Most, if not all, people worry or experience mild anxiety throughout their lives. Adolescents and students of all ages worry or get nervous about homework deadlines, studying for exams, pending grades, or getting into the right college. Young adults worry from time to time about snagging a job or promotion, having enough money to make rent or buy their first house, and dating or marriage. As adults enter middle age, they still may worry about finances, work, and family, just in a different context. Additionally, adults in middle age may develop new worries or anxiety about health concerns or preparing for retirement.
Some people are anxious only in specific situations. For example, a person with a type of social phobia may develop anxiety during large gatherings or parties. Others may experience anxiety during thunderstorms or severe weather. Maybe you get anxious about speaking in front of a crowd or have a fear of flying in an airplane.
Occasional worry or nervousness about specific situations or life events is completely normal. However, when worry or anxiety becomes excessive, or your constant worry interferes with your daily life, you may have a mental health condition known as generalized anxiety disorder, or GAD.
What is GAD?
Generalized anxiety disorder is much different from normal, day-to-day, or situational worry or concern or a phobia of specific things or events. People with GAD are in a constant state of exaggerated and often unfounded worry. They can’t shake feelings of dread or impending doom, even when there is nothing going on in their lives to justify those emotions.
For example, someone with typical anxiety levels may hear a news broadcast about unemployment rates or the economy and simply file away that information in their minds. People with GAD, however, will immediately begin to worry about being laid off from their job or losing all of their investments. This level of excessive worry is difficult to decrease, and permeates many aspects of their lives. It can impair their ability to function at work or school, or interact normally with friends and family members.
According to the Anxiety and Depression Association of America (ADAA), more than 6.8 million American adults, or 3.1% of the general population, suffer from generalized anxiety disorder in any given year. Women are twice as likely to suffer from GAD, and the disorder is most often developed between childhood and middle age, although it can begin at any life stage. There is no exact cause or trigger for developing GAD, although the ADAA reports that genetics, brain chemistry, stressful life experiences, and biological factors may play a role.
Signs and Symptoms of GAD
Although GAD is a mental health condition, it presents behavioral and physical symptoms as well as emotional ones. People with GAD find it difficult to relax or enjoy quiet time by themselves. They have trouble concentrating, and often put things off because they feel overwhelmed. They will also avoid any situation which might make them feel anxious.
In addition to these behaviors, GAD may cause physical ailments like muscle tension or tightness, body aches, headaches, or stomach problems like nausea or diarrhea. Constant, unending worry or fretting may lead to insomnia. GAD sufferers also may feel edgy, restless, or jumpy and may tremble, twitch, or be easily startled.
Emotionally, the excessive anxiety associated with this psychiatric disorder seems uncontrollable, and despite their best efforts, they can’t stop worrying. People with GAD simply have difficulty tolerating even the most insignificant uncertainty; everything from not knowing where they’re eating lunch to whether their as-of-yet-unborn grandchildren will go to college is a source of constant worry. It’s hard for them to shake a feeling of dread or apprehension, and their anxious thoughts intrude on many aspects of their daily life, even when they try to avoid them.
The fifth edition of the Diagnostic Statistical Manual of Mental Disorders (DSM-5) recommends a medical diagnosis of GAD in an adult when the following symptoms are present:
- Excessive anxiety or worry occurs more days than not for at least six months about a number of events or activities
- Difficulty controlling the worry
- Experiencing three of these six symptoms: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, or sleep disturbance
- The symptoms cause significant distress or impairment in daily functioning
- The symptoms aren’t attributable to a substance use disorder or medical condition (like hyperthyroidism) or better explained by another disorder like panic disorder, obsessive-compulsive disorder (OCD), or social anxiety disorder
Only a primary care physician, psychologist, psychiatrist, or other mental health professional can make a diagnosis of generalized anxiety disorder. A physical exam can rule out other potential medical conditions causing these symptoms. However, once diagnosed, GAD can be treated with medication, psychotherapy like cognitive behavioral therapy (CBT), or a combination of both. These treatments have been found to improve the function of neurotransmitters in the brain, creating and improving pathways that connect particular brain regions and improving symptoms related to anxiety.
Medications can be especially helpful for patients whose anxiety interferes with daily functioning. Anti-anxiety drugs known as benzodiazepines are often prescribed for short-term treatment of anxiety. Benzodiazepines decrease physical symptoms of anxiety and have a sedative effect. However, long-term use of benzodiazepines or using them in combination with drugs or alcohol is not recommended. Common benzodiazepines are alprazolam and lorazepam.
Physicians and psychologists may prescribe antidepressants to treat anxiety symptoms for a longer period of time. Some of the most common antidepressants are known as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). SSRIs and SNRIs may take a few weeks to take effect, but can be quite effective. Common SNRIs include venlafaxine (Effexor) and duloxetine (Cymbalta); escitalopram (Lexapro) and paroxetine (Paxil) are commonly prescribed SSRIs. These medications may cause side effects like nausea, insomnia, or headaches, but for most people these are mild.
