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Generalized anxiety disorder: Overview

Last Update: August 13, 2014; Next update: 2017.

Introduction

Everyone feels frightened or very scared every once in a while. When a threat approaches, such as a dangerous situation on the highway, fear can help to protect you. It puts the body in a state of readiness so that it can react to threats quickly. Worries and anxiety about the future, your job or family might also help to guard against danger. For example, by keeping you from making rash decisions that could lead to a precarious situation. But when these sorts of fears gain the upper hand, they can be a real burden. Some people end up constantly worrying about practically everything. If fears and anxiety are overshadowing everything else and not going away, it may be that the person has developed generalized anxiety disorder (GAD). Someone with generalized anxiety disorder usually realizes that their fears have become excessive, but they are not able to control them. It is a difficult position to get out of, but there are treatments that can help.

Symptoms

Generalized anxiety disorder can have both emotional and physical symptoms. The emotional symptoms include persistent, unrealistic and exaggerated fears that can affect different parts of someone’s life. They are not a response to a threat and are not related to concrete things or situations. Because this feeling of anxiety can be associated with just about anything, it is referred to as “generalized” anxiety.

People who have generalized anxiety disorder may first worry that their partner could have an accident on the way in to work, for example. The next moment they might be afraid that their child could be hit by a car on the way to school, and then that they lose their keys and possibly have a heart attack the next day. They worry about almost everything – including both big and small problems and even things that might not be important at all. Many are also afraid of their own worrying.

Some fears are justified of course. Most parents worry when a child does not show up on time after school. The degree of fear is absolutely unreasonable in generalized anxiety disorder. The constant worrying either has a significant impact on normal everyday life or makes it impossible.

When we worry or are afraid, the body reacts by the adrenal glands releasing the hormone adrenalin. This speeds up many of the body’s functions – usually to temporarily increase alertness and ability to respond. Your heart beats faster, and breathing can become more shallow and rapid. This physical state of alert can last much longer in people with generalized anxiety disorder, and may cause lightheadedness, nervousness, muscle tension, a racing heartbeat or stomach problems. This makes being worried all the time exhausting, and concentration and sleep may also be affected.

If you have anxiety only in certain situations, you most likely do not have generalized anxiety disorder. Sudden fear or panic attacks are also not a sign of generalized anxiety disorder, although they can both happen as well.

Causes and risk factors

The causes of generalized anxiety disorder are not fully understood. It is likely that both biological and emotional factors are involved. Some people who have generalized anxiety disorder were severely traumatized as a child or later on in life. Others might have suffered difficult losses or lived through hard times, possibly caused by family strife or severe stress at work.

Sometimes a life crisis can trigger fears that later develop into generalized anxiety disorder. There is also some evidence suggesting that a tendency to develop anxieties can run in the family. Sometimes an anxiety disorder can be caused by another condition – like depression or panic disorder. It could also be related to an addiction. It may also develop without there being any identifiable cause.

Prevalence

Generalized anxiety disorder is a common form of anxiety disorder. It is estimated that up to 5% of people will be diagnosed with this disorder in the course of their lifetime. Women are affected twice as often as men. Generalized anxiety disorder most commonly develops between the ages of 30 and 35, but it can also develop in people who are older or younger. Children can also have generalized anxiety disorder. The condition is rare in people over the age of 65.

Outlook

Generalized anxiety disorder usually develops gradually and often goes undetected at first. Severe anxiety disorder can be very difficult to get rid of. It often takes many months or even years to get over it. Someone going through this process may experience better and worse phases.

In one study about 25 out of 100 people had gotten over their anxiety disorder after two years. But over the longer term, many people manage to conquer their fears. Anxiety disorders often improve with age because older people can draw on more experience in dealing with stress and anxiety. Many of them start putting things in a broader perspective.

Diagnosis

There are different types of anxiety disorders, each with its own set of symptoms. Examples include phobias, panic disorders and obsessive-compulsive disorder. Many people who have an anxiety disorder also have symptoms of depression. This means that getting an exact diagnosis can be challenging. That is why psychologists and psychiatrists need longer conversations to arrive at a diagnosis.

Knowing the main symptoms and problems can help to find a more suitable treatment faster.

“Generalized anxiety disorder” is diagnosed if the person’s excessive fears

  • are present most days and last for at least six months,
  • are uncontrollable,
  • are so great that they affect everyday life, and
  • are the cause of at least three physical symptoms.

The physical symptoms mentioned above, such as quickened pulse, trembling or shaking, muscle tension and stomach problems, may also be signs of generalized anxiety disorder. But they could also be caused by other conditions, like an overactive thyroid gland. Various medications and drugs like amphetamines (“speed”) can also cause these kinds of symptoms, so doctors also look into other possible explanations for these kinds of symptoms.

It can take a while for generalized anxiety disorder to be diagnosed – especially if people first seek medical help for their physical symptoms. Sometimes only one of the symptoms of the disorder might be treated, like insomnia, for example.

Treatment

There are different ways of gradually getting a handle on an anxiety disorder. It is unrealistic to expect a quick and simple “cure,” but you can find better ways of dealing with stress and anxiety. Medication may also relieve some of the symptoms. Here are the different kinds of treatment approaches:

  • Psychological and psychotherapeutic treatments: These include approaches like cognitive behavioral therapy. This therapy can help you to learn how to control and then change your thoughts and fears.
  • Relaxation techniques such as autogenic training and progressive muscle relaxation can help you to relax and handle stress better. These techniques are often part of psychotherapeutic treatment.
  • Medications: Medications often used to treat anxiety disorders include some antidepressants and anti-anxiety drugs. Some people also use herbal sedatives such as valerian.
  • Self-help: Self-help groups offer you the opportunity to share with others who have the same condition. Some people also find it helpful to learn more about the disorder – be it from books, informational flyers or on the Internet.

It is hard to get a handle on severe anxiety, but many people succeed over time. A therapist can help to reveal the underlying patterns of the worries and anxiety. With their guidance it is possible to learn how to control negative thoughts and behavior patterns so that they no longer dominate your life. It takes a lot of patience to find the way back to a life determined less by anxiety, but noticeable improvement can be achieved after a few weeks.

Sources

  • Bandelow B, Boerner J R, Kasper S, Linden M, Wittchen HU, Möller HJ. Generalisierte Angststörung: Diagnostik und Therapie. Dtsch Arztebl Int 2013; 110(17): 300-310.
  • Gale CK, Millichamp J. Generalised anxiety disorder. Clin Evid 2011; 10: 1002. [PMC free article: PMC2943796] [PubMed: 19450347]
  • Hoge EA, Ivkovic A, Fricchione GL. Generalized anxiety disorder: diagnosis and treatment. BMJ 2012; 345: e7500. [PubMed: 23187094]
  • National Collaborating Centre for Mental Health. Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults: Management in primary, secondary and community care. NICE Clinical Guideline January 2011; Volume 113.
  • IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

    Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. We do not offer individual consultations.

    Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

© IQWiG (Institute for Quality and Efficiency in Health Care)

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