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Generalized anxiety disorderBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/generalized-anxiety-disorder/DS00502
It's normal to feel anxious from time to time, especially if your life is stressful. However, severe, ongoing anxiety that interferes with day-to-day activities may be a sign of generalized anxiety disorder.
It's possible to develop generalized anxiety disorder as a child or as an adult. Generalized anxiety disorder has similar symptoms as panic disorder, obsessive-compulsive disorder and other types of anxiety, but they're all different conditions.
Living with generalized anxiety disorder can be a long-term challenge. In many cases, it occurs along with other anxiety or mood disorders. In most cases, generalized anxiety disorder improves with medications or psychological counseling (psychotherapy). Making lifestyle changes, learning coping skills and using relaxation techniques also can help.
Generalized anxiety disorder symptoms can vary. They can include:
- Constant worrying or obsession about small or large concerns
- Restlessness and feeling keyed up or on edge
- Difficulty concentrating or your mind "going blank"
- Muscle tension or muscle aches
- Trembling, feeling twitchy or being easily startled
- Trouble sleeping
- Sweating, nausea or diarrhea
- Shortness of breath or rapid heartbeat
There may be times when your worries don't completely consume you, but you still feel anxious even when there's no apparent reason. 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.
Symptoms in children and adolescents
In addition to the symptoms above, children and adolescents may have excessive worries about:
- Performance at school or sporting events
- Being on time (punctuality)
- Earthquakes, nuclear war or other catastrophic events
A child with the disorder may also:
- Feel overly anxious to fit in
- Be a perfectionist
- Lack confidence
- Redo tasks because they aren't perfect the first time
- Strive for approval
- Require a lot of reassurance about performance
When to see a doctor
Some anxiety is normal, but see your doctor if:
- You feel like you're worrying too much, and it's interfering with your work, relationships or other parts of your life
- You feel depressed, have trouble with drinking or drugs, or you have other mental health concerns along with anxiety
- You have suicidal thoughts or behaviors — seek emergency treatment immediately
Your worries are unlikely to simply go away on their own, and they may actually get worse over time. Try to seek professional help before your anxiety becomes severe — it may be easier to treat early on.
As with many mental health conditions, what causes generalized anxiety disorder isn't fully understood. It may involve naturally occurring brain chemicals (neurotransmitters), such as serotonin, dopamine and norepinephrine. It's likely that the condition has several causes that may include genetics, your life experiences and stress.
Some physical health conditions are associated with anxiety. Examples include:
- Gastroesophageal reflux disease (GERD)
- Heart disease
- Hypothyroidism or hyperthyroidism
Things that may increase your risk of developing generalized anxiety disorder include:
- Being female. More than twice as many women as men are diagnosed with generalized anxiety disorder.
- Childhood trauma. Children who endured abuse or trauma, including witnessing traumatic events, are at higher risk of developing generalized anxiety disorder at some point in life.
- Illness. Having a chronic health condition or serious illness, such as cancer, can lead to constant worry about the future, your treatment and your finances.
- Stress. A big event or a number of smaller stressful life situations may trigger excessive anxiety.
- Personality. People with some personality types are more prone to anxiety disorders than are others. In addition, some personality disorders, such as borderline personality disorder, also may be linked to generalized anxiety disorder.
- Genetics. Generalized anxiety disorder may run in families.
- Substance abuse. Drug or alcohol abuse can worsen generalized anxiety disorder. Caffeine and nicotine also may increase anxiety.
Generalized anxiety disorder does more than just make you worry. It can also lead to, or worsen, other mental and physical health conditions, including:
- Substance abuse
- Trouble sleeping (insomnia)
- Digestive or bowel problems
- Teeth grinding (bruxism)
- Substance use disorders
Preparing for your appointment
You may start by seeing your family doctor. However, you may need to see a psychiatrist or psychologist if you have severe anxiety or if you also have another mental health condition, such as depression. A psychiatrist is a medical doctor who specializes in diagnosing and treating mental health conditions. A psychologist and certain other mental health providers can diagnose mental health conditions and provide counseling (psychotherapy).
