Generalized Anxiety Disorder (GAD)

Definition

Generalized anxiety disorder (GAD) is characterized by a pattern of frequent, persistent worry and anxiety about several events or activities during at least a 6-month period.

Alternative Names
GAD

Causes, incidence, and risk factors
Generalized anxiety disorder (GAD) is a common condition. Reasonable estimates for its 1-year prevalence range from 3-8%. The disorder is characterized by excessive anxiety and worry that is out of proportion to the impact of the event or circumstance that is the focus of the worry.

For example, while college students often worry about tests, a student who persistently worries about failure, despite consistently obtaining good grades, displays the pattern of worry typical of this disorder.

The person finds it difficult to control the worry. The cause of GAD is not known, but biological and psychological factors play a role. Stressful life situations or maladaptive behavior, acquired through learning, may also contribute to GAD.

The disorder may start at any time in life, including childhood. Most patients with the disorder report that they have been anxious for as long as they can remember. GAD occurs somewhat more often among women than among men.

Symptoms

Anxiety and worry are often associated with the following symptoms:

     
  • restlessness or feeling keyed up or on the edge  
  • being easily fatigued  
  • difficulty concentrating  
  • irritability  
  • muscle tension - shakiness, headaches  
  • sleep disturbance (difficulty falling or staying asleep; or restless, unsatisfying sleep)  
  • excessive sweating, palpitations, shortness of breath, and various gastrointestinal symptoms

Signs and tests
A physical examination and a psychological evaluation should be completed in order to rule out other causes of anxiety. Physical disorders that may mimic an anxiety state should be ruled out, as well as drug-induced symptoms. Various diagnostic tests may be done in this process.

Treatment
Medications used to treat anxiety disorders include antidepressants and anti-anxiety agents. Treatment may also involve sedative (sleep-inducing) drugs, antihistamines, and/or minor tranquilizers.

These medications act on the central nervous system to reduce the feelings of anxiety and associated symptoms. A common class of anti-anxiety medications, the benzodiazepines, are usually used with caution due to their potential for dependence.

Behavioral therapies, which have been effective with GAD, include relaxation training (a systematic relaxation of the major muscle groups in the body) and cognitive behavioral therapy (treatment that identifies cognitions or thoughts that contribute to anxiety).

Caffeine and other stimulants that can make anxiety worse should be reduced or eliminated.

Support Groups
Patient support groups may be helpful for some patients suffering from GAD. Patients have the opportunity to learn that they are not unique in experiencing excessive worry and anxiety.

Support groups are not a substitute for effective treatment, but are complementary to it.

Expectations (prognosis)
The disorder may be long-standing and difficult to treat. Although many people with this disorder may not be cured with treatment, the majority, if not all, can expect substantial improvement with medications and/or behavioral therapy.

Complications
Persons with GAD may eventually experience other mental disorders, such as panic disorder, major depressive disorder, and/or substance abuse or dependence (sometimes due to self-medication of anxiety symptoms).

Calling your health care provider
Call your health-care provider if you are experiencing the signs and symptoms of generalized anxiety disorder, especially if this has been going on for a period of 6 months or longer, or it interferes with your daily functioning.

Johns Hopkins patient information

Last revised: December 8, 2012
by Armen E. Martirosyan, M.D.

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