Generalized anxiety disorder

Overview

It's normal to feel anxious from time to time, especially if your life is stressful. However, excessive, ongoing anxiety and worry that are difficult to control and interfere with day-to-day activities may be a sign of generalized anxiety disorder.

It's possible to develop generalized anxiety disorder as a child or an adult. Generalized anxiety disorder has symptoms that are similar to panic disorder, obsessive-compulsive disorder and other types of anxiety, but they're all different conditions.

Living with generalized anxiety disorder can be a long-term challenge. In many cases, it occurs along with other anxiety or mood disorders. In most cases, generalized anxiety disorder improves with psychotherapy or medications. Making lifestyle changes, learning coping skills and using relaxation techniques also can help.

Symptoms

Generalized anxiety disorder symptoms can vary. They may include:

• Persistent worrying or anxiety about a number of areas that are out of proportion to the impact of the events
• Overthinking plans and solutions to all possible worst-case outcomes
• Perceiving situations and events as threatening, even when they aren't
• Difficulty handling uncertainty
• Indecisiveness and fear of making the wrong decision
• Inability to set aside or let go of a worry
• Inability to relax, feeling restless, and feeling keyed up or on edge
• Difficulty concentrating, or the feeling that your mind "goes blank"

Physical signs and symptoms may include:

• Fatigue
• Trouble sleeping
• Muscle tension or muscle aches
• Trembling, feeling twitchy
• Nervousness or being easily startled
• Sweating
• Nausea, diarrhea or irritable bowel syndrome
• Irritability

There may be times when your worries don't completely consume you, but you still feel anxious even when there's no apparent reason. For example, you may feel intense worry about your safety or that of your loved ones, or you may have a general sense that something bad is about to happen.

Your anxiety, worry or physical symptoms cause you significant distress in social, work or other areas of your life. Worries can shift from one concern to another and may change with time and age.

Symptoms in children and teenagers

Children and teenagers may have similar worries to adults, but also may have excessive worries about:

• Performance at school or sporting events
• Family members' safety
• Being on time (punctuality)
• Earthquakes, nuclear war or other catastrophic events

A child or teen with excessive worry may:

• Feel overly anxious to fit in
• Be a perfectionist
• Redo tasks because they aren't perfect the first time
• Spend excessive time doing homework
• Lack confidence
• Strive for approval
• Require a lot of reassurance about performance
• Have frequent stomachaches or other physical complaints
• Avoid going to school or avoid social situations

When to see a doctor

Some anxiety is normal, but see your doctor if:

• You feel like you're worrying too much, and it's interfering with your work, relationships or other parts of your life
• You feel depressed or irritable, have trouble with drinking or drugs, or you have other mental health concerns along with anxiety
• You have suicidal thoughts or behaviors — seek emergency treatment immediately

Your worries are unlikely to simply go away on their own, and they may actually get worse over time. Try to seek professional help before your anxiety becomes severe — it may be easier to treat early on.

Causes

As with many mental health conditions, the cause of generalized anxiety disorder likely arises from a complex interaction of biological and environmental factors, which may include:

• Differences in brain chemistry and function
• Genetics
• Differences in the way threats are perceived
• Development and personality

Risk factors

Women are diagnosed with generalized anxiety disorder somewhat more often than men are. The following factors may increase the risk of developing generalized anxiety disorder:

• Personality. A person whose temperament is timid or negative or who avoids anything dangerous may be more prone to generalized anxiety disorder than others are.
• Genetics. Generalized anxiety disorder may run in families.
• Experiences. People with generalized anxiety disorder may have a history of significant life changes, traumatic or negative experiences during childhood, or a recent traumatic or negative event. Chronic medical illnesses or other mental health disorders may increase risk.

Complications

Having generalized anxiety disorder can be disabling. It can:

• Impair your ability to perform tasks quickly and efficiently because you have trouble concentrating
• Take your time and focus from other activities
• Sap your energy
• Increase your risk of depression

Generalized anxiety disorder can also lead to or worsen other physical health conditions, such as:

• Digestive or bowel problems, such as irritable bowel syndrome or ulcers
• Headaches and migraines
• Chronic pain and illness
• Sleep problems and insomnia
• Heart-health issues

Generalized anxiety disorder often occurs along with other mental health problems, which can make diagnosis and treatment more challenging. Some mental health disorders that commonly occur with generalized anxiety disorder include:

• Phobias
• Panic disorder
• Post-traumatic stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)
• Depression
• Suicidal thoughts or suicide
• Substance abuse

Prevention

There's no way to predict for certain what will cause someone to develop generalized anxiety disorder, but you can take steps to reduce the impact of symptoms if you experience anxiety:

• Get help early. Anxiety, like many other mental health conditions, can be harder to treat if you wait.
• Keep a journal. Keeping track of your personal life can help you and your mental health professional identify what's causing you stress and what seems to help you feel better.
• Prioritize issues in your life. You can reduce anxiety by carefully managing your time and energy.
• Avoid unhealthy substance use. Alcohol and drug use and even nicotine or caffeine use can cause or worsen anxiety. If you're addicted to any of these substances, quitting can make you anxious. If you can't quit on your own, see your doctor or find a treatment program or support group to help you.

Diagnosis

To help diagnose generalized anxiety disorder, your doctor or mental health professional may:

• Do a physical exam to look for signs that your anxiety might be linked to medications or an underlying medical condition
• Order blood or urine tests or other tests, if a medical condition is suspected
• Ask detailed questions about your symptoms and medical history
• Use psychological questionnaires to help determine a diagnosis
• Use the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

Treatment

Treatment decisions are based on how significantly generalized anxiety disorder is affecting your ability to function in your daily life. The two main treatments for generalized anxiety disorder are psychotherapy and medications. You may benefit most from a combination of the two. It may take some trial and error to discover which treatments work best for you.

