Generalized anxiety disorder

Definition

It's normal to feel anxious or worried at times. Everyone does. In fact, a moderate amount of anxiety can be good. Anxiety helps you respond appropriately to real danger, and it can help motivate you to excel at work and at home.

But if you often feel very anxious without reason and your worries disrupt your daily life, you may have generalized anxiety disorder. Generalized anxiety disorder causes excessive or unrealistic anxiety and worry — well beyond what's appropriate for a situation.

Living with generalized anxiety disorder can be difficult, but treatment is available. Medications and psychotherapy can help ease symptoms, and you can learn healthy coping skills to manage generalized anxiety disorder and take back your life.

Symptoms

Signs and symptoms of generalized anxiety disorder can vary in combination or severity. Generalized anxiety disorder symptoms may include:

• Restlessness
• Feeling of being keyed up or on edge
• Feeling a lump in your throat
• Difficulty concentrating
• Fatigue
• Irritability
• Impatience
• Being easily distracted
• Muscle tension
• Trouble falling or staying asleep
• Excessive sweating
• Shortness of breath
• Stomachache
• Diarrhea
• Headache

If you have generalized anxiety disorder, you may experience times when your worries don't completely consume you, but you still feel rather anxious. You may feel on edge about many or all aspects of your life. 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, even when there's no apparent danger.

Generalized anxiety disorder often begins at an early age, and the signs and symptoms may develop more slowly than in other anxiety disorders. Many people with generalized anxiety disorder can't recall when they last felt relaxed or at ease.

Causes

As with many mental health conditions, what causes generalized anxiety disorder isn't fully understood. Researchers believe that it may involve naturally occurring chemicals in the brain called neurotransmitters, such as serotonin and norepinephrine. However, it's likely that the condition has a complex set of causes that may include your body's biological processes, genetics and your environment and life situation.

Risk factors

Along with phobias, panic attacks and obsessive-compulsive disorder, generalized anxiety disorder is among the most common of anxiety disorders. Many people with generalized anxiety disorder believe their worries date back to childhood, but it's also possible to develop the condition as an adult. More women than men are diagnosed with generalized anxiety disorder.

Certain factors that may increase your risk of developing generalized anxiety disorder include:

• Childhood adversity. Children who endured hardships or adversity, including witnessing traumatic events, are at higher risk.
• Illness. Having a serious illness, such as cancer, can make you anxious. Worrying about the future, your treatment and your finances can become excessive and overwhelming.
• Stress. A buildup of stressful life situations may trigger excessive anxiety. For example, having a physical illness, along with the stress of missing work or losing pay, may combine to cause generalized anxiety disorder.
• Personality. People with some personality types are more prone to anxiety disorders. People with unmet psychological needs, such as having a close relationship that isn't fulfilling, may feel less secure and may be more at risk of generalized anxiety disorder. In addition, some personality disorders, such as borderline personality disorder, also may be associated with generalized anxiety disorder.
• Genetics. Some evidence suggests that generalized anxiety disorder has a genetic component that causes it to run in families.

When to seek medical advice

People — both adults and children — with generalized anxiety disorder are constantly plagued by worries. They may feel anxious and worried about things both large and small, such as:

• School
• Work
• Sports performance
• Car repairs
• Household chores
• Earthquakes
• War
• Finances
• Airplane flights
• Their own and others' health

You may find it impossible to banish your fears and worries, even when you're trying to relax or unwind. This anxiety can go on for months and months. You may feel you've lost control over managing it. And it may interfere with your ability to carry out daily routines.

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

Tests and diagnosis

To help diagnose generalized anxiety disorder, mental health providers perform a thorough psychological evaluation. They ask many questions about your worries, fears and emotional well-being. They may also ask about any obsessions, to make sure that you don't have obsessive-compulsive disorder. You may also fill out psychological questionnaires. And you may have a physical exam to check for any other health problems that may be causing generalized anxiety disorder symptoms.

To be diagnosed with generalized anxiety disorder, someone must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health professionals to diagnose mental conditions and by insurance companies to reimburse for treatment.

