Generalized Anxiety Disorder

In generalized anxiety disorder, a person has frequent or nearly constant, nagging feelings of worry or anxiety. These feelings are either unusually intense or out of proportion to the real troubles and dangers of the person's everyday life.

The disorder is defined as persistent worry every day or almost every day for six months or more. In some cases, a person with generalized anxiety disorder feels he or she has always been a worrier, even since childhood or adolescence. In other cases, the anxiety may be triggered by a crisis or a period of stress, such as a job loss, a family illness or the death of a relative. Although the crisis eventually goes away and the stress passes, an unexplained feeling of anxiety may last months or years.

In addition to suffering from constant (or non-stop) worries and anxieties, people with generalized anxiety disorder may have low self-esteem or feel insecure because they see people's intentions or events in negative terms, or they experience them as intimidating or critical. Physical symptoms may lead them to seek treatment from a primary care doctor, cardiologist, pulmonary specialist or gastroenterologist. Stress can intensify the anxiety.

Experts believe that some people with this disorder have a genetic (inherited) tendency to develop it. The disorder probably stems from how a variety of brain structures communicate with each other as they manage the fear response. Chemical messengers, gamma aminobutyric acid (GABA) and serotonin, transmit signals along the circuits connecting brain regions. The medications used to treat anxiety affect these chemicals.

About 3% to 8% of people in the United States have generalized anxiety disorder. Women have the problem twice as often as men. The average adult patient first seeks medical attention between the ages of 20 and 30. However, the illness can occur at any age. Generalized anxiety disorder also has been diagnosed in young children, teenagers and elderly people. The illness is the most common anxiety disorder affecting people age 65 and older.

Of all psychiatric illnesses, generalized anxiety disorder is the least likely to occur alone. Between 50% and 90% of people with the disorder also have at least one other problem, usually panic disorder, a phobia, depression, dysthymia (a less severe form of depression), alcoholism or some other form of substance abuse.
To be diagnosed with generalized anxiety disorder, a person has to have at least three of the following symptoms:


Feeling restless or keyed up


Becoming tired very easily


Having difficulty concentrating or remembering (your mind goes blank)


Feeling irritable, crabby or grouchy


Having tense muscles


Having trouble falling asleep or staying asleep, or not feeling rested after sleep

People with generalized anxiety disorder also may have a wide range of anxiety-related physical symptoms that may seem like symptoms of heart disease, respiratory illness, digestive diseases and other medical illnesses.
You may consult a primary care doctor first if you suspect your physical symptoms are part of a medical illness. Your doctor may do tests to check for medical problems. If the results are normal, your doctor may ask about your family history, your history of any mental distress, current anxieties, recent stresses, and daily use of prescription and nonprescription drugs. Some drugs can cause anxiety symptoms. The doctor then may refer you to a psychiatrist for care.

Your psychiatrist will diagnose generalized anxiety disorder based on a full psychiatric evaluation that includes:


Asking you to describe your worries, anxieties and anxiety-related symptoms


Determining how long you have had these symptoms


Assessing how worry and anxiety have affected your ability to function normally at home, at work and socially


Checking for symptoms of other forms of psychiatric illness that might be present at the same time as generalized anxiety disorder. Symptoms of depression are very common in someone with this disorder.

The psychiatrist also may order diagnostic tests, if necessary, to check for a medical illness. These won't be needed if they already have been done by the doctor who referred you to the psychiatrist.