Generalized anxiety disorder is a very debilitating mental illness characterized by intense irrational fear and worry that is not appropriate for the given situation. It is not uncommon for someone with this disorder to be “on edge” most of the time and to even experience full blown panic attacks.

Someone with generalized anxiety disorder may find it very difficult to do something as simple as making small talk with a cashier or even being in the presence of other people. They will usually isolate themselves from others or avoid the particular thing that gives them anxiety in order to help them feel “safe” and to help minimize the intense fear that the aforementioned stimuli would give them.

The essential feature of generalized anxiety disorder is excessive anxiety and worry (apprehensive expectation) about a number of events or activities. The intensity, duration, or frequency of the anxiety and worry is out of proportion to the actual likelihood or impact of the anticipated event.

The individual finds it difficult to control the worry and to keep worrisome thoughts from interfering with attention to tasks at hand. Adults with generalized anxiety disorder often worry about everyday, routine life circumstances, such as possible job responsibilities, health and finances, the health of family members, misfortune to their children, or minor matters (American Psychiatric Association, 2013, p. 222).




Symptoms of Generalized Anxiety Disorder

Excessive worrying impairs the individual’s capacity to do things quickly and efficiently, whether at home or at work. The worrying takes time and energy; the associated symptoms of muscle tension and feeling keyed up or on edge, tiredness, difficulty concentrating, and disturbed sleep contribute to the impairment.

Importantly the excessive worrying may impair the ability of individuals with generalized anxiety disorder to encourage confidence in their children.

Generalized anxiety disorder is associated with significant disability and distress that is independent of comorbid disorders, and most non-institutionalized adults with the disorder are moderately to seriously disabled. Generalized anxiety disorder accounts for 110 million disability days per annum in the U.S. population (American Psychiatric Association, 2013, p. 225).

Common symptoms of generalized anxiety disorder:

  • Excessive worrying
  • Unable to control worrying
  • Easily startled
  • Irritable or “on edge”
  • Excessive overthinking
  • Easily fatigued
  • Feeling weak or tired
  • Excessive sweating
  • Difficulty concentrating
  • Increased heart rate
  • Muscle tension, trembling
  • Trouble sleeping
  • Unable to relax, restless
  • Difficulty making decisions
  • Feeling nauseous
  • Extreme nervousness




Causes of Generalized Anxiety Disorder

Temperamental. Behavioral inhibition, negative affectivity (neuroticism), and harm avoidance have been associated with generalized anxiety disorder.

Environmental. Although childhood adversities and parental overprotection have been associated with generalized anxiety disorder, no environmental factors have been identified as specific to generalized anxiety disorder or necessary or sufficient for making the diagnosis.

Genetic and physiological. One-third of the risk of experiencing generalized anxiety disorder is genetic, and these genetic factors overlap with the risk of neuroticism and are shared with other anxiety and mood disorders, particularly major depressive disorder (American Psychiatric Association, 2013, p. 224).

Many individuals with generalized anxiety disorder report that they have felt anxious and nervous all of their lives. The median age at onset for generalized anxiety disorder is 30 years; however, age at onset is spread over a very broad range.

The median age at onset is later than that for the other anxiety disorders. The symptoms of excessive worry and anxiety may occur early in life but are then manifested as an anxious temperament. Onset of the disorder rarely occurs prior to adolescence.

The clinical expression of generalized anxiety disorder is relatively consistent across the lifespan. The primary difference across age groups is in the content of the individual’s worry.

Children and adolescents tend to worry more about school and sporting performance, whereas older adults report greater concern about the well-being of family or their own physical health. Thus, the content of an individual’s worry tends to be age appropriate. Younger adults experience severity of symptoms than do older adults.

The earlier in life individuals have symptoms that meet criteria for generalized anxiety disorder, the more comorbidity they tend to have and the more impaired they are likely to be. The advent of chronic physical disease can be a potent issue for excessive worry in the elderly. In the frail elderly, worries about safety – and especially about falling – may limit activities.

In children and adolescents with generalized anxiety disorder, the anxieties and worries often concern the quality of their performance or competence at school or in sporting events, even when their performance is not being evaluated by others.

Generalized anxiety disorder may be overdiagnosed in children. When this diagnosis is being considered in children, a thorough evaluation for the presence of other childhood anxiety disorders and other mental disorders should be done to determine whether the worries may be better explained by one of these disorders: separation anxiety disorder, social anxiety disorder (social phobia), and obsessive-compulsive disorder are often accompanied by worries that may mimic those described in generalized anxiety disorder (American Psychiatric Association, 2013, pp. 223-224).