For generalized anxiety disorder to be diagnosed, someone must meet these criteria:

• Excessive anxiety and worry every day for at least six months
• Difficulty managing anxiety
• Anxiety that is associated with several specific symptoms, such as feeling keyed up, difficulty concentrating, muscle tension and sleep disturbances
• Anxiety that causes significant distress or impairment in your daily life
• Anxiety that isn't related to another condition, such as panic attacks or substance abuse

Complications

Generalized anxiety disorder does more than make you worry. It can also lead to or worsen a variety of potentially serious conditions, including:

• Depression
• Substance abuse
• Insomnia
• Digestive or bowel problems
• Headache
• Teeth grinding (bruxism)

Treatments and drugs

The two main treatments for generalized anxiety disorder are medications and psychotherapy, either alone or in combination. It may take some trial and error to discover which treatment works best for you and which you are most comfortable with. Your health insurance coverage also may be a factor.

Medications
Several different types of medications are used to relieve generalized anxiety disorder symptoms:

• Anti-anxiety medications. Benzodiazepines are sedatives that have the advantage of easing anxiety within 30 to 90 minutes. On the downside, they can be habit-forming if you take them for more than a few weeks. For this reason, your doctor may prescribe them for only a short time to help you get through a particularly rough period. The most commonly prescribed sedatives include alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), diazepam (Valium) and lorazepam (Ativan). These medications may cause unsteadiness, drowsiness, reduced muscle coordination and problems with balance. Higher doses and long-term use can cause memory problems. Don't drive or use heavy machinery while taking these drugs.

  A different type of anti-anxiety medication often prescribed for generalized anxiety disorder is buspirone (BuSpar). While this medication typically takes several weeks to improve symptoms, it doesn't pose a risk of dependence. A common side effect of buspirone is a brief feeling of lightheadedness shortly after taking it. Less common side effects include headaches, nausea, nervousness and insomnia.

• Antidepressants. These medications influence the activity of certain neurotransmitters that are thought to play a role in anxiety disorders. Examples of antidepressants used to treat generalized anxiety disorder include fluoxetine (Prozac), paroxetine (Paxil), imipramine (Tofranil), venlafaxine (Effexor), escitalopram (Lexapro) and duloxetine (Cymbalta).

  Whether you try anti-anxiety medications, antidepressants or both, you may need to try several to find which works best for you with the fewest side effects. Also keep in mind that some medications don't work immediately, particularly antidepressants. It may take several weeks before you notice the full effects of anxiety relief. Psychotherapy or healthy coping skills can help you weather this challenging waiting period.

Psychotherapy
Also known as talk therapy or counseling, psychotherapy involves receiving help from a mental health provider through a combination of talking and listening.

Evidence shows that cognitive behavior therapy in particular can help improve symptoms of generalized anxiety disorder. Cognitive behavior therapy helps you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones. It's based on the idea that your own thoughts — not other people or situations — determine how you behave. Even if an unwanted situation doesn't change, you can change the way you think and behave in a positive way. Generally a short-term treatment, cognitive behavior therapy emphasizes learning to develop a sense of mastery and control over your thoughts and feelings.

Treatment for generalized anxiety disorder or any mental illness is tailored to each person. No single treatment regimen works for everyone. Most treatment occurs on an outpatient basis, but some people may need care in a hospital setting.

Coping and support

Living with generalized anxiety disorder can truly be difficult. In addition to dealing with excessive worry, you may also have feelings of depression to cope with. Ultimately, anxiety may affect your interaction with friends and family, your productivity at work, and the overall quality of your life.

Still, there are healthy ways to cope with generalized anxiety disorder, even when it becomes a chronic condition that may always have a small presence in your life.

Some ways to cope with generalized anxiety disorder include:

• Joining an anxiety support group. Here, you can find compassion, understanding and shared experiences.
• Taking action. Work with your mental health provider to figure out what's making you anxious and address it. For example, if finances are your concern, work toward drawing up a budget.
• Letting it go. Don't dwell on past concerns. Change what you can and let the rest take its course. Repeat as needed.
• Breaking the cycle. When you feel anxious, take a brisk walk or delve into a hobby to refocus your mind away from your worries.
• Taking care of yourself. Get enough rest, eat a balanced diet, exercise and take time to relax. Avoid caffeine and nicotine, which can worsen anxiety. Don't turn to alcohol or unprescribed drugs for relief.
• Sticking to your treatment plan. Take medications as directed. Keep therapy appointments. Consistency can help keep your treatment plan on track.
• Socializing. Don't let worries make you isolated from loved ones or enjoyable activities. Touching base with others offers a healthy diversion.