Because there's often a lot of ground to cover during an initial appointment, it's a good idea to be well prepared. Here's some information to help you get ready, and know what to expect from your doctor or mental health provider.
What you can do
To be prepared for your visit, it can be helpful to think about a few things ahead of time and write down some notes to take with you. Things to write down include:
- A list of your symptoms. Include when they occur and whether anything seems to make them better or worse. Also note how much they affect your day-to-day activities, such as work, school or relationships.
- What's causing you stress. Include any major life changes or stressful events you've dealt with recently. Also write down any traumatic experiences you've had in the past.
- Any health problems you have. Include both physical conditions and mental health issues.
- A list of all medications you're taking. Be sure to write down the doses, and include any vitamins or supplements you take.
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. Some basic questions to ask your doctor include:
- What's the most likely cause of my symptoms?
- Are there other possible situations, psychological issues or physical health problems that could be causing or worsening my anxiety?
- Do I need medical tests or other tests?
- Are there any restrictions or steps I need to follow?
- Should I see a psychiatrist, psychologist or other mental health provider?
- Would medication help? If so, is there a generic alternative to the medicine you're prescribing?
- Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.
What to expect from your doctor
Your doctor will do a physical examination and ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Some questions the doctor may ask include:
- Exactly what are your symptoms, and how severe are they?
- Have your feelings of anxiety been occasional or continuous?
- When did you first begin noticing your feelings of anxiety?
- Does anything in particular seem to trigger your feelings of anxiety or make them worse?
- What, if anything, seems to improve your feelings of anxiety?
- What, if any, physical or mental health conditions do you have?
- What traumatic experiences have you had recently or in the past?
- Do you regularly drink alcohol or use recreational drugs?
- Do you have any blood relatives with anxiety or other mental health conditions such as depression?
Tests and diagnosis
Your mental health provider will take a number of steps to help diagnose generalized anxiety disorder. He or she may start by asking detailed questions about your symptoms and medical history. In some cases, mental health providers use psychological questionnaires to help identify what's going on. Your doctor may also do a physical examination to look for signs that your anxiety might be linked to an underlying medical condition.
To be diagnosed with generalized anxiety disorder, you 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.
The following criteria must be met for a diagnosis of generalized anxiety disorder:
- Excessive anxiety and worry about several events or activities most days of the week, for at least six months
- Difficulty controlling your feelings of worry
- Anxiety or worry that causes you significant distress or interferes with your daily life
- Anxiety that isn't related to another mental health condition, such as panic attacks, substance abuse or post-traumatic stress disorder (PTSD)
- At least three of the following symptoms in adults and one of the following in children: restlessness, fatigue, trouble concentrating, irritability, muscle tension or sleep problems
Generalized anxiety disorder often occurs along with other mental health problems, which can make diagnosis and treatment more challenging. Some disorders that commonly occur with generalized anxiety disorder include:
- Panic disorder
- Substance abuse
- Post-traumatic stress disorder
If your doctor suspects your anxiety may have a medical cause, he or she may order blood or urine tests or other tests to look for signs of a physical problem.
Treatments and drugs
The two main treatments for generalized anxiety disorder are medications and psychotherapy. You may even benefit more from a combination of the two. It may take some trial and error to discover exactly what treatments work best for you.
Several different types of medications are used to treat generalized anxiety disorder:
- Antidepressants. These medications influence the activity of brain chemicals (neurotransmitters) thought to play a role in anxiety disorders. Examples of antidepressants used to treat generalized anxiety disorder include Paroxetine (Paxil), sertraline (Zoloft) and venlafaxine (Effexor).
- Buspirone. This anti-anxiety medication may be used on an ongoing basis. As with most antidepressants, it typically takes up to several weeks to become fully effective. A common side effect of buspirone is a feeling of lightheadedness shortly after taking it. Less common side effects include headaches, nausea, nervousness and insomnia.
