Generalized Anxiety Disorder

What is Generalized Anxiety Disorder (GAD)?

GAD is characterized by chronic and persistent worry and anxiety related to a number of life domains (work, family, health, etc.).  Individuals with GAD often describe themselves as lifelong worriers, and their tendency to worry is often so pronounced and persistent it is often and readily recognized by others as extreme or exaggerated.  They may find themselves deeply bothered by uncertainty and are apprehensive about an wide range of possible negative outcomes and potential problems.  Although individuals with GAD may recognize their worries are irrational and disproportionate to actual risks they may face, they often find it difficult to control or stop worrying, and consequently may frequently experience feeling “on edge” and have difficulty relaxing or letting go.

How do clinicians define the diagnosis of GAD?

The diagnostic criteria for GAD as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), are as follows:

  1. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).
  2. The individual finds it difficult to control the worry.
  3. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):
  4. Restlessness or feeling keyed up or on edge.
  5. Being easily fatigued.
  6. Difficulty concentrating or mind going blank.
  7. Irritability.
  8. Muscle tension.
  9. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).
  10. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Are their characteristics associated with the development of GAD?

While there are many causal influences that may lead to the development of persistent and chronic worry, research has shown there are a few individual characteristics associated with GAD.  Among others, these include a history of childhood adversity, including trauma (e.g., physical or sexual abuse, loss of a loved one, etc.), and certain personality styles characterized by high levels of emotional instability (frequent anxiety, fear, moodiness, etc.), as well as timid behavior, avoidance, and wariness of new situations, places, or people, etc.  As is the case with all forms of anxiety, frequent use of safety behaviors (defined as unnecessary protective actions to avoid perceived threats) also play a prominent role in the development of GAD.  Individuals with GAD often use counterproductive strategies to attempt to avoid negative outcomes.  For instance, excessive planning and mental rehearsal of possible adverse outcomes, and general avoidance of feared situations may lead to short-term reductions in distress but serve to amplify and maintain distress in the long run.

How common is GAD in the general population?

Some studies estimate that around 6% of the population has experienced generalized anxiety disorder at some point during their lives. GAD seems to be more prevalent in women than men, with twice as many women being diagnosed than men.

Can GAD be effectively treated?

Across studies, there is strong evidence for the effectiveness of cognitive-behavioral therapies for the treatment of GAD in both adults and children.  Selective-serotonin re-uptake inhibitors (SSRIs) have also been demonstrated to be effective, and are considered the first-line among medication treatments for GAD.

Links to additional GAD-related information.

Information on Generalized Anxiety Disorder (GAD) from the Anxiety and Depression Association of America (ADAA).

Information on GAD from the Association of Behavioral and Cognitive Therapy (ABCT).