Diagnostic Criteria

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item is required in children.

  1. Restlessness or feeling keyed up or on edge.
  2. Being easily fatigued.
  3. Difficulty concentrating or mind going blank.
  4. Irritability.
  5. Muscle tension.
  6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worrying, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another mental disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder [social phobia], contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic  disorder, having  a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

(American Psychiatric Association, 2013, p. 222)



Prevalence

The 12-month prevalence of generalized anxiety disorder is 0.9% among adolescents and 2.9% among adults in the general community of the United States. The 12-month prevalence for the disorder in other countries ranges from 0.4% to 3.6%. The lifetime morbid risk is 9.0% Females are twice as likely as males to experience generalized anxiety disorder.

The prevalence of the diagnosis peaks in middle age and declines across the later years of life. Individuals of European descent tend to experience generalized anxiety disorder more frequently than do individuals of non-European descent (i.e., Asian, African, Native American and Pacific Islander). Furthermore, individuals from developed countries are more likely than individuals from non-developed countries to report that they have experienced symptoms that meet criteria for generalized anxiety disorder in their lifetime (American Psychiatric Association, 2013, p. 223).

Comorbidity

Individuals whose presentation meets criteria for generalized anxiety disorder are likely to have met, or currently meet, criteria for other anxiety and unipolar depressive disorders. The neuroticism or emotional liability that underpins this pattern of comorbidity is associated with temperamental antecedents and genetic and environmental risk factors shared between these disorders, although independent pathways are also possible. Comorbidity with substance use, conduct, psychotic, neurodevelopmental, and neurocognitive disorders is less common (American Psychiatric Association, 2013, p. 226).

Gender-Related Diagnostic Issues

In clinical settings, generalized anxiety disorder is diagnosed somewhat more frequently in females than in males (about 55%-60% of those presenting with the disorder are female). In epidemiological studies, approximately two-thirds are female. Females and males who experience generalized anxiety disorder appear to have similar symptoms but demonstrate different patterns of comorbidity consistent with gender differences in the prevalence of disorders. In females, comorbidity is largely confined to the anxiety disorders and unipolar depression, whereas in males, comorbidity is more likely to extend to the substance use disorders as well (American Psychiatric Association, 2013, pp. 224-225).

Treatments for Generalized Anxiety Disorder

Cognitive behavioral therapy (CBT) and/or psychiatric medication may be very effective at helping to reduce symptoms of generalized anxiety disorder. Oftentimes, CBT is used in conjunction with a low dose of an antidepressant or an anti-anxiety drug.

Dialectical behavior therapy (DBT) may also be effective at treating some of the symptoms of generalized anxiety disorder, especially with regards to regulating the emotion of fear. Although DBT is often used to treat people with emotion regulation issues, such as those seen in borderline personality disorder, DBT can also be beneficial for someone with general anxiety disorder too.

Some common drugs that may help treat generalized anxiety disorder are SSRIs like Lexapro, Zoloft, and Prozac, among several others. Benzodiazepines like Valium, Xanax, and Ativan may also be prescribed to help with short term anxiety relief. Talk to your doctor or therapist to see what the best course of action is for you with regards to psychiatric medication.

Treatments (expanded)

Cognitive Behavioral Therapy (CBT)

CBT is a psycho-social intervention that aims to improve one’s mental health. It is a modality that is often used to treat people suffering from anxiety disorders such as generalized anxiety disorder and obsessive-compulsive disorder. Someone with generalized anxiety disorder may be able to benefit from CBT seeing as how it would allow them to have a much better understanding as to why they think and behave the way they do in relation to their irrational fears.

CBT can be very helpful for someone with generalized anxiety disorder given the sheer automaticity of their symptoms. For example, when someone with this condition is exposed to their fear, they will almost always have an instantaneous subconscious reaction to that fear. Such a lack of introspection is likely a large part of why someone with generalized anxiety disorder will suffer to the extent that they will. CBT can help you to take a step back and analyze your fears more deeply than you typically would.

Besides learning to be more fastidious with regards to understanding one’s specific fears, someone with generalized anxiety disorder engaging in CBT can also expect to learn various other skills aimed at helping to relieve the anxiety caused by this condition.