Psychotherapy

Also known as talk therapy or psychological counseling, psychotherapy involves working with a therapist to reduce your anxiety symptoms. Cognitive behavioral therapy is the most effective form of psychotherapy for generalized anxiety disorder.

Generally a short-term treatment, cognitive behavioral therapy focuses on teaching you specific skills to directly manage your worries and help you gradually return to the activities you've avoided because of anxiety. Through this process, your symptoms improve as you build on your initial success.

Medications

Several types of medications are used to treat generalized anxiety disorder, including those below. Talk with your doctor about benefits, risks and possible side effects.

• Antidepressants. Antidepressants, including medications in the selective serotonin reuptake inhibitor (SSRI) and serotonin and norepinephrine reuptake inhibitor (SNRI) classes, are the first line medication treatments. Examples of antidepressants used to treat generalized anxiety disorder include escitalopram (Lexapro), duloxetine (Cymbalta), venlafaxine (Effexor XR) and paroxetine (Paxil, Pexeva). Your doctor also may recommend other antidepressants.
• Buspirone. An anti-anxiety medication called buspirone may be used on an ongoing basis. As with most antidepressants, it typically takes up to several weeks to become fully effective.
• Benzodiazepines. In limited circumstances, your doctor may prescribe a benzodiazepine for relief of anxiety symptoms. These sedatives are generally used only for relieving acute anxiety on a short-term basis. Because they can be habit-forming, these medications aren't a good choice if you have or had problems with alcohol or drug abuse.

Lifestyle and home remedies

While most people with anxiety disorders need psychotherapy or medications to get anxiety under control, lifestyle changes also can make a difference. Here's what you can do:

• Keep physically active. Develop a routine so that you're physically active most days of the week. Exercise is a powerful stress reducer. It may improve your mood and help you stay healthy. Start out slowly and gradually increase the amount and intensity of your activities.
• Make sleep a priority. Do what you can to make sure you're getting enough sleep to feel rested. If you aren't sleeping well, see your doctor.
• Use relaxation techniques. Visualization techniques, meditation and yoga are examples of relaxation techniques that can ease anxiety.
• Eat healthy. Healthy eating — such as focusing on vegetables, fruits, whole grains and fish — may be linked to reduced anxiety, but more research is needed.
• Avoid alcohol and recreational drugs. These substances can worsen anxiety.
• Quit smoking and cut back or quit drinking coffee. Both nicotine and caffeine can worsen anxiety.

Alternative medicine

Several herbal remedies have been studied as treatments for anxiety. Results tend to be mixed, and in several studies people report no benefits from their use. More research is needed to fully understand the risks and benefits.

Some herbal supplements, such as kava and valerian, increase the risk of serious liver damage. Other supplements, such as passionflower or theanine, may have a calming effect, but they're often combined with other products so it's hard to tell whether they help with symptoms of anxiety.

Before taking any herbal remedies or supplements, talk with your doctor to make sure they're safe and won't interact with any medications you take.

Coping and support

To cope with generalized anxiety disorder, here's what you can do:

• Stick to your treatment plan. Take medications as directed. Keep therapy appointments. Practice the skills you learn in psychotherapy. Consistency can make a big difference, especially when it comes to taking your medication.
• Take action. Work with your mental health professional to figure out what's making you anxious and address it.
• Let it go. Don't dwell on past concerns. Change what you can in the present moment and let the rest take its course.
• Break the cycle. When you feel anxious, take a brisk walk or delve into a hobby to refocus your mind away from your worries.
• Socialize. Don't let worries isolate you from loved ones or enjoyable activities. Social interaction and caring relationships can lessen your worries.
• Join a support group for people with anxiety. Here, you can find compassion, understanding and shared experiences. You may find support groups in your community or on the internet, for example, the National Alliance on Mental Illness (NAMI).

Preparing for an appointment

You may see your primary care doctor, or your doctor may refer you to a mental health professional. Here's some information to help you get ready for your appointment.

What you can do

Before your appointment, make a list of:

• Any symptoms you've been experiencing, including when they occur, what seems to make them better or worse, and how much they affect your day-to-day activities, such as work, school or relationships
• Key personal information, including major life changes or stressful events you've dealt with recently and any traumatic experiences you've had in the past
• Medical information, including other physical or mental health conditions with which you've been diagnosed
• Any medications, vitamins, herbs or other supplements you're taking, including the dosages
• Questions to ask your doctor or mental health professional

Some questions to ask your doctor may include:

• What's the most likely cause of my symptoms?
• Are there other possible issues or physical health problems that could be causing or worsening my anxiety?
• Do I need any tests?
• What treatment do you recommend?
• Should I see a psychiatrist, psychologist or other mental health professional?
• Would medication help? If so, is there a generic alternative to the medicine you're prescribing?
• Are there any brochures or other printed material that I can have? What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor or mental health professional will likely ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to focus on. Questions may include:

• What are your symptoms?
• What things do you tend to worry about?
• Do your symptoms interfere with your daily activities?
• Do you avoid anything because of your anxiety?
• Have your feelings of anxiety been occasional or continuous?
• When did you first begin noticing your anxiety?
• Does anything in particular seem to trigger your anxiety or make it worse?
• What, if anything, seems to improve your feelings of anxiety?
• What, if any, physical or mental health conditions do you have?
• What traumatic experiences have you had recently or in the past?
• Do you regularly drink alcohol or use recreational drugs?
• Do you have any blood relatives with anxiety or other mental health conditions, such as depression?