Overview
It’s normal to feel anxious from time to time, especially if your life is stressful. However, excessive, ongoing anxiety and worry that are difficult to control and 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 psychotherapy or medications. Making lifestyle changes, learning coping skills and using relaxation techniques also can help.
Generalized anxiety disorder care at Mayo Clinic
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Symptoms
Generalized anxiety disorder symptoms can vary. They may include:
- Persistent worrying or anxiety about a number of areas that are out of proportion to the impact of the events
- Overthinking plans and solutions to all possible worst-case outcomes
- Perceiving situations and events as threatening, even when they aren’t
- Difficulty handling uncertainty
- Indecisiveness and fear of making the wrong decision
- Inability to set aside or let go of a worry
- Inability to relax, feeling restless, and feeling keyed up or on edge
- Difficulty concentrating, or the feeling that your mind “goes blank”
Physical signs and symptoms may include:
- Fatigue
- Trouble sleeping
- Muscle tension or muscle aches
- Trembling, feeling twitchy
- Nervousness or being easily startled
- Sweating
- Nausea, diarrhea or irritable bowel syndrome
- Irritability
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
Children and teenagers may have similar worries to adults, but also may have excessive worries about:
- Performance at school or sporting events
- Family members’ safety
- Being on time (punctuality)
- Earthquakes, nuclear war or other catastrophic events
A child or teen with excessive worry may:
- 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
- Have frequent stomachaches or other physical complaints
- Avoid going to school or avoid social situations
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 or irritable, 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.
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Causes
As with many mental health conditions, the cause of generalized anxiety disorder likely arises from a complex interaction of biological and environmental factors, which may include:
- Differences in brain chemistry and function
- Genetics
- Differences in the way threats are perceived
- Development and personality
Risk factors
Women are diagnosed with generalized anxiety disorder somewhat more often than men are. The following 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.
- Experiences. People with generalized anxiety disorder may have a history of significant life changes, traumatic or negative experiences during childhood, or a recent traumatic or negative event. Chronic medical illnesses or other mental health disorders may increase risk.
Complications
Having generalized anxiety disorder can be disabling. 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
- Increase your risk of depression
Generalized anxiety disorder can also lead to or worsen other physical health conditions, such as:
- Digestive or bowel problems, such as irritable bowel syndrome or ulcers
- Headaches and migraines
- Chronic pain and illness
- Sleep problems and insomnia
- Heart-health issues
Generalized anxiety disorder often occurs along with other mental health problems, which can make diagnosis and treatment more challenging. Some mental health disorders that commonly occur with generalized anxiety disorder include:
- Phobias
- Panic disorder
- Post-traumatic stress disorder (PTSD)
- Obsessive-compulsive disorder (OCD)
- Depression
- Suicidal thoughts or suicide
- Substance abuse
Prevention
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 professional 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 nicotine or caffeine 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.
What Are Anxiety Disorders?
Anxiety is a normal emotion. It’s your brain’s way of reacting to stress and alerting you of potential danger ahead.
Everyone feels anxious now and then. For example, you may worry when faced with a problem at work, before taking a test, or before making an important decision.
Occasional anxiety is OK. But anxiety disorders are different. They’re a group of mental illnesses that cause constant and overwhelming anxiety and fear. The excessive anxiety can make you avoid work, school, family get-togethers, and other social situations that might trigger or worsen your symptoms.
With treatment, many people with anxiety disorders can manage their feelings.
Anxiety disorders are generally treated with psychotherapy, medication, or both. There are many ways to treat anxiety, and you should work with a health care provider to choose the best treatment for you.
Psychotherapy
Psychotherapy or “talk therapy” can help people with anxiety disorders. To be effective, psychotherapy must be directed at your specific anxieties and tailored to your needs.
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) is an example of one type of psychotherapy that can help people with anxiety disorders. It teaches people different ways of thinking, behaving, and reacting to situations to help you feel less anxious and fearful. CBT has been well studied and is the gold standard for psychotherapy.
