By Mayo Clinic Staff
It's normal to feel anxious from time to time, especially if your life is stressful. However, excessive, ongoing anxiety and worry that interfere 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 an adult. Generalized anxiety disorder has symptoms that are similar to 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 talk therapy (psychotherapy). Making lifestyle changes, learning coping skills and using relaxation techniques also can help.
Generalized anxiety disorder symptoms can vary. They may include:
- Persistent worrying or obsession about small or large concerns that's out of proportion to the impact of the event
- Inability to set aside or let go of a worry
- Inability to relax, restlessness, and feeling keyed up or on edge
- Difficulty concentrating, or the feeling that your mind "goes blank"
- Worrying about excessively worrying
- Distress about making decisions for fear of making the wrong decision
- Carrying every option in a situation all the way out to its possible negative conclusion
- Difficulty handling uncertainty or indecisiveness
Physical signs and symptoms may include:
- Muscle tension or muscle aches
- Trembling, feeling twitchy
- Being easily startled
- Trouble sleeping
- Nausea, diarrhea or irritable bowel syndrome
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.
Your anxiety, worry or physical symptoms cause you significant distress in social, work or other areas of your life. Worries can shift from one concern to another and may change with time and age.
Symptoms in children and teenagers
In addition to the symptoms above, children and teenagers who have generalized anxiety disorder may have excessive worries about:
- Performance at school or sporting events
- Being on time (punctuality)
- Earthquakes, nuclear war or other catastrophic events
A child or teen with generalized anxiety disorder may also:
- Feel overly anxious to fit in
- Be a perfectionist
- Redo tasks because they aren't perfect the first time
- Spend excessive time doing homework
- Lack confidence
- 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, the exact cause of generalized anxiety disorder isn't fully understood, but it may include genetics as well as other risk factors.
These factors may increase the risk of developing generalized anxiety disorder:
- Personality. A person whose temperament is timid or negative or who avoids anything dangerous may be more prone to generalized anxiety disorder than others are.
- Genetics. Generalized anxiety disorder may run in families.
- Being female. Women are diagnosed with generalized anxiety disorder somewhat more often than men are.
Having generalized anxiety disorder does more than just make you worry. It can:
- Impair your ability to perform tasks quickly and efficiently because you have trouble concentrating
- Take your time and focus from other activities
- Sap your energy
- Disturb your sleep
Generalized anxiety disorder can also lead to or worsen other mental and physical health conditions, such as:
- Depression (which often occurs with generalized anxiety disorder)
- Substance abuse
- Trouble sleeping (insomnia)
- Digestive or bowel problems
- Heart-health issues
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.
What you can do
To prepare for your appointment, make a list of:
- Your symptoms, including when they occur, what seems to make them better or worse, and how much they affect your day-to-day activities, such as work, school or relationships
- What's causing you stress, including major life changes or stressful events you've dealt with recently and any traumatic experiences you've had in the past
- Health problems you have, both physical conditions and mental health issues
- All medications you're taking, including any vitamins or other supplements, and the dosages
- Questions to ask your doctor
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 any tests?
- What treatment do you recommend?
- 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 have? What websites do you recommend?
Don't hesitate to ask questions at any time during your appointment.
What to expect from your doctor
Being ready to answer questions from your doctor may reserve time to go over any points you want to spend more time on. Some questions the doctor may ask include:
- What are your symptoms?
- Do your symptoms interfere with your daily activities?
- Have your feelings of anxiety been occasional or continuous?
- When did you first begin noticing your anxiety?
- Does anything in particular seem to trigger your anxiety or make it 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?
To help diagnose generalized anxiety disorder, your health provider may:
- Do a physical exam to look for signs that your anxiety might be linked to an underlying medical condition
- Order blood or urine tests or other tests, if a medical condition is suspected
- Ask detailed questions about your symptoms and medical history
- Use psychological questionnaires to help determine a diagnosis
Many experts use the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, to diagnose mental conditions. This manual is also used by insurance companies to reimburse for treatment.
DSM-5 criteria for generalized anxiety disorder include:
- 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
- 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
- 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 or post-traumatic stress disorder (PTSD), substance abuse, or a medical condition
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
The two main treatments for generalized anxiety disorder are psychotherapy and medications. You may benefit most from a combination of the two. It may take some trial and error to discover which treatments work best for you.
