Generalized anxiety disorder

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Causes

The cause of GAD is unknown. Genes may play a role. Stress may also contribute to the development of GAD.

GAD is a common condition. Anyone can develop this disorder, even children. GAD occurs more often in women than in men.

Definition

Generalized anxiety disorder (GAD) is a mental disorder in which a person is often worried or anxious about many things and finds it hard to control this anxiety.

If you feel anxious all the time for no reason, you should think about talking with your health care provider.The correct answer is true. Excessive worry may be a sign of an anxiety disorder. You may have an anxiety disorder if you can't control your worry about everyday problems such as work, relationships, money, or health. Talk with your doctor, if worry interferes with your job, home life, or activities you enjoy.Anxiety can also cause physical symptoms.The correct answer is true. Along with constant worry, your muscles may feel tense, or you may have headaches and stomach problems such as nausea and diarrhea. Your doctor may do tests to see whether other medical problems could be causing these symptoms.A panic attack can cause:The correct answer is all of the above. Panic attacks are sudden bouts of terror that peak within 20 minutes. They can be so intense that you live in fear of the next one, and you may avoid things you think may trigger another attack. This can cause you to change how you live your life, so it's best to get help soon.A panic attack may seem like a heart attack.The correct answer is true. A panic attack can cause chest pain, a racing heart, and shortness of breath. Many people with this condition first seek treatment in the emergency room, because the panic attack feels like a heart attack.Post-traumatic stress disorder (PTSD) is a type of anxiety disorder.The correct answer is true. Post-traumatic stress disorder is a type of anxiety disorder. It can occur after you've experienced a traumatic event involving injury or death. It can cause repeated nightmares, feelings of detachment, flashbacks, and feeling hyperaware of your surroundings, along with other anxiety symptoms.PTSD only happens to war veterans.The correct answer is false. While it does occur in some vets, PTSD can occur in anyone who has experienced trauma. PTSD changes the body's response to stress. No one knows why some people develop PTSD and others don't. See your doctor right away if you think you have PTSD. Early treatment has the best chance of success.PTSD may occur after:The correct answer is all of the above. Most people will feel some anxiety right after these types of events. With PTSD, symptoms continue for at least 30 days. But don't wait to seek help. Call your doctor right away if you feel out of control, feel like hurting yourself or others, or have other symptoms of PTSD such as those in question 5.Feeling driven to do the same action over and over to relieve anxiety may be a sign of:The correct answer is obsessive-compulsive disorder (OCD). People with OCD have unwanted and repeated thoughts or behaviors. This may include counting constantly or washing your hands over and over. Treatment can help, so tell your doctor if your symptoms interfere with daily life, work, or relationships.Social phobia is just another term for shyness.The correct answer is false. People with social phobia have an intense fear of being judged. They may avoid going to parties, meeting new people, or speaking in public. They can worry for days or weeks about an upcoming event. This fear may interfere with ordinary activities and can make it hard to make and keep friends.Antidepressants can help treat anxiety disorders.The correct answer is true. Antidepressants can help treat many types of anxiety problems. Other medicines also may help. Your doctor can determine which treatment is best for you.Medicine is the only effective treatment for anxiety disorders.The correct answer is false. A type of talk therapy called cognitive-behavioral therapy can help you change thoughts or behaviors that cause anxiety. You may also learn new ways to react to symptoms of anxiety. Support groups may be helpful for some types of anxiety. Exercise, rest, and eating healthy can also help you feel better.

Exams and Tests

There is no test that can make a diagnosis of GAD. The diagnosis is based on your answers to questions about the symptoms of GAD. Your health care provider will ask about these symptoms. You will also be asked about other aspects of your mental and physical health. A physical exam or lab tests may be done to check for other conditions that cause similar symptoms.

Outlook (Prognosis)

How well a person does depends on how severe the condition is. In some cases, GAD is long-term and is difficult to treat. Most people get better with medicine or talk therapy.

Possible Complications

Depression and substance abuse may occur with an anxiety disorder.

References

American Psychiatric Association. Anxiety disorders. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Text Revision (DSM-5-TR). Arlington, VA: American Psychiatric Publishing; 2022:chap 5.

Calkins AW, Bui E, Taylor CT, Pollack MH, LeBeau RT, Simon NM. Anxiety disorders. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 32.

Lyness JM. Psychiatric disorders in medical practice. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 369.

National Institute of Mental Health website. Anxiety disorders. www.nimh.nih.gov/health/topics/anxiety-disorders. Updated April 2023. Accessed June 7, 2023.

Support Groups

You can ease the stress of having GAD by joining a support group. Sharing with others who have common experiences and problems can help you not feel alone. Support groups are usually not a good substitute for talk therapy or taking medicine, but can be a helpful addition.

Symptoms

The main symptom is frequent worry or tension for at least 6 months, even when there is little or no clear cause. Worries often seem to float from one problem to another. Problems may involve family, other relationships, work, school, money, and health.

Even when they are aware that worries or fears are stronger than appropriate for the situation, a person with GAD still has difficulty controlling them.

Other symptoms of GAD include:

  • Problems concentrating
  • Fatigue
  • Irritability
  • Problems falling or staying asleep, or sleep that is restless and unsatisfying
  • Restlessness when awake

The person may also have other physical symptoms. These can include muscle tension, upset stomach, sweating, or difficulty breathing.

Treatment

The goal of treatment is to help you feel better and function well in daily life. Talk therapy or medicine alone can be helpful. Sometimes, a combination of these may work best.

TALK THERAPY

Many types of talk therapy may be helpful for GAD. One common and effective talk therapy is cognitive-behavioral therapy (CBT). CBT can help you understand the relationship between your thoughts, behaviors, and symptoms. Often CBT involves a set number of visits. During CBT you can learn how to:

  • Understand and gain control of distorted views of stressors, such as other people's behavior or life events.
  • Recognize and replace panic-causing thoughts to help you feel more in control.
  • Manage stress and relax when symptoms occur.
  • Avoid thinking that minor problems will develop into terrible ones.

Other types of talk therapy may also be helpful in managing symptoms of an anxiety disorder. Your provider can discuss talk therapy options with you. Then you can decide together if it is right for you.

MEDICINES

Certain medicines, often also used to treat depression, may be very helpful for this disorder. They work by preventing your symptoms or making them less severe. You must take these medicines every day. DO NOT stop taking them without talking with your provider. They include:

  • Selective serotonin reuptake inhibitors (SSRIs), which are most often the first choice of antidepressants
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs), which are another choice

Other medicines such as hydroxyzine or medicines used to treat seizures, like gabapentin, may also be tried. These medicines act more quickly and may be taken as needed rather than regularly.

Medicines called sedatives or hypnotics may also be prescribed.

  • These medicines should only be taken under a provider's direction.
  • Your provider will prescribe a limited amount of these medicines. They should not to be used every day.
  • They may be used when symptoms become very severe or when you are about to be exposed to something that always brings on your symptoms.
  • If you are prescribed a sedative, do not drink alcohol while on this medicine.

SELF-CARE

Other than taking medicine and going to therapy, you can help yourself get better by:

  • Reducing caffeine intake
  • Not using street drugs or large amounts of alcohol
  • Exercising, getting enough rest, and eating healthy foods
  • Keeping a regular schedule and getting out of the house every day

When to Contact a Medical Professional

Contact your provider if you frequently worry or feel anxious, especially if it interferes with your daily activities.

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