Worry that does not switch off
Everyone worries. A layoff rumor, a biopsy result or a teenager who is late getting home can keep anyone up at night. The National Institute of Mental Health (NIMH) describes generalized anxiety disorder as something different: worry that comes more often or more intensely than the situation calls for, that keeps returning even when nothing is wrong, and that can last for months or years.
People with GAD often say the content of the worry hardly matters. When one concern is settled, another takes its place. MedlinePlus puts it this way: worries often seem to float from one problem to another, moving among family, relationships, work, money and health. Many people know their worry is out of proportion and still cannot set it down. That gap between knowing and stopping is one of the most frustrating parts of the condition.
GAD is also more common than many people assume. NIMH estimates that 2.7% of U.S. adults had generalized anxiety disorder in the past year, and 5.7% will have it at some point in their lives. It usually develops gradually and often starts in early adulthood, although it can begin at any age, and NIMH notes that it is more common in women.
What GAD can look like day to day
NIMH lists the everyday topics adults with GAD tend to worry about: job security or performance, health, finances, the well-being of children or other family members, being late, and keeping up with chores and responsibilities. In practice it often sounds like this:
- Rehearsing a routine conversation with your manager on the drive in, then replaying it on the way home
- Checking the bank balance several times a day although nothing has changed
- Picturing an accident every time your partner drives on I-75 or I-696 in bad weather
- Leaving for appointments far too early because being late feels unbearable
- Lying awake making lists, then feeling tired and on edge the next day
The body is involved too. NIMH lists headaches, muscle aches, stomachaches, trembling, sweating, lightheadedness, feeling out of breath, trouble swallowing and frequent trips to the bathroom. Many people first describe GAD to a doctor as tension, poor sleep or a stomach that is always unsettled. Physical Symptoms of Anxiety explains why worry shows up in the body this way.
Symptoms often rise and fall. NIMH notes they are often worse during stressful periods, such as a physical illness or a family or relationship conflict, so a hard season can make long-standing worry suddenly feel louder.
How GAD is diagnosed
There is no blood test or scan for GAD. MedlinePlus explains that diagnosis is based on your answers to questions about your symptoms, along with questions about your mental and physical health. NIMH describes the core criteria: finding it difficult to control worry on most days for at least six months, along with at least three of these symptoms:
- Feeling restless or on edge
- Tiring easily
- Trouble concentrating
- Irritability
- Muscle tension
- Problems with sleep
The list is there to show what a clinician looks for, not to score yourself. A provider will also ask when the worry started, how often it happens and what it is costing you. Because some medical problems and medications can mimic anxiety, NIMH notes that a physical exam may be part of the process. A visit with your primary care physician is a sensible early step if you have not had one recently.
What causes it
No single cause has been found. NIMH explains that GAD may run in families and appears to come from a mix of genetics, brain chemistry, biology and environment. Traumatic events and long periods in a stressful environment may raise the risk. In therapy, people often recognize patterns that started early, such as growing up in a household where someone was always bracing for bad news, or learning that staying vigilant was the way to stay safe.
GAD rarely travels alone
NIMH notes that many people with GAD also have depression, another anxiety disorder, post-traumatic stress, chronic pain or heart problems, and that GAD is commonly linked with alcohol and substance misuse. The NHS also says it is common to have more than one anxiety disorder at a time, such as GAD alongside panic disorder or a phobia. If low mood has crept in alongside the worry, Can Anxiety and Depression Happen at the Same Time? looks at how the two feed each other.
What helps
NIMH describes psychotherapy, medication, or both as the usual treatment, chosen around a person's needs, preferences and medical situation. It also notes that psychotherapy can be effective in person or by telehealth. Cognitive behavioral therapy is the most studied approach for GAD, and NIMH also describes acceptance and commitment therapy. Different therapies suit different people, so it is reasonable to ask any therapist how they work and what training they have.
Medication decisions belong with a physician, psychiatrist or psychiatric nurse practitioner. If you already take something for anxiety, talk with your prescriber before changing anything.
Daily habits do not replace treatment, but they can make it work better. NIMH and MedlinePlus point to a few that matter:
- Cutting back on caffeine, including energy drinks and afternoon coffee
- Protecting sleep with a regular bedtime
- Regular exercise, even a daily walk
- Keeping a steady schedule and getting out of the house every day
- Avoiding street drugs and large amounts of alcohol, which can feel calming at first and make anxiety worse later
The NHS adds one that runs against instinct: try not to avoid situations that make you anxious, and build up time in them gradually instead.
Bringing it to a first appointment
It helps to write a few notes beforehand: what you worry about most, roughly when the pattern began, how it affects sleep and work, what you have already tried, and how much caffeine and alcohol you use. NIMH advises seeking professional help once anxiety starts to cause problems at work, at home or with friends and family.
In anxiety therapy with Dr. Lehmann, a licensed clinical psychologist in Franklin, the work usually combines practical ways to manage worry in the moment with an insight-oriented look at where the pattern came from and what keeps it going. Sessions are available in person in Oakland County or by telehealth for adults located in Michigan.