Anxiety disorder

Definition

Generalized anxiety disorder (GAD) is behavior marked by a pattern of frequent, persistent worry and anxiety over many different activities and events.

Alternative Names

Causes

Generalized anxiety disorder (GAD) is a common condition. It is characterized by excessive anxiety and worry, which is out of proportion to the impact of the event or circumstance that is the focus of the worry.

For example, while college students often worry about tests, a student who constantly worries about failure -- despite getting consistently good grades -- has the pattern of worry typical of this disorder.

The person finds it difficult to control the worry. The cause of GAD is not known, but biological and psychological factors play a role. Stressful life situations or maladaptive behavior, acquired through learning, may also contribute to GAD.

The disorder may start at any time in life, including childhood. Most patients with the disorder report that they have been anxious for as long as they can remember. GAD occurs somewhat more often in women than in men.

Symptoms

Anxiety and worry are often associated with the following symptoms:

• Restlessness or feeling keyed up or "on the edge"
• Being easily fatigued
• Difficulty concentrating
• Irritability
• Muscle tension -- shakiness, headaches
• Sleep disturbance (difficulty falling or staying asleep; or restless, unsatisfying sleep)
• Excessive sweating, palpitations, shortness of breath, and various gastrointestinal symptoms

Exams and Tests

A physical examination and a psychological evaluation should be completed in order to rule out other causes of anxiety. Physical disorders that may mimic an anxiety state should be ruled out, as well as drug-induced symptoms. Various diagnostic tests may be done in this process.

Treatment

Treatment may involve specific medications that provide a sedative (sleep-inducing) or calming effect. Several antidepressant medicines are approved for generalized anxiety disorder.

Other drugs such as antihistamines, which have the favorable side effect of reducing anxiety, may be used. Benzodiazepines, a common class of anti-anxiety medications, are used with caution because they can cause judgment problems and can be addictive.

Two types of therapy are used to treat GAD:

• Relaxation training -- a systematic relaxation of the major muscle groups in the body
• Cognitive behavioral therapy -- helps patients identify thoughts that contribute to anxiety

Caffeine and other stimulants that can make anxiety worse should be reduced or eliminated.

Support Groups

Patient support groups may be helpful for some patients suffering from GAD. Patients have the opportunity to learn that they are not unique in experiencing excessive worry and anxiety.

Support groups are not a substitute for effective treatment, but can be a helpful addition to it.

Outlook (Prognosis)

The disorder may be long-standing and difficult to treat, but the majority of patients can expect substantial improvement with medications and/or behavioral therapy.

Possible Complications

People with GAD may eventually develop other psychiatric disorders, such as panic disorder or clinical depression. In addition, substance abuse or dependence may become a problem, usually because the person tries to self-medicate with drugs or alcohol to alleviate their anxiety.

When to Contact a Medical Professional

Call your health-care provider if you are experiencing the signs and symptoms of generalized anxiety disorder, especially if this has been going on for a period of 6 months or longer, or it interferes with your daily functioning.

Moore DP, Jefferson JW. Handbook of Medical Psychiatry. 2nd ed. St. Louis, Mo: Mosby; 2004: 174-175.

Noble J. Textbook of Primary Care Medicine. 3rd ed. St. Louis, Mo: Mosby; 2001:416.