs most days and persists for at least six months
- You have difficulty controlling your worry
- You experience significant distress or impairment at work, socially, or in other vital areas due to anxiety, worry, and physical symptoms
- Your symptoms are not attributable to the effects of a substance or other medical condition
You experience three or more of the following symptoms:
- Restlessness, feeling on edge or keyed up
- Easily fatigued
- Trouble concentrating or mind going blank
- Irritability
- Muscle tension
- Difficulty falling or staying asleep, or other sleep changes
- Another mental health condition does not better explain your symptoms
Other generalized anxiety disorder symptoms:
- Physical symptoms such as headaches, muscle tension, stomachaches, or unexplained chest pain
- Excessive and persistent worry
- Perceiving a threat that is not present
- Difficulty relaxing
- Trouble handling uncertainty
- Easily startled or jumpy
Understanding the physical symptoms of GAD
Anxiety is more than being nervous. Among other things, it is your body’s response to perceived threats, triggering the “fight or flight” response. GAD involves constant tension, which can lead to physical symptoms like nausea, sweating, trembling, headaches, racing heart, hyperventilating, lightheadedness, fatigue, muscle tension, gastrointestinal issues, restlessness, pent-up energy, and other physical symptoms.
How is GAD diagnosed?
GAD should be diagnosed by your doctor or a mental health professional. The process may start with a physical exam to identify any potential causes due to medication or an underlying medical condition. You will be asked detailed questions about your symptoms and medical history. Many clinicians use a series of psychological questionnaires to help determine a diagnosis, along with the criteria presented above from the DSM-5.
How common are these disorders?
According to research published by the Anxiety and Depression Association of America (ADAA), the country’s most common mental health conditions are anxiety disorders. The research states that the lifetime prevalence of GAD in the U.S. reaches 19.1% of the population. The ADAA further says that anxiety disorders are “highly treatable,” though only 36.9% of people with the condition reach out to professionals in an attempt to treat anxiety.
Comorbidity of GAD
According to a recent study, generalized anxiety disorder is frequently comorbid — present in the same person at the same time — with various other mental health conditions. The disorder is commonly seen alongside mood disorders (e.g., major depression, bipolar disorder), other anxiety disorders (e.g., social anxiety disorder, panic disorder, post-traumatic stress disorder, phobia-related disorder), chronic pain conditions, eating disorders (e.g., anorexia nervosa), personality disorders, and sleep disorders. Individuals with GAD are at a higher risk of developing substance use disorder.
If you are struggling with substance use, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.
If you are experiencing trauma, support is available. Please see our Get Help Now page for more resources.
Recognizing GAD in children
Generalized anxiety disorder does not always present the same in children as in adults. According to child development experts at Boston Children’s Hospital, kids with GAD tend to show excessive and uncontrollable worry compared to non-anxious peers. In addition to typical anxiety symptoms, children with generalized anxiety disorder often exhibit fear over future events, such as what will happen to them if their caregivers get sick or die. They may also fixate on events, consistently expect the worst, show extreme concern over their performance in school, socially, or in other circumstances, and show restless or excess energy.
As with many mental health conditions, the causes of GAD are believed to be a complex interaction of several genetic and environmental factors. Variations in brain chemistry, developmental experiences, personality, and the body’s response to threats can all factor into whether a person develops a generalized anxiety disorder.
Treating GAD
Many mental health professionals develop a plan to treat generalized anxiety disorder based on how significantly the disorder affects your daily functioning and interferes with your life. In general, you have two paths for treatment — psychotherapy and medication — though a comprehensive treatment plan may involve both. From these treatments, many people managing GAD notice a reduction in symptoms and improved quality of life.
Medication
Clinicians use a variety of medication categories to help treat GAD, including selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). The most common GAD medication categories include antidepressants, anti-anxiety, and benzodiazepines. If you are interested in how medication may affect your GAD symptoms and function level, speak to your doctor or mental health provider about the possible risks, benefits, and potential side effects.
Anxiety medication symptoms differ based on the type and individual reaction. Common side effects include drowsiness, dizziness, blurred vision, dry mouth, nausea, constipation, and losing or gaining weight. Some may experience severe reactions like allergies or breathing difficulties. It's crucial to consult a healthcare provider about any concerns.
Psychotherapy
Talk therapy is a primary treatment for generalized anxiety disorder. Many patients have seen reduced symptoms and an improved ability to manage their anxiety while working with a licensed therapist. Cognitive behavioral therapy (also known as cognitive behavior therapy or CBT) is one of the most frequently used treatments for GAD, as it focuses on identifying and replacing harmful or maladaptive thought patterns and behaviors. Patients have also found success with acceptance and commitment therapy (ACT), which can help reduce anxiety-related discomfort through mindfulness and goal setting.
