Health Encyclopedia

Generalized anxiety disorder

Definition

Generalized anxiety disorder (GAD) is a pattern of frequent, constant worry and anxiety over many different activities and events.

Alternative Names

GAD; Anxiety disorder

Causes, incidence, and risk factors

Generalized anxiety disorder (GAD) is a common condition. The cause of GAD is not known, but biological and psychological factors play a role. Stressful life situations or behavior developed through learning may also contribute to GAD.

The disorder may start at any time in life, including childhood. Most people with the disorder report that they have been anxious for as long as they can remember. GAD occurs somewhat more often in women than in men.

Symptoms

Generalized anxiety disorder has the following symptoms:

Excess anxiety and worry that is out of proportion to the situation
Difficulty controlling the worry
Restlessness or feeling keyed up or "on the edge"
Being easily tired
Difficulty concentrating
Irritability
Muscle tension -- shakiness, headaches
Sleep disturbance (difficulty falling or staying asleep; or restless, unsatisfying sleep)
Excessive sweating, palpitations, shortness of breath, and stomach/intestinal symptoms

Signs and tests

A physical examination and a psychological evaluation can rule out other causes of anxiety. Physical disorders that may mimic an anxiety state should be ruled out, as well as symptoms caused by drugs. This process may include different tests.

Treatment

The goal of treatment is to help the person function well. The success of treatment usually depends in part on how severe the generalized anxiety disorder is.

The standard approach combines cognitive-behavioral therapy (CBT) and an antidepressant medication.

Selective serotonin reuptake inhibitors (SSRIs), such as Paxil, are usually the first choice. Serotonin-norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (Effexor), are another choice. Other antidepressants and some anti-seizure drugs may be used for severe cases.

Other anti-anxiety medications may also be prescribed. Benzodiazepines may be recommended if antidepressants don't help.

Behavioral therapies that may be used together with drug therapy include relaxation techniques, pleasant mental imagery, and cognitive behavioral therapy to change distorted and possibly harmful perceptions of severe anxiety.

Other counseling and therapy techniques may help people gain an understanding of the illness and the factors that protect against or trigger it.

A healthy lifestyle that includes exercise, enough rest, and good nutrition can help reduce the impact of anxiety.

Support Groups

Support groups may be helpful for some patients with GAD. Patients have the opportunity to learn that they are not unique in experiencing excessive worry and anxiety.

Support groups are not a substitute for effective treatment, but can be a helpful addition to it.

Expectations (prognosis)

The disorder may continue and be difficult to treat, but most patients see great improvement with medications or behavioral therapy.

Complications

People with GAD may develop other psychiatric disorders, such as panic disorder or depression. Substance abuse or dependence may become a problem if you try to self-medicate with drugs or alcohol to relieve anxiety.

Calling your health care provider

Call your health care provider if you are experiencing the signs and symptoms of generalized anxiety disorder, especially if this has been going on for a period of 6 months or longer, or it interferes with your daily functioning.

References

Moore DP, Jefferson JW. Handbook of Medical Psychiatry. 2nd ed. St. Louis, Mo: Mosby; 2004: 174-175.

Noble J. Textbook of Primary Care Medicine. 3rd ed. St. Louis, Mo: Mosby; 2001:416.

Gale C, Davidson O. Generalised anxiety disorder. BMJ, 2007;334:579-581.

Schneier FR. Social anxiety disorder. NEJM, 2006;355:1029-1036.

Katon WJ. Panic Disorder. NEJM. 2006;354:2360-2367.

Bernstein GA, Shaw K. Practice parameters for the assessment and treatment of children and adolescents with anxiety disorders. J Am Acad Child Adolesc Psychiatry, 2007;46:267-283.

Review Date:2/6/2008
Reviewed By:Christos Ballas, MD, Attending Psychiatrist, Hospital of the University of Pennsylvania, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

ADAM Quality A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial process. A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The Agency for Health Care Administration (Agency) and this website do not claim the information on, or referred to by, this site is error free. This site may include links to websites of other government agencies or private groups. Our Agency and this website do not control such sites and are not responsible for their content. Reference to or links to any other group, product, service, or information does not mean our Agency or this website approves of that group, product, service, or information.

Additionally, while health information provided through this website may be a valuable resource for the public, it is not designed to offer medical advice. Talk with your doctor about medical care questions you may have.