- Benzodiazepines. In limited circumstances your doctor may prescribe one of these sedatives for short-term relief of anxiety symptoms. Examples include lorazepam (Ativan), diazepam (Valium), chlordiazepoxide (Librium) and alprazolam (Xanax). Benzodiazepines are generally only used for relieving acute anxiety on a short-term basis. They can be habit forming and can cause a number of side effects, including drowsiness, reduced muscle coordination, and problems with balance and memory.
In some cases, medications not specifically approved for generalized anxiety disorder may be tried. Off-label use is a common and legal practice of using a medication to treat a condition not specifically listed on its prescribing label as an FDA-approved use.
Also known as talk therapy and psychological counseling, psychotherapy involves working out underlying life stresses and concerns and making behavior changes. It can be a very effective treatment for anxiety.
Cognitive behavioral therapy is one of the most common types of psychotherapy for generalized anxiety disorder. Generally a short-term treatment, cognitive behavioral therapy focuses on teaching you specific skills to identify negative thoughts and behaviors and replace them with positive ones. Even if an undesirable situation doesn't change, you can reduce stress and gain more control over your life by changing the way you respond.
Lifestyle and home remedies
While most people with generalized anxiety disorder need psychotherapy or medications to get anxiety under control, lifestyle changes also can make a difference. Here are a few things that you can do:
- Get daily exercise. Exercise is a powerful stress reducer, can improve your mood and can keep you healthy. It's best if you develop a regular routine and work out most days of the week. Start out slow and gradually increase the amount and intensity of exercise.
- Eat a healthy diet. Avoid fatty, sugary and processed foods. Include foods in your diet that are rich in omega-3 fatty acids and B vitamins.
- Avoid alcohol and other sedatives. These can worsen anxiety.
- Use relaxation techniques. Visualization techniques, meditation and yoga are examples of relaxation techniques that can ease anxiety.
- Make sleep a priority. Do what you can to make sure you're getting enough quality sleep. If you aren't sleeping well, see your doctor.
Certain supplements may help relieve anxiety, although it isn't clear how much they help or what possible side effects they might have. Some supplements used to treat anxiety include:
- Kava. This herb is reported to relax you without making you feel sedated. Some studies have linked kava to liver problems, so it isn't a good idea to take it if you have a liver condition, drink alcohol daily or take medications that affect your liver.
- Valerian. Most commonly used as a sleep aid, valerian has a sedative effect and may also relieve anxiety.
- Vitamin B and folic acid. These nutrients may relieve anxiety by affecting the production of chemicals needed for your brain to function (neurotransmitters).
Talk to your doctor before taking herbal remedies or supplements to make sure they're safe for you and won't interact with any medications you take.
Coping and support
To cope with generalized anxiety disorder, here are some things you can do:
- Join an anxiety support group. Here, you can find compassion, understanding and shared experiences. You may find support groups in your community, and there are also several available on the Internet.
- Take 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.
- Let it go. Don't dwell on past concerns. Change what you can and let the rest take its course.
- Break the cycle. When you feel anxious, take a brisk walk or delve into a hobby to refocus your mind away from your worries.
- Stick to your treatment plan. Take medications as directed. Keep therapy appointments. Consistency can make a big difference, especially when it comes to taking your medication.
- Socialize. Don't let worries isolate you from loved ones or enjoyable activities. Social interaction and caring relationships can lessen your worries.
There's no way to predict for certain what will cause someone to develop generalized anxiety disorder in the first place, but you can take steps to reduce the impact of symptoms if you're anxious:
- Get help early. Anxiety, like many other mental health conditions, can be harder to treat if you wait.
- Keep a journal. Keeping track of your personal life can help you and your mental health provider identify what's causing you stress and what seems to help you feel better.
- Prioritize your life. You can reduce anxiety by carefully managing your time and energy.
- Avoid unhealthy substance use. Alcohol and drug use and even caffeine or nicotine use can cause or worsen anxiety. If you're addicted to any of these substances, quitting can make you anxious. If you can't quit on your own, see your doctor or find a support group to help you.
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