Also known as talk therapy or psychological counseling, psychotherapy involves working with a therapist to reduce your anxiety symptoms. It can be an effective treatment for generalized anxiety disorder.
Cognitive behavioral therapy is one of the most effective forms of psychotherapy for generalized anxiety disorder. Generally a short-term treatment, cognitive behavioral therapy focuses on teaching you specific skills to gradually return to the activities you've avoided because of anxiety. Through this process, your symptoms improve as you build on your initial success.
Several types of medications are used to treat generalized anxiety disorder, including those below. Talk with your doctor about benefits, risks and possible side effects.
- Antidepressants. Antidepressants, including medications in the selective serotonin reuptake inhibitor (SSRI) and serotonin norepinephrine reuptake inhibitor (SNRI) classes, are the first-line medication treatments. Examples of antidepressants used to treat anxiety disorders include escitalopram (Lexapro), duloxetine (Cymbalta), venlafaxine (Effexor XR) and paroxetine (Paxil, Pexeva). Your doctor also may recommend other antidepressants.
- Buspirone. An anti-anxiety medication called buspirone may be used on an ongoing basis. As with most antidepressants, it typically takes up to several weeks to become fully effective.
- Benzodiazepines. In limited circumstances, your doctor may prescribe one of these sedatives for relief of anxiety symptoms. Examples include alprazolam (Niravam, Xanax), chlordiazepoxide (Librium), diazepam (Valium) and lorazepam (Ativan). Benzodiazepines are generally used only for relieving acute anxiety on a short-term basis. Because they can be habit-forming, these medications aren't a good choice if you've had problems with alcohol or drug abuse.
While most people with anxiety disorders need psychotherapy or medications to get anxiety under control, lifestyle changes also can make a difference. Here's what you can do:
- Keep physically active. Develop a routine so that you're physically active most days of the week. Exercise is a powerful stress reducer. It may improve your mood and help you stay healthy. Start out slowly and gradually increase the amount and intensity of your activities.
- Avoid alcohol and other sedatives. These substances can worsen anxiety.
- Quit smoking and cut back or quit drinking coffee. Both nicotine and caffeine 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 sleep to feel rested. If you aren't sleeping well, see your doctor.
- Eat healthy. Healthy eating — such as focusing on vegetables, fruits, whole grains and fish — may be linked to reduced anxiety, but more research is needed.
Some people are interested in trying alternative medicine (a nonconventional approach instead of conventional medicine) or complementary medicine (a nonconventional approach used along with conventional medicine).
Several herbal remedies have been studied as a treatment for anxiety, such as those listed below, but more research is needed to fully understand the risks and benefits. Here's what researchers know — and don't know:
- Kava. Kava appeared to be a promising treatment for anxiety, but reports of serious liver damage — even with short-term use — caused several European countries and Canada to pull it off the market. The Food and Drug Administration has issued warnings but not banned sales in the United States. Avoid using kava until more rigorous safety studies are done, especially if you have liver problems or take medications that affect your liver.
- Valerian. In some studies, people who used valerian reported less anxiety and stress, but in other studies, people reported no benefit. Discuss valerian with your doctor before trying it. While it's generally well-tolerated, there are a few case reports of people developing liver problems when taking preparations containing valerian. If you've been using valerian for a long time and want to stop using it, many authorities recommend that its use be tapered down to prevent withdrawal symptoms.
- Passionflower. A few small clinical trials suggest that passionflower might help with anxiety. In many commercial products, passionflower is combined with other herbs, making it difficult to distinguish the unique qualities of each herb. Passionflower is generally considered safe when taken as directed, but some studies have found it can cause drowsiness, dizziness and confusion.
- Theanine. This amino acid is found in green tea and may be found in some supplements. Preliminary evidence shows that theanine may make some people feel calmer, but there is limited evidence that it helps treat anxiety.
Before taking herbal remedies or supplements, talk to your doctor to make sure they're safe for you and won't interact with any medications you take.
To cope with generalized anxiety disorder, here's what you can do:
- 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.
- Join an anxiety support group. Here, you can find compassion, understanding and shared experiences. You may find support groups in your community or on the Internet.
- Take action. Work with your mental health provider to figure out what's making you anxious and address it.
- 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.
- 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, but you can take steps to reduce the impact of symptoms if you experience anxiety:
- 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 issues in 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 treatment program or support group to help you.
Sept. 25, 2014
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