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Generalized Anxiety Disorder: Causes, Symptoms & Treatment

anxiety, generalized anxiety disorder, worry
One symptom of generalized anxiety disorder is an inability to sleep because of worrying about everyday things.
Credit: Rommel Canlas | Shutterstock

People who experience generalized anxiety disorder (GAD) exhibit excessive concern about multiple events or activities most days of the week. While it is not unusual for people to experience some stress as they go about their daily lives, GAD sufferers rarely get a break from worrying.

Although some of the symptoms and reactions may be similar to those of a phobia (an extreme, irrational fear), GAD is not a direct response to a specific situation or experience. Sufferers experience unease that casts a shadow over all of their activities.

While not nearly as intense as a panic attack, the unease lasts much longer and almost doesn't let up. GAD sufferers describe it as a feeling of being "wired" all of the time, according to the National Institute of Mental Health (NIMH).

"It is just a constant feeling of dread," said Thelma Duffey, professor and chairwoman of the Department of Counseling at the University of Texas at San Antonio, a licensed counselor and president-elect of the American Counseling Association. "Patients have a constant feeling of tension and anxiety that never goes away. They worry about things that have not yet even happened."

GAD affects about 6.8 million American adults, and strikes twice as many women as men, according to the NIMH. That translates to about 3.1 percent of the adult population suffering from the disorder, and about one-third of those cases can be classified as severe.

Symptoms of GAD

Though people who suffer from GAD worry about the same things that other people do — relationships, money, health, work, etc. — they have a much higher level of worry that is nearly constant. The level of concern is not in sync with reality and is greatly magnified. Most people with GAD realize that their concerns are overblown, but they cannot seem to shake their anxiety, according to the NIMH.

Duffey said GAD patients are aware that their anxiety level is high compared to that of others, but they feel shame and embarrassment to address the problem. "They know better, but they can't help the negative thoughts," she said.

The symptoms typically come on slowly, usually between childhood and middle age, according to the Mayo Clinic, but they can occur at any time. In some instances, a major life event, such as a change in health, or a life transition such as a divorce, can trigger the onset of GAD, Duffey told Live Science. 

"GAD patients have always been anxious to some degree, but an event such as a car accident, poor grades, relationship or work difficulties can enhance their anxiety," she said. 

The symptoms tend to ebb and flow, but can be exacerbated during times of stress. What sets the worry of GAD suffers apart from the normal concerns is that the worry is intrusive, excessive, debilitating and persistent, and lasts for more than six months, according to the NIMH. 

Fatigue, nausea, muscle tension and headaches are some of the physical symptoms of GAD, according to the Anxiety and Depression Association of America (ADAA). Some people with GAD experience hot flashes, trembling, sweating and frequent urges to go to the bathroom, the ADAA noted.

Sleeplessness is another sign of GAD, because people with the disorder often feel as if they can't stop their mind from racing, Duffey said. People with GAD are also jumpy, fidgety and easily startled, as the disorder causes a sensation of always being on edge or very restless, according to the University of Maryland Medical Center.

Like those with panic disorder, GAD sufferers have difficulty with everyday tasks, the NIMH noted. However, people with GAD are not gripped by an overwhelming fear, and are typically able to function. However, some may be unable to perform even routine tasks during times when their symptoms are the worst, according to the NIMH. 

Causes

GAD may run in families, although as with all mental-health issues, the causes are typically a combination of biological and environmental factors, according to the NIMH. 

"It is likely due to a combination of stress and environmental factors that contribute to the expression of genes in individuals who are born with the risk/vulnerability to develop the condition," said Dr. Andrew Gilbert, a psychiatrist and medical director at the Hallowell Center in New York. "Since GAD can emerge in adolescence, there are some interesting developmental/pediatric studies suggesting that individuals born with particular temperaments and/or wiring in their brains may be more vulnerable to develop GAD."

An imbalance of naturally occurring brain chemicals — such as serotonin, dopamine and norepinephrine — is often seen in people with GAD and could be an indicator of a propensity to develop the disorder, according to the Mayo Clinic. An imbalance of these chemicals, called neurotransmitters, can impact emotional stability and mental well-being. 

[Related: Nervous System: Facts, Function & Diseases]

Enduring a trauma, especially during childhood, is also linked to GAD, according to the Mayo Clinic. Those who experienced abuse or trauma as a child, including witnessing a traumatic event, are at higher risk of developing generalized anxiety disorder.

Connection to addiction

Many GAD sufferers use alcohol, tranquilizers or other drugs to calm their nerves and provide them some relief, according to the ADAA. Those with anxiety disorders are two to three times more likely than the general population to abuse alcohol or other substances at some point in their lives, according to the ADAA. About 20 percent of Americans with an anxiety or mood disorder, such as depression, have an alcohol or other substance-abuse disorder, according to the ADAA.

Typically, those suffering from GAD and other anxiety disorders have low self-esteem, which is a factor in substance abuse. Many GAD sufferers also abuse prescription drugs, the ADAA noted. Many GAD sufferers build up a tolerance to some of the drugs they have been given to treat their physical symptoms, leading them to visit multiple doctors for prescriptions.

GAD sufferers are also cautioned to avoid caffeine and some over-the-counter cold medications, which can worsen the symptoms of anxiety disorders, according to the NIMH. 

Treatment

GAD can be difficult to diagnose, as it is the symptoms, such as sleeplessness or headaches, that cause someone to seek medical attention. It is estimated that 43 percent of the people who live with GAD receive treatment, according to the NIMH.

As with many mental-health issues, some patients respond to psychotherapy, others are helped with medication and still others need a combination of treatments to achieve success, the ADAA noted. 

Cognitive behavioral therapy (CBT), which teaches a patient new ways of reacting to situations, can help reduce the anxiety and worry, according to the ADAA. "Numerous studies have found CBT effective treatment for GAD in children, adolescents and adults," Gilbert said. 

Many GAD sufferers also benefit from self-help and support groups, where they can share their challenges and discuss coping mechanisms, according to the ADAA. 

The NIMH noted that anti-anxiety medications and antidepressants are the two most common types of medications used to treat GAD.

An article in the December 2011 issue of the Journal of Anxiety Disorders described a study on the use of CBT in combination with medication in the treatment of GAD. Patients who were being treated with venlafaxine XR, a common drug used to treat GAD, were offered CBT. Of those that received CBT, there was no additional benefit of combined treatment compared to mediation-only treatment.

Duffey said that while medication can be helpful for some GAD patients, she advocates for treatment that emphasizes lifestyle factors, such as nutrition, exercise and establishing a routine. 

"I focus on knowledge, as knowledge is power and can provide a sense of hope and safety, as well as self-empowerment and self-acceptance," Duffey said. 

This article is for informational purposes only, and is not meant to offer medical advice. 

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