Introduction

Everyone feels frightened or very scared every once in a while. In dangerous situations, for instance 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 difficult situations.

But if these sorts of fears become overwhelming, they can be very distressing. Some people end up constantly worrying about practically everything. If fears and anxiety overshadow everything else and don’t go away, the person may have developed generalized anxiety disorder (GAD). People with generalized anxiety disorder usually realize that their fears are exaggerated, but they aren’t able to control them. Although it’s difficult to get out of this state, there are treatments that can help.

Symptoms

Generalized anxiety disorder can have both emotional and physical effects. The emotional symptoms include fears that are always there, unrealistic and exaggerated. These fears affect different parts of people's lives. They aren’t a response to a threat, and aren’t always related to concrete things or situations. Because people may feel anxious about almost anything, it is referred to as “generalized” anxiety.

One minute they may worry that their partner could have an accident on the way to work. The next, they might be afraid that their child could be hit by a car on the way to school, and then that they might lose their keys, and also that they could have a heart attack the next day. They worry about almost everything – including both big and small problems, and even extremely trivial things. Many are also afraid of being afraid, or worried about constantly worrying. The constant worrying has a major impact on everyday life, sometimes making it impossible to lead a normal life.

When we are afraid, our adrenal glands release the hormone adrenaline (epinephrine). This speeds up many of the body’s functions – usually to temporarily increase alertness and our ability to respond. Your heart beats faster, and your breathing becomes shallow and rapid. In generalized anxiety disorder, this state of physical alertness tends to last much longer. Other possible symptoms include feeling drowsy, nervous or dizzy, trembling, sweating, muscle tension, a racing heartbeat and stomach problems. Being worried all the time is exhausting, and may lead to problems concentrating and sleeping. People with generalized anxiety disorder may have suicidal thoughts, especially if they also have depression.

If you only feel anxious in certain situations, you probably don’t have generalized anxiety disorder. Sudden fear or panic attacks are also not a sign of generalized anxiety disorder, although it is possible to have both.

Causes and risk factors

The causes of generalized anxiety disorder aren’t fully understood. It is thought 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, suffered difficult losses or lived through hard times, possibly caused by problems in the family or extreme stress at work.

Sometimes a life crisis can trigger fears that later develop into generalized anxiety disorder. There is also some evidence to suggest that anxiety may run in families. Sometimes an anxiety disorder is caused by another condition – like depression or a panic disorder – or it may be related to an addiction. But it can also develop for no known reason.

Prevalence

Generalized anxiety disorder is a common type of anxiety disorder. It is estimated that about 5% of people will be diagnosed with this disorder in their lifetime. It is twice as common in women as in men. Generalized anxiety disorder usually starts in middle age, but it can also develop in people who are older or younger. Children can have generalized anxiety disorder too. The condition is less common in people over the age of 65.

Outlook

Generalized anxiety disorder usually develops gradually and often goes unnoticed at first. Severe anxiety disorders 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 1 out of 4 people had overcome their anxiety disorder after two years. But many people manage to conquer their fears in the long term. Anxiety disorders often improve with age because older people can draw on more experience in dealing with stress and anxiety. Many of them start seeing things more objectively.

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, and is only possible after in-depth talks with psychologists or psychiatrists.

Knowing what the main symptoms and problems are can make it easier to find a suitable treatment faster, though.

Generalized anxiety disorder is diagnosed if the person’s exaggerated fears

• are present on most days and last for at least six months,
• are uncontrollable,
• are so extreme that they affect everyday life, and
• are accompanied by at least three physical symptoms of fear, such as a racing heartbeat, trembling, muscle tension or stomach problems.

But these physical symptoms could also be caused by other conditions, like an overactive thyroid gland, or by medications and drugs such as amphetamines (“speed”). Because of this, doctors also look into other possible explanations.

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

Treatment

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

• Psychological 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 psychological treatment.
• Medication: The most commonly used medications for anxiety disorders are antidepressants. Some people also use herbal sedatives such as valerian.
• Self-help: Self-help groups offer you the opportunity to share your thoughts, feelings and experiences with others who have the same condition. Some people also find it helpful to learn more about the disorder – be it from books, information leaflets 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 harmful thoughts and behavior patterns so that they no longer dominate your life. It can take a lot of patience to find your way back to a life with less anxiety, but a noticeable improvement can often already be achieved after a few weeks.

Sources

• Bandelow B, Boerner RJ, Kasper S, Linden M, Wittchen HU, Möller HJ. Generalisierte Angststörung: Diagnostik und Therapie. Dtsch Arztebl Int 2013; 110(17): 300-310. [PMC free article: PMC3651952] [PubMed: 23671484]
• Deutsche Gesellschaft für Psychosomatische Medizin und Ärztliche Psychotherapie (DGPM). S3-Leitlinie: Behandlung von Angststörungen. AWMF-Registernr.: 051-028. April 15, 2014.
• Gale CK, Millichamp J. Generalised anxiety disorder. BMJ Clin Evid 2011: pii: 1002.
• Hoge EA, Ivkovic A, Fricchione GL. Generalized anxiety disorder: diagnosis and treatment. BMJ 2012; 345: e7500. [PubMed: 23187094]
• National Institute for Health and Care Excellence (NICE). Generalised anxiety disorder and panic disorder in adults: management. January 2011. (NICE Clinical guidelines; 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.