Exposure therapy is a CBT method that is used to treat anxiety disorders. Exposure therapy focuses on confronting the fears underlying an anxiety disorder to help people engage in activities they have been avoiding. Exposure therapy is sometimes used along with relaxation exercises.
Acceptance and Commitment Therapy
Another treatment option for some anxiety disorders is acceptance and commitment therapy (ACT). ACT takes a different approach than CBT to negative thoughts. It uses strategies such as mindfulness and goal setting to reduce discomfort and anxiety. Compared to CBT, ACT is a newer form of psychotherapy treatment, so less data are available on its effectiveness.
Medication
Medication does not cure anxiety disorders but can help relieve symptoms. Health care providers, such as a psychiatrist or primary care provider, can prescribe medication for anxiety. Some states also allow psychologists who have received specialized training to prescribe psychiatric medications. The most common classes of medications used to combat anxiety disorders are antidepressants, anti-anxiety medications (such as benzodiazepines), and beta-blockers.
Antidepressants
Antidepressants are used to treat depression, but they can also be helpful for treating anxiety disorders. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has manageable side effects.
Antidepressants can take several weeks to start working so it’s important to give the medication a chance before reaching a conclusion about its effectiveness. If you begin taking antidepressants, do not stop taking them without the help of a health care provider. Your provider can help you slowly and safely decrease your dose. Stopping them abruptly can cause withdrawal symptoms.
In some cases, children, teenagers, and adults younger than 25 may experience increased suicidal thoughts or behavior when taking antidepressant medications, especially in the first few weeks after starting or when the dose is changed. Because of this, people of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment.
Anti-anxiety Medications
Anti-anxiety medications can help reduce the symptoms of anxiety, panic attacks, or extreme fear and worry. The most common anti-anxiety medications are called benzodiazepines. Although benzodiazepines are sometimes used as first-line treatments for generalized anxiety disorder, they have both benefits and drawbacks.
Benzodiazepines are effective in relieving anxiety and take effect more quickly than antidepressant medications. However, some people build up a tolerance to these medications and need higher and higher doses to get the same effect. Some people even become dependent on them.
To avoid these problems, health care providers usually prescribe benzodiazepines for short periods of time.
If people suddenly stop taking benzodiazepines, they may have withdrawal symptoms, or their anxiety may return. Therefore, benzodiazepines should be tapered off slowly. Your provider can help you slowly and safely decrease your dose.
Beta-blockers
Although beta-blockers are most often used to treat high blood pressure, they can help relieve the physical symptoms of anxiety, such as rapid heartbeat, shaking, trembling, and blushing. These medications can help people keep physical symptoms under control when taken for short periods. They can also be used “as needed” to reduce acute anxiety, including to prevent some predictable forms of performance anxieties.
Choosing the Right Medication
Some types of drugs may work better for specific types of anxiety disorders, so people should work closely with a health care provider to identify which medication is best for them. Certain substances such as caffeine, some over-the-counter cold medicines, illicit drugs, and herbal supplements may aggravate the symptoms of anxiety disorders or interact with prescribed medication. People should talk with a health care provider, so they can learn which substances are safe and which to avoid.
Choosing the right medication, medication dose, and treatment plan should be done under an expert’s care and should be based on a person’s needs and their medical situation. Your and your provider may try several medicines before finding the right one.
Support Groups
Some people with anxiety disorders might benefit from joining a self-help or support group and sharing their problems and achievements with others. Support groups are available both in person and online. However, any advice you receive from a support group member should be used cautiously and does not replace treatment recommendations from a health care provider.
Stress Management Techniques
Stress management techniques, such as exercise, mindfulness, and meditation, also can reduce anxiety symptoms and enhance the effects of psychotherapy. You can learn more about how these techniques benefit your treatment by talking with a health care provider.
