What Is It?

Generalized anxiety disorder is a mental illness that causes a person to have persistent, nagging feelings of worry or anxiety (apprehension or uneasiness triggered by a threatening situation). These feelings are either unusually intense, or out of proportion to the real troubles and dangers of the person’s everyday life.

There is no clear dividing line between normal worry and generalized anxiety disorder. People with the disorder typically experience excessive, persistent worry every day or almost every day, for a period of six months or more. In some cases, a person with generalized anxiety disorder finds it hard to remember a time when he or she was not always worrying. This is especially true for adults whose illness started during childhood or adolescence. In other cases, the initial 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 feeing of anxiety persists, sometimes for years.

In addition to suffering from nagging worries and anxieties, people with generalized anxiety disorder have a variety of physical and psychological symptoms that are related to their anxious feelings. The physical symptoms are so noticeable most people with generalized anxiety disorder first seek treatment with a primary-care doctor, cardiologist, pulmonary specialist or gastroenterologist. Stress also can intensify the anxiety or lead to a situation-specific phobia, such as fear of being near dogs, driving a car or attending a party. People with generalized anxiety disorder may have low self-esteem or may feel insecure, because they interpret people’s intentions or events in negative, intimidating or critical ways.

Although the exact cause of generalized anxiety disorder remains a mystery, several studies involving close relatives of people with the illness show that there may be a genetic (inherited) tendency toward developing the problem. Doctors believe the disorder involves a disturbance in levels of certain chemicals that carry signals between brain cells. These chemicals are called neurotransmitters. Generalized anxiety disorder seems to involve the neurotransmitters gamma aminobutyric acid and serotonin. This disturbance in brain chemicals may be especially severe in certain areas of the brain:

• The limbic system, which deals with anxiety and other emotional states
• The basal ganglia, which filter messages involving the performance of body movements
• The frontal cortex, which is involved in judgment and planning

About 3 percent to 8 percent 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, usually for physical symptoms, 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, teen-agers 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 percent and 90 percent of people with the disorder also have at least one other mental illness, usually panic disorder, a phobia, depression, dysthymia (a less severe form of depression), alcoholism or some other form of substance abuse.

Generalized anxiety disorder causes persistent worry or anxiety that lasts for at least six months. This worry or anxiety is excessive, troubling and hard to control, and it often interferes with a person’s ability to function at home, at work or in social situations.

Generalized anxiety disorder also causes at least three of the following symptoms:

• Feeling restless, keyed up or edgy
• 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. These symptoms can include:

• Chest pains, palpitations, abnormally rapid pulse, abnormally rapid breathing, shortness of breath, a smothering sensation
• Abdominal pains, abdominal gas, indigestion, nausea, diarrhea, constipation, frequent urination
• Abnormal or irregular menstrual bleeding
• Problems in sexual function
• Tingling in the arms and legs, chills, sweating, hot flashes, itching skin

Like many people with generalized anxiety disorder, you may consult a nonpsychiatric doctor because you think your physical symptoms are signs 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 cause side effects that can seem like the symptoms of generalized anxiety disorder. 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 suffered from 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

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.

By definition, symptoms of generalized anxiety disorder last for at least six months. If untreated, the condition can be long lasting, with symptoms occurring over many years. During this time, the person may make many fruitless visits to a doctor, or to several different doctors, in the hope of finding effective medical treatment for his or her anxiety-related symptoms.

There is no way to prevent generalized anxiety disorder. However, if you have already been diagnosed, you may be able to decrease your anxiety level by cutting down on caffeine, alcohol or other substances that might be triggering your symptoms.

If you have generalized anxiety disorder, your doctor probably will treat you with a combination of medications and psychotherapy.

Three classes of medications typically are prescribed to treat generalized anxiety disorder:

• Benzodiazepines — Examples are clonazepam (Klonopin), lorazepam (Ativan), diazepam (Valium) and alprazolam (Xanax). They are very safe, and often bring quick relief from the symptoms of anxiety. They may be used only during the first weeks of treatment while waiting for other medications, such as antidepressants, to start working. In some people, the medication eventually stops working because the body becomes accustomed to it. This is called tolerance. If you need to stop taking these drugs, it needs to be done gradually under a doctor’s direction, because withdrawal reactions can occur.
• Antidepressants — These are the main treatment, especially when anxiety is long lasting or when of the person also has depression. The drugs used to treat generalized anxiety disorder include the popular selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), sertraline (Zoloft) and paroxetine (Paxil), and the tricyclic antidepressants, such as nortriptyline (Aventyl, Pamelor) and imipramine (Tofranil). They take several weeks to work, so a benzodiazepine often is prescribed to give relief during that time.
• Buspirone (BuSpar) — Buspirone is an antianxiety drug that can be effective for generalized anxiety disorder. However, it is used much less frequently than the drugs listed above. Like antidepressants, it usually takes two to three weeks to begin working.

Psychotherapy

A number of psychotherapy techniques may be helpful depending on several factors, including the events that may have contributed to the problem, the availability of family and other social support, and personal preference. It is important to get education about anxiety and what support is available. Cognitive behavioral therapy is designed to help you recognize the unreasonableness of fearful thinking and teach you techniques for controlling your symptoms. Psychodynamic, insight-oriented or interpersonal psychotherapy can help a person to sort out conflicts in important relationships or explore the history behind the symptoms.

Two specialized approaches for the treatment of anxiety are:

• Applied relaxation — This method teaches people with generalized anxiety disorder to control their symptoms by using imagination and muscle control. Relaxation techniques, such as diaphragmatic breathing, meditation and visualization, can relieve some of the more bothersome physical symptoms.
• Biofeedback — This form of therapy uses special sensors to teach people with generalized anxiety disorder to recognize anxiety-related changes in their physiological functions, such as pulse, skin temperature and muscle tone. With time and practice, they learn to modify these anxiety-related changes, and to control the effect of anxiety on the entire body.

See your doctor if you are troubled by severe worry or anxiety, especially if:

• Your anxious feelings have lasted for several months.
• You feel that you can no longer control your anxious feelings, and this makes you feel helpless or frightened.
• Your constant anxiety is interfering with your personal relationships or with your ability to function normally at home, at school or at work.
• You are having difficulty concentrating or remembering.
• You are having trouble sleeping.
• You have unexplained physical symptoms that may be anxiety-related.

In general, the prognosis is good. With appropriate treatment, about 50 percent of patients improve within three weeks of starting treatment, and 77 percent improve within nine months.

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.