Mindfulness-Based Stress Reduction (MBSR)

MBSR is an 8-week evidence-based program that offers secular, intensive mindfulness training to help people who are suffering from anxiety, stress, depression, and other sorts of mental anguish. MBSR may be able to significantly help someone who is suffering from generalized anxiety disorder as mindfulness meditation has been shown to be very beneficial for anxious people. In such a structured program, someone with generalized anxiety disorder can expect to learn a plethora of different skills that can help them to relieve the intense anxiety that’s associated with their fears.

Meditation

There are many different forms of meditation that exist which can be very advantageous for someone suffering from generalized anxiety disorder. Specifically, mindfulness meditation has been shown to be quite beneficial for helping people to enter into a more equanimous state. There are many different ways with which you can implement mindfulness meditation and there are also many different meditation apps which are designed to make things as easy as possible for you.

Mindfulness has the potential to significantly help those suffering from generalized anxiety disorder due to how it will help one to distract themselves from their fear by refocusing their attention onto something else that does not have any sort of emotional baggage attached to it, such as by focusing on the breath for example. This is one of the most basic ways that one can meditate and be present.

For someone with generalized anxiety disorder in the midst of a panic attack, redirecting one’s attention to the various sensations felt when breathing can actually help to reduce the amount of mental anguish experienced during such an influx of anxiety.

To implement mindfulness meditation to help relieve one’s symptoms of this disorder, you can do so by paying close attention to the way the muscles in your abdomen and chest contract and relax with every inhale and exhale. You can spend time dwelling on how it feels as your chest expands during each inhale and how it sinks in with every exhale, for example.

Besides focusing on your breathing, you can also focus on the sounds around you, the way your skin feels as you touch certain objects, the way foods taste, as well as the way certain aromas smell. Remember, that it will take a lot of practice to become an adept meditator. So, practice is key.

Exposure Therapy

Exposure therapy is one of the most common ways to treat anxiety disorders such as generalized anxiety disorder. It can be an efficient way to help desensitize the patient to their specific fears. Be that as it may, it is imperative that the therapist implementing it on their patient is very adept at doing so. For example, if the therapist were to slightly expose someone with generalized anxiety disorder to their fear, then it may not be very effective as they may need a higher amount of exposure to truly trigger any sort of worthwhile change in the patient.

The same can be said for the antithesis of this scenario. If the therapist were to excessively expose someone with this disorder to their fear, then doing so could be highly counterproductive to the point to where their generalized anxiety disorder may become immensely worse due to the therapy alone. So, it is paramount that the therapist implementing exposure therapy for someone with this condition has a very strong sense of just how severe their symptoms are so that they can know the level of exposure that the patient will likely be able to handle.

Exercise

Exercise has been shown to be extremely beneficial for people suffering from anxiety disorders. Specifically, cardiovascular exercise can significantly help to relieve one’s stress. This is not to say that weight-resistance training would not benefit someone with anxiety, but rather that aerobic exercise has been shown to be more effective at releasing those feel good chemicals in the brain, such as endorphins.

According to the American Psychology Association, exercise can help to condition the mind to better cope with stressful situations. This makes sense when we take into consideration the high amount of stress that the body is put under during strenuous exercise. So, if you yourself are sedentary, then engaging in some form of aerobic exercise may be able to significantly help reduce your symptoms of generalized anxiety disorder by making it much easier for you to cope with the anxiety and stress that’s associated with this condition.

There are many different aerobic modalities that you can partake in to help reduce your symptoms of this disorder, such as swimming, biking, skiing, walking, and jogging. You can also acquire the many benefits of exercise by playing sports such as tennis, soccer, basketball, and racquetball, among many other sports. Engaging in some form of exercise consistently may be able to help relieve some of the pain associated with generalized anxiety disorder over time.





Yoga

There are numerous different yoga poses that can substantially benefit someone who is suffering from generalized anxiety disorder. In part, this is due to the meditative state of mind that yoga tends to emit in those who practice it on a consistent basis. Yoga can be thought of as meditation in motion. It can help to relieve some of the anxiety associated with generalized anxiety disorder due to the mere fact that by engaging in yoga, your attention will be redirected to something more productive than your recurrent worry thoughts.

There are many different types of yoga that someone with this condition can benefit from, such as hatha yoga or hot yoga, among many others. Nevertheless, regardless of the many different forms of yoga that exist, virtually all of them can help to relieve some of the stress and anxiety that is associated with generalized anxiety disorder.