Support groups
For many people, the support of a group therapy situation can be enormously helpful. In the group setting, you gain other people who are likely experiencing similar issues and will understand much of what you’re going through without explanation. It can be difficult to explain mental health symptoms to people who do not know how the condition can affect a person’s thoughts and behaviors.
Lifestyle changes that can help
- Practice a mindful lifestyle focused on positive thinking. Work to shift your perspective about situations that cause anxiety
- Develop positive affirmations to help reassure yourself when you’re feeling anxious
- Practice deep breathing to recenter yourself and help with calm and focus
- Keep a journal. Writing about your emotions helps you process them and gives you a written record to track your progress, triggers, and effective coping methods
- Exercise and consume nutritious foods
- Try taking on a calming hobby
- Enjoy a walk in nature to ground yourself
Reach out for professional support and guidance
Living with generalized anxiety disorder can be challenging, but you are not alone. Reach out for a licensed therapist's professional support and guidance and gain an additional resource as you build a repertoire of practical coping skills to manage your anxiety symptoms and stress reactions.
How therapy can help you manage GAD symptoms
A licensed therapist can help you manage the symptoms of generalized anxiety disorder. Many people have successfully received treatment for GAD and other mental health conditions through online therapy providers such as BetterHelp. Flexible appointment formats make it easier to fit treatment into your busy schedule, and online therapy is often less expensive, with shorter wait times.
According to a recent study, online therapy is a practical, affordable treatment option for anxiety disorders that can be as effective as in-person sessions. In the study, professionals in the industry reported that the efficacy of therapy increases with the number of sessions attended. The patients often said the convenience of receiving therapy from home meant they could attend more reliably. Many also said the added physical distance made opening emotionally to their therapists easier.
Takeaway
Generalized anxiety disorder can significantly impact your life and mental stability. While symptoms can be challenging to manage alone, working with a licensed therapist can substantially reduce symptoms and their effect. The information presented in this article may offer some insight into GAD and how therapy can help reduce the interference of symptoms in your life.The DSM-5 dictates that in order for someone to be diagnosed with generalized anxiety disorder, they must exhibit excessive anxiety and at least some symptoms from the following list: irritability, muscle tension, restlessness or feeling on edge, becoming easily fatigued, difficulty concentrating, and difficulty falling or staying asleep.
Mental health professionals will utilize the DSM-5 along with the GAD-7 to understand your condition and symptoms present and determine if you have GAD.
An anxiety disorder is an umbrella term for conditions that revolve around anxiety about a particular situation or phobia, such as illness anxiety disorder, separation anxiety disorder, and social anxiety disorder. Generalized anxiety disorder is its own condition that falls under the umbrella term of “anxiety disorders.”
Treatment for GAD depends on an individual’s symptoms and the severity of their anxiety. Someone looking for panic attack treatment may consider medication (most commonly antidepressant medication, such as a selective serotonin reuptake inhibitor or a serotonin and norepinephrine reuptake inhibitor), therapy, or lifestyle interventions, while someone experiencing physical complaints related to their anxiety may benefit from stress relief techniques like yoga, meditation, and mindfulness-based stress reduction. Ultimately, the first line of treatment tends to be therapy and medication.
People with high-functioning anxiety may appear calm, cool, and successful to the outside observer but may experience significant mental health distress and severe anxiety internally.
All forms of anxiety can range from mild to severe, from somatic symptom disorder to social anxiety. However, some may consider panic disorder one of the more severe types of anxiety disorders, as the symptoms of panic disorder can be debilitating and hard to predict.
GAD is a mental disorder that presents in a range of mild to severe symptoms. Just like other medical conditions like post-traumatic stress disorder and obsessive-compulsive disorder, certain triggers, like traumatic events or a serious illness, may increase the severity of symptoms.
Anxiety is normal and happens to most people at some point in their lives. However, anxiety may require treatment if you experience anxiety more days than not; if you are experiencing recurrent, unexpected panic attacks; if the symptoms are affecting your ability to work, go to school, or socialize; or if the anxiety is worsening another condition, such as delusional disorder (a disorder in which an individual holds one or more delusional beliefs) or substance use disorder.
Someone with untreated anxiety may fixate on a certain part of their life or themselves, projecting their anxiety into that particular area. An individual with GAD might engage in excessive worry and fear of negative evaluation from others, leading to avoidance of social situations and impairment in daily functioning. A person with body dysmorphic disorder might fixate on perceived appearance flaws to the extent of causing clinically significant distress.
The American Psychiatric Association notes that people with anxiety disorders often avoid situations that may trigger their anxiety. This may be one of the worst characteristics of anxiety, as it can prevent people from doing things they enjoy and completing day-to-day tasks.
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