Generalized anxiety disorder

At a glance

  • People who have generalized anxiety disorder are almost constantly anxious.
  • This feeling of anxiety is uncontrollable and affects their everyday life.
  • It can also cause symptoms like a racing heart or stomach problems.
  • Psychological treatment and, if needed, medication can help to manage the anxiety.
  • But it often takes a long time for the treatment to start working.

Introduction

Photo of doctor and patient
PantherMedia / nyul

We all feel scared sometimes. In dangerous situations, fear can help to protect you. It puts the body in a state of readiness so that you 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 a rash decision that could lead to difficult situations.

But if these fears become overwhelming, they can be a big problem. People then worry nearly constantly about all sorts of things. If the fears and anxiety overshadow everything else and don’t go away, it may be generalized anxiety disorder (GAD). People with generalized anxiety disorder usually realize that their fears are exaggerated, but they aren’t able to control them. It is difficult to manage this problem on your own. There are various treatments that can help, though.

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. Doctors call this kind of anxiety "generalized" because these fears can be related to just about anything and aren't limited to specific situations.

One minute people 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 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 and can really get you down. Particularly if you also have , an anxiety disorder can make you feel even more like life isn't worth living.

When you are afraid, your 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. This state of alarm with a racing or pounding heartbeat and shortness of breath usually passes quickly. But in people who have generalized anxiety disorder, it often lasts longer and feels very unpleasant.

Other possible symptoms include drowsiness, nervousness and dizziness. Trembling, sweating, muscle cramps and stomach problems are also common.

Being worried all the time is exhausting, and may lead to problems concentrating and sleeping.

If you only feel anxious in certain situations, you probably don’t have generalized anxiety disorder. Sudden panic attacks are also not a sign of generalized anxiety disorder, although some people have both.

Causes and risk factors

The causes of generalized anxiety disorder aren’t fully understood. It is thought that both physical 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 are also signs that anxiety disorders are more common in some 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 all people will be diagnosed with this disorder in their lifetime. It is twice as common in women as in men. Generalized anxiety disorder typically first develops in middle age, but can also sometimes start in childhood or older age.

Outlook

Generalized anxiety disorder usually develops gradually. The fears and possible physical symptoms such as a racing heart aren't noticeable as signs of a medical condition at first. They only gradually affect your everyday life and wellbeing more and more.

Severe generalized anxiety disorder can be very difficult to get rid of. It often takes many months or even years to get better. But before then people go through phases when their anxiety is less severe.

In one study, about 1 out of 4 people had overcome their anxiety disorder after two years. But many people manage to get a handle on their anxiety in the long term. The disorder often improves on its own with age.

Diagnosis

The symptoms of generalized anxiety disorder may be similar to those of other psychological illnesses, such as phobias, panic disorders or obsessive-compulsive disorder. Many people who have generalized anxiety disorder also have symptoms that are more similar to those of .

The possible symptoms of generalized anxiety – such as a racing heart – are the same as those of diseases like an overactive thyroid, or can also be caused by certain medicines or drugs like speed (amphetamines).

As a result, it can be difficult to diagnose generalized anxiety disorder and might take a long time – especially if people first look for help because of the physical symptoms, perhaps even in the emergency department of a hospital. Sometimes, only one of the symptoms is then treated, like insomnia or one of the physical symptoms of the disorder. But specialists are able to diagnose it in the first few sessions of psychological treatment. Generalized anxiety is diagnosed if you have anxiety that

  • has lasted for at least six months, and you experience it on most days,
  • is uncontrollable,
  • is so extreme that it affects your everyday life, and
  • is accompanied by at least three physical symptoms, like a rapid pulse, shaking, tense muscles or stomach problems.

Treatment

There are different ways to gradually get a handle on generalized anxiety disorder. They include the following:

  • 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, progressive muscle relaxation and breathing exercises can help you to relax and better manage stress. These techniques are often part of psychological treatment.
  • Medication: The most commonly used medications for anxiety disorders are certain antidepressants. Some people also use plant-based sedatives that contain valerian or chamomile.
  • Support groups: Support groups offer you the opportunity to share your thoughts, feelings and experiences with others who are affected by 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.

None of the treatments promises a quick and easy "cure," but the various approaches can help to relieve the symptoms and make it easier to deal with the anxiety. There is often a noticeable improvement after just a few weeks. Through patience and the support of a therapist, many people also manage to overcome their anxiety disorder over time.

Everyday life

People with generalized anxiety disorder often find that it affects their work and private life, as well as their relationships. For instance, some might regularly call in sick to work because of their anxiety. Many people try to hide their anxiety, and withdraw from others as a result. Some people might then stay at home, where they feel safe. That way they can try to avoid situations that make them feel more anxious and could trigger or worsen the physical symptoms.

It's often difficult to talk openly about having general anxiety disorder. Many people don't, or they only tell one person who they can trust. But with the support of a therapist, it's often possible to open up to family members, for instance, and let them know about your disorder. Many people feel that seeking professional support or help from people they know is an important step towards getting a handle on their anxiety. It can also be helpful to stay as active as possible in your everyday life despite the anxiety – perhaps by doing sports or taking care of other people.

Further information

When people are ill or need medical advice, they usually go to see their family doctor first. Read about how to find the right doctor, how to prepare for the appointment and what to remember.

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Deutsche Gesellschaft für Psychosomatische Medizin und Ärztliche Psychotherapie (DGPM). S3-Leitlinie: Behandlung von Angststörungen. AWMF-Registernr.: 051-028. 2021.

Gale CK, Millichamp J. Generalised anxiety disorder. BMJ Clin Evid 2011: pii: 1002.

Hieu TH, Dibas M, Surya Dila KA et al. Therapeutic efficacy and safety of chamomile for state anxiety, generalized anxiety disorder, insomnia, and sleep quality: A systematic review and meta-analysis of randomized trials and quasi-randomized trials. Phytother Res 2019; 33(6): 1604-1615.

Hoge EA, Ivkovic A, Fricchione GL. Generalized anxiety disorder: diagnosis and treatment. BMJ 2012; 345: e7500.

National Institute for Health and Care Excellence (NICE). Generalised anxiety disorder and panic disorder in adults: management. (NICE Clinical guidelines; No. CG113). 2019.

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. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. 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.

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Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?

Updated on July 7, 2021
Next planned update: 2024

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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