How to recognize the symptoms of generalized anxiety disorder and get the right treatment
anxiety disorderis characterized by excessive, debilitating worry about life situations for at least six months.
- The symptoms of generalized
anxietydisorder include being unable to stop worrying, even after the stressor has been resolved.
- Generalized anxiety disorder is treatable with a combination of lifestyle changes, therapy, and medication.
- This article was medically reviewed by David A. Merrill, MD, PhD, psychiatrist and director of the Pacific Brain
HealthCenter at Pacific Neuroscience Institute at Providence Saint John's Health Center.
Feeling anxious, worried, or concerned is a normal part of life. However, people with generalized anxiety disorder (GAD) worry so intensely that it interferes with their daily life.
GAD is associated with a constant feeling of being overwhelmed. Those with GAD may find it difficult to control how much they worry on a daily basis, even if they know their fears are exaggerated.
This excessive worry can be about any life situation — from your finances to social interactions — and must routinely occur for at least six months in order to be classified as GAD.
With proper treatment, including therapy, medication, and lifestyle changes, GAD can be managed and sometimes resolved. Here's what you need to know about generalized anxiety symptoms, diagnosis, and how to get the treatment that's right for you.
GAD affects 6.8 million Americans, or about 3.1% of the US population. The major symptoms are both psychological and physical:
- A persistent worrying or obsession with everyday concerns that are out of proportion
- An inability to control the anxiety and worrying on a daily basis
- Restlessness or feeling on edge
- Being easily fatigued
- Difficulty concentrating or mind going blank
- Muscle tension
- Sleep disturbance — difficulty falling or staying asleep, or restless unsatisfying sleep
Say you have an electricity bill due, and you're anxious about paying it on time. Some people can stop worrying once the bill is paid.
But people who have chronic worry with generalized anxiety disorder are unable to do that, according to clinical psychologist Kevin Chapman, who specializes in treating anxiety.
"They're still thinking about it," Chapman says. "They're still thinking, 'What if it doesn't get there on time? What if they cut off my electricity?' So the worry is still there despite having problem-solved."
To be diagnosed, you have to have excessive anxiety and worry on more days than not for at least six months, according to the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
In addition, the worry cannot be attributed to any specific triggers, which would be an example of a phobia, or fear of having a panic attack, which would be classified as panic disorder.
Your doctor or
What causes generalized anxiety disorder?
- Genetics. Evidence suggests that GAD is a heritable condition, meaning it can run in the family. One study reported that children are 2.1 to 2.6 times more likely to be diagnosed with GAD if one of their parents has it.
- Stress. Exposure to traumatic and stressful life events, such as child abuse, increases the brain's sensitivity to stress and in turn weakens the stress-response system. This increases the individual's risk of developing GAD.
- Other emotional disorders. Generalized anxiety disorder often occurs alongside other mental health problems, such as depression, post-traumatic stress disorder, and panic disorder. One study found that 56% of individuals with GAD also had depression. There is also evidence that GAD and depression share the same genetic origin.
- Physical conditions. Researchers report that anxiety affects about 40% of people with diabetes. This is because people with diabetes are at risk of developing hypoglycemia, or low blood sugar, and there is evidence that recurrent hypoglycemic episodes trigger chemical and metabolic changes that physically affect the part of the brain that plays a role in processing anxiety.
GAD usually develops gradually, and often goes unnoticed at first. It can also develop for no known reason. "There isn't an exact understanding as to the cause of GAD," says Ahmet Mehmet, a psychotherapist who works with anxiety disorders.
According to Mehmet, a deeper, underlying issue can cause normal anxieties to develop into GAD. For instance, an adult may have anxiety about relationships, and this could turn into GAD if they experienced attachment issues — such as a fear of being abandoned — in early childhood.
Overall, family upbringing can have a significant impact on the development of anxiety.
"Another example could be that a child is raised in an environment where parents and other significant people display anxious behaviours, which the child takes on as quite normal as it is learning via modelling what it experiences," says Mehmet.
The main treatments for generalized anxiety disorder are cognitive behavioral therapy (CBT), lifestyle changes, and antidepressant medication.
Most patients benefit from a combination of all these treatment methods, but it may take some trial and error to discover which treatments work best. Here's what you need to know:
Cognitive behavioral therapy (CBT) can help you learn how to control anxious thoughts. During CBT, a therapist will reveal the underlying patterns of your worries and help you practice better responses so the anxiety no longer dominates your life.
CBT is widely proven to be effective in treating GAD: across 11 effectiveness studies, the 'effect size' of CBT for GAD — that is, how effective it was compared to a placebo — was 0.92, meaning it was largely effective compared to placebo treatment.
In addition, there are a number of lifestyle changes that can help you manage generalized anxiety. These include:
- Relaxation techniques. Progressive muscle relaxation can help you release muscle tension and reduce anxiety symptoms. In addition, mindfulness meditation has been found to improve stress reactivity and help patients cope with GAD.
- Diet. Foods to avoid or limit include simple carbs — such as white bread and cookies — fried food, processed food, alcohol, and caffeine. Foods to eat include complex carbs, whole grain bread, fresh fruit and vegetables, and healthy fats found in nuts and seed.
- Regular exercise. In one study of patients, including those with GAD, 150 min of walking exercise spread across five sessions per week over an 8 to 10 week period significantly lowered the levels of depression, anxiety, and stress reported.
The most commonly used medications for anxiety disorders are antidepressants, such as:
- Selective Serotonin Reuptake Inhibitors (SSRIs). SSRIs, like Zoloft or Paxil, are one of the most commonly prescribed antidepressants. These work by boosting levels of serotonin in the brain, the neurotransmitter associated with contentment and lower levels of anxiety.
- Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs). SNRIs, another type of antidepressant, are also prescribed as a first-line treatment option, according to international guidelines. These function similarly to SSRIs, except they also increase levels of norepinephrine, a neurotransmitter that helps the body respond to stress.
However, antidepressants do not treat the underlying issue. According to Mehmet, low levels of serotonin isn't what necessarily causes anxiety or depression. So, while antidepressants can help stabilise the individual's emotional state, they do not address the underlying cause of anxiety.
Benzodiazepines are prescribed as a second-line option if antidepressants do not work. These are a type of psychoactive drug with sedative and muscle relaxant properties that calm the symptoms associated with anxiety. They act on the neurotransmitter gamma-aminobutyric acid (GABA), which helps calm the nervous system.
They're often taken as-needed or on a short-term basis to relieve anxiety episodes, as they can cause dependency if used long-term. Benzodiazepines may also block memory formation in the brain, making it more difficult to benefit from CBT while on this type of medication.
The bottom line
With proper diagnosis and treatment, people with generalized anxiety disorder can show improvement over time.
"An individual can learn to manage the symptoms and begin to live a much fuller and engaging life where they are not constantly plagued by the fear of what if scenarios," says Mehmet.
And while the anxiety and worry may never be cured, you will be able to work with your doctor to find the strategies that allow you to lead a healthy life.
Related articles from Health Reference:
- The 5 types of anxiety disorders and how to know if you have one
- The difference between a panic attack and an anxiety attack
- How to deal with anxiety and improve your mental health
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