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Everyone experiences occasional anxiety about life, finances, family, work, etc.
However, if your anxiety starts to take over your life and prevents you from doing what you want to do, you may have an anxiety disorder. The National Institute of Mental Health (NIMH) estimates that over 30% of people experience any form of anxiety disorder at some point in their lives (NIMH, 2017).
Anxiety disorders are medical conditions and not just “worrying too much.” There are several different anxiety disorders, but we will focus on generalized anxiety disorder (GAD).
What is generalized anxiety disorder (GAD)?
People with generalized anxiety disorder feel excessive anxiety—they may worry about anything and everything, including everyday things like work, family matters, chores, appointments, etc.
This anxiety can interfere with school, work, personal relationships, or other aspects of their daily life. Symptoms like muscle tension, trouble sleeping, restlessness, etc., can accompany persistent worrying.
Signs and symptoms of GAD
Common symptoms of generalized anxiety disorder include (Chand, 2020):
- Excessive and persistent worry about everyday matters
- Difficulty controlling the feeling of worry or anxiety
- Restlessness or edginess
- Concentration difficulties or mind “going blank”
- Easily irritated
- Muscle tension
- Muscle aches, stomach aches, headaches, or other unexplained pains
- Increased heart rate
- Sleep difficulties (e.g., trouble falling asleep or staying asleep)
- Inability to identify the source of worry
Panic attack vs. anxiety attack: what’s the difference?
Causes of generalized anxiety disorder
No one knows what causes generalized anxiety disorder, but there are several theories. GAD is likely due to the complex interaction of biological and environmental factors.
Evidence suggests that after worry-inducing triggers, people with GAD may have increased activation of the parts of their brain associated with fear and anxiety. This change in the regulation of brain activity and circuitry may explain the inability of people with generalized anxiety disorder to stop worrying (Chand, 2020).
GAD may also be due to an imbalance in brain chemicals responsible for mood and stress responses (Munir, 2021).
Risk factors for GAD
Several risk factors seem to play a role in GAD, including (Munir, 2021):
- Genetics, especially a first-degree relative (sibling, child, parent) with GAD
- Having another mental health disorder, like depression
- History of trauma or child abuse
- Substance abuse
Diagnosis of generalized anxiety disorder
Diagnosis of generalized anxiety disorder begins with detailed questions about your symptoms and medical history. Your provider will also do a physical exam to look for an underlying medical condition that may be causing your anxiety. They may order laboratory testing if a medical condition is suspected.
Your provider may use the criteria listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to determine if you fit the criteria for generalized anxiety disorder.
Treatment for generalized anxiety disorder
The treatment for generalized anxiety disorder usually involves psychotherapy, medication, or both.
Psychotherapy (“talk therapy”) can be individualized to each person’s specific anxieties. Cognitive behavioral therapy (CBT) is a form of psychotherapy that helps people learn various ways of thinking, behaving, and dealing with situations that cause anxiety.
The goal is to help you feel less anxious and worried. CBT focuses on identifying, challenging, and then neutralizing anxieties. You can go through CBT either in group sessions or individually (Munir, 2021).
For some people, psychotherapy is not enough, and they need to take medication to help with the symptoms that go along with their anxiety. Common drugs prescribed to treat GAD symptoms include (Bystritsky, 2020):
- Benzodiazepines, like lorazepam (brand name Ativan) and diazepam (brand name Valium)
- Buspirone (brand name Buspar; see Important Safety Information), a non-benzodiazepine anti-anxiety medication
- Selective serotonin reuptake inhibitors (SSRIs) like paroxetine (brand name Paxil, Brisdelle; see Important Safety Information) and escitalopram (brand name Lexapro; see Important Safety Information)
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) like duloxetine (brand name Cymbalta; see Important Safety Information) and venlafaxine (brand name Effexor; see Important Safety Information)
- Tricyclic antidepressants like imipramine (brand name Tofranil)
Beta-blockers are drugs that are usually used to lower heart rate and treat high blood pressure.
However, they are sometimes given to help with anxiety symptoms, like the pounding heart you feel before public speaking. Beta-blockers seem to work best for phobias, like social phobia. Examples include propranolol and metoprolol (Chand, 2020).
High functioning anxiety: signs and what to do about it
These medications should be taken as directed and only under the supervision of your healthcare provider.
Lifestyle modifications and anxiety-relieving behaviors may help you take control of your anxiety. You can use these tips in combination with other treatments, depending on the severity of your GAD (Munir, 2021).
- Eat a healthy diet rich in fruits and vegetables, and exercise, even for a short duration, several times a week.
- Improve your sleep habits since poor sleep can worsen your symptoms.
- Practice relaxation techniques, like yoga, meditation, and deep breathing exercises, which can ease anxiety.
- Avoid stimulants, like caffeine, that can aggravate the symptoms of anxiety.
- Quit smoking, as nicotine can worsen anxiety.
- Avoid alcohol since it can interfere with your medications and make you more irritable and depressed.
- Lean on friends, family, community, religious organizations, and others as sources of help and support when you are feeling anxious.
- Work with a mental health professional to identify your anxiety triggers and learn how to cope with them.
Some people may feel trapped by their generalized anxiety disorder. You are not alone, and treatment is possible. However, to get the appropriate treatment, you need to talk to your healthcare provider.
If you feel that your excessive worrying negatively affects your ability to function in your daily life, it’s time to seek help. Discuss how much and how often you worry, and don’t be afraid to ask for a referral to a mental health specialist.
With the proper therapy combination, you can manage your generalized anxiety disorder and get back to living your life.
- Baldwin, D. (2021). Generalized anxiety disorder in adults: epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis. In UptoDate. Stein, M.B. & Friedman, M. (Eds.). Retrieved from https://www.uptodate.com/contents/generalized-anxiety-disorder-in-adults-epidemiology-pathogenesis-clinical-manifestations-course-assessment-and-diagnosis
- Bystritsky, A. (2020). Pharmacotherapy for generalized anxiety disorder in adults. In UptoDate. Stein, M.B. & Friedman, M. (Eds.). Retrieved from https://www.uptodate.com/contents/pharmacotherapy-for-generalized-anxiety-disorder-in-adults
- Chand SP, Marwaha R. (2020). Anxiety. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK470361/
- Munir S, Takov V. (2021) Generalized anxiety disorder. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK441870/
- National Institute of Mental Health. (2017, Nov). Statistics-any anxiety disorder. Retrieved May 19, 2021 from https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder.shtml
- Substance Abuse and Mental Health Services Administration. (2016). Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 3.15, DSM-IV to DSM-5 Generalized Anxiety Disorder Comparison. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t15/
Dr. Steve Silvestro is a board-certified pediatrician and Senior Manager, Medical Content & Education at Ro.