If you can’t take SSRIs and SNRIs, or if they don’t produce the desired effects, you may be prescribed buspirone, which achieves maximum effect in four to six weeks. Unlike benzodiazepines, buspirone does not pose risks of dependence, substance abuse or withdrawal symptoms.
Therapy, especially cognitive behavioral therapy (CBT), is a long-term solution to manage GAD and a wide range of other psychiatric disorders. During CBT treatment, your therapist will help you to develop different behaviors, thoughts, and reactions to situations so you will feel less anxious or worried. CBT helps you to look at your worries in a more realistic way so situations or potential outcomes don’t become overblown in your mind.
In addition to medication and therapy, there are lots of ways you can contribute to your own treatment for generalized anxiety disorder. Relaxation, for example, can help you control or lessen your symptoms. Practicing relaxation techniques like meditation, deep breathing, or yoga can ease physical symptoms like muscle tension as well as help you clear and focus your mind on positives rather than negatives. Relaxation also helps to manage stress, which often triggers anxiety.
Overall physical wellness also helps relieve symptoms of GAD and perhaps even prevents its development. Physicians recommend regular exercise, a healthy diet with plenty of fruits and vegetables, and avoidance of nicotine, alcohol, and caffeine as ways to decrease your risk for GAD or other anxiety disorders.
Support from others is key to overcoming GAD. Living in isolation can exacerbate symptoms of GAD, but spending quality time with friends and family members who care about you can help to calm your nerves and reduce anxiety. When you trust your support network enough to share your concerns with them, your worries may seem less threatening.
Knowing who not to call or visit when you’re in an especially anxious mindset is just as important as knowing who you should reach out to. You should be aware of and avoid certain people who tend to make you feel worse when you’re worrying or having an anxiety or panic attack. Even though this may even be someone you love, like a parent or spouse, they may not be the right person to calm you down in this particular situation.
If you can’t reach out to a trusted friend or loved one when you’re feeling overwhelmed or anxious, you can refocus your mind and attention using your physical senses. For example, light a candle or step outside for a few deep breaths of fresh, clean air. Turn on soothing, meditative music or a favorite tune that evokes great memories. Wrap yourself in a soft, warm blanket or cuddle up with a stuffed animal or pet. Try to look at and focus your attention on things that make you happy or smile, like a family photo or even cat videos on the internet.
Some GAD sufferers have found relief in making lists of daily goals they need to accomplish, and checking off each item as it’s completed to keep their mind satisfied. Many people whose worry tends to focus on financial well-being can overcome concerns by actually addressing their financial situation by working with a financial planner to ensure they have adequate savings or retirement funds.
Putting Your Worry Into Perspective
Worry only becomes a psychiatric disorder when it becomes obsessive, intrusive, and uncontrollable. Otherwise, worrying is a normal part of everyday life. But even though it’s normal, it’s most often unproductive.
There will always be uncertainties in your life and situations of which you have no control. You may think that trying to predict worst-case scenarios will help you be prepared when these events may eventually arrive. However, most of the time worrying about these unknowns doesn’t result in a real plan for dealing with or preventing them. You just spiral deeper and deeper into the world of “what-ifs.” Worry will not reduce the chances of bad things happening to you or your loved ones. Plus, since your worry doesn’t usually result in a concrete plan to deal with potential events, your worry is completely unproductive.
Worry is self-generated. You may attempt to justify your anxiety by blaming external factors like other people or outside events when in fact, your anxiety stems from the way you’re personally reacting to these situations. With proper treatment, you can learn to control your response to stimuli like an off-hand comment by a coworker or an unanswered phone call to a friend. You’ll learn that avoiding situations because the outcomes may be unknown, like travel, new relationships, or a job promotion, is unfounded. In short, treating your GAD with self-help approaches, therapy, and perhaps medication will help you discover and enjoy a wide, new range of experiences and emotions while also avoiding the long-term effects of chronic stress.
If you think you may be experiencing the symptoms of generalized anxiety disorder, your first step is to visit your primary care physician for a physical exam to rule out any medical conditions. If your physician suspects you may have GAD, you’ll want to find a therapist.
Finding the right therapist to treat your symptoms of GAD involves more than just picking someone whose practice is located close to your home or work and who has appointments available when you are. For the most effective treatment, you’ll want a therapist with whom you’re compatible and comfortable. That specific, personal criteria varies from patient to patient. You may prefer to work with a therapist of a certain gender, race, ethnicity, or sexual orientation. You might look for one with a certain education, number of years of experience, or specialty in or track record of treating anxiety disorders.
Therapist directories can be overwhelming, especially in a large metropolitan area like New York City. That’s why we created With Therapy. Our innovative platform matches you with a therapist in New York City or the surrounding areas who fits your particular preferences in addition to your schedule and geographic needs.
If you’re ready to address your generalized anxiety disorder symptoms or just talk to someone for further information, visit With Therapy and start a healthy, productive relationship with one of the best therapists in New York City today.