If you have never practiced yoga before, then it may be in your best interest to take a class or watch some guided videos that can help you through each pose. Just like with meditation, the more you practice yoga, the more adept you will become at it. Besides helping you to reduce your symptoms of generalized anxiety disorder, you can also expect to acquire increased strength and flexibility, among other benefits.

Reducing Caffeine

It is no secret that consuming large amounts of caffeine throughout the day can aid in making you more anxious. This makes sense when we look closely at how caffeine affects our body’s physiology. When we consume a high dose of caffeine, our heart will start to beat faster, and we become more tense. In some instances, our body will begin to go into a state that is commonly referred to as “fight or flight.” Such a frame of mind is often a precursor for someone with generalized anxiety disorder to experience panic attacks.

So, consuming little to no caffeine throughout the day may be able to significantly help reduce one’s anxiety. Although doing so will likely not make all of your anxiety go away, it will indeed help you to reduce any unnecessary suffering that you would have otherwise experienced if you were to consume a large amount of caffeine.

Beverages like coffee and tea are often high in caffeine, as well as some energy drinks. In fact, even some foods have caffeine in them as well, such as dark chocolate. Being more conscious of your daily caffeine consumption may help you to reduce some of the symptoms associated with generalized anxiety disorder over time.

Dialectical Behavior Therapy (DBT)

DBT is a very effective form of treatment for people struggling with emotion regulation. It is often used to treat people suffering from borderline personality disorder. Nevertheless, it can also be very advantageous for someone suffering from anxiety disorders too. This is due to the numerous amount of coping skills you can expect to learn in a DBT group. These groups typically last about 6 months long and can have anywhere from two people to several people depending on how many join the group.

One very effective DBT skill for helping someone with this anxiety disorder is half-smiling. This technique works by having you think about that which you fear or upsets you all while slightly raising the corners of your mouth by lightly smiling, thus the term “half-smiling.” Although, it isn’t enough to just think about your fear while half-smiling, you also have to try and refrain from entertaining those painful emotions that your specific fears may evoke.

Mindfulness meditation is also heavily used in DBT and can greatly benefit someone with this disorder as it is done in a group setting, which helps to put the patient out of their comfort zone. These group mindfulness practices may include drinking warm tea to home in on the sense of taste and tactile senses or simply focusing on the breath.

Coping ahead is another very useful DBT skill that can help someone with this condition. With coping ahead, you will want to find a place where you can sit down quietly without distraction. Close your eyes and then think about the many different possible scenarios where you would face your specific fears and overcome them or cope with them. Doing so will help you to be much better adept at coping with your generalized anxiety disorder when you are actually exposed to your fears in real life.

Psychiatric Medications

Anti-anxiety meds

These types of medications may be very useful to help prevent panic attacks. Such drugs can be extremely useful for people suffering from severe generalized anxiety disorder due to the fact that people with this condition may experience panic attacks. Some common anti-anxiety medications include Xanax, Valium, and Klonopin, among many others.

These types of drugs are not typically taken on a daily basis, but they may be insofar as an individual’s generalized anxiety disorder is severe enough. However, this is something that you should first discuss with your doctor before you decide to do so to ensure that it is safe and effective.

Antidepressants

These types of medications aren’t only for people who suffer from depression as they can also help people suffering from anxiety disorders as well, such as generalized anxiety disorder. Some common antidepressants are Paxil, Zoloft, and Lexapro, among several others. These drugs may be able to help reduce some of the symptoms of this disorder.

These types of drugs are typically taken on a daily basis. They can help prevent panic attacks from occurring, but they are more so used to help reduce people’s daily anxiety. Talk to your doctor to see if taking antidepressants can help to reduce your symptoms of generalized anxiety disorder, as well as whether or not it is safe to do so.


References:

  • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5 (5th ed.). American Psychiatric Publishing.
  • Generalized Anxiety Disorder (GAD) | Anxiety and Depression Association of America, ADAA. (n.d.). Anxiety and Depression Association of America. Retrieved November 11, 2020, from https://adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad
  • Generalized anxiety disorder – Symptoms and causes. (2017, October 13). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/generalized-anxiety-disorder/symptoms-causes/syc-20360803
  • NIMH » Generalized Anxiety Disorder: When Worry Gets Out of Control. (2020, November 11). National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/generalized-anxiety-disorder-gad/index.shtml
  • Weir, K. (2011, December 1). The exercise effect. American Psychological Association. https://www.apa.org/monitor/2011/12/exercise