Generalized anxiety disorder (GAD): what it is and symptoms

Anxiety that does not let up for weeks and moves from one topic to another is familiar to many. Doctors call this condition generalized anxiety disorder, or GAD. Below is what this diagnosis is, how it manifests, and how it is defined.

What generalized anxiety disorder is

GAD is a common mental health condition in which a person frequently and intensely worries about many different things, and finds it hard to control this. The anxiety is not tied to a single object: the worry concerns family, relationships, work, studies, money, health. The cause is usually not obvious; among the factors that increase the likelihood are another anxiety disorder, close relatives with anxiety disorders or depression, severe or traumatic experiences, and a long-term illness with pain. GAD is more common in women and can develop in anyone, including children.

GAD symptoms: psychological and physical

The main sign is a feeling of tension or restlessness that affects daily life and is poorly controlled. A person may understand that they are worrying more than the situation requires, but still cannot cope with it.

• sleep difficulties: hard to fall asleep, sleep is interrupted and does not bring rest;
• restlessness, irritability, difficulty concentrating;
• rapid fatigue and a feeling of muscle tension;
• physical manifestations: stomach problems, noticeable or unusual heartbeat, sweating, dizziness, difficulty breathing;
• low mood, feeling down.

How the diagnosis is made: ICD-10 criteria F41.1

There is no separate analysis or test that confirms GAD: the diagnosis is made based on answers to questions about symptoms and about other aspects of mental and physical health. A doctor may diagnose the disorder if the anxiety persists for a long time — at least six months — concerns a wide range of topics, affects daily life, and is poorly controlled.

In ICD-10, generalized anxiety disorder is designated by code F41.1: the primary symptoms of anxiety are present on most days for at least several consecutive weeks, and usually several months. These include apprehensions (worry about future failures, difficulty concentrating), motor tension (restlessness, tension headaches, trembling, inability to relax), and autonomic hyperactivity (sweating, rapid heartbeat or breathing, discomfort in the stomach area, dizziness, dry mouth). In children, the need for reassurance and repeated physical complaints are more noticeable.

Before making a diagnosis, the doctor rules out other explanations: neurasthenia, thyrotoxicosis (a thyroid hormone check may be needed), coronary heart disease, the effects of medications or their abrupt withdrawal. A physical examination and laboratory tests may be performed.

How GAD differs from ordinary anxiety and other disorders

Everyone worries sometimes, and this does not mean a diagnosis. GAD is more likely when a person is anxious most of the time and this interferes with life. Anxiety disorders vary and often co-occur: for example, panic disorder or phobias with a persistent fear of something specific. In GAD, the anxiety is general, "floating", without a clear object. Brief other symptoms, especially depressive ones, do not cancel the diagnosis of GAD as the primary one if they do not meet the full criteria for a depressive episode, panic disorder, or obsessive-compulsive disorder.

Possible consequences and complications

The course can be fluctuating and prone to becoming chronic, and the severity of the condition varies from person to person. In some cases the disorder lasts a long time and is difficult to treat, although most people feel improvement. Possible complications include depression and substance abuse.

When to see a doctor

A reason to talk to a doctor is frequent worry or anxiety, especially if it interferes with everyday tasks. If a diagnosis of GAD has already been made and help is not working, this can also be mentioned. The doctor assesses the symptoms and general condition and may refer to a mental health specialist; the care plan is discussed together.

Generalized anxiety disorder by itself is not a reason to call an ambulance. Numbers 103 and 112 are for life-threatening conditions: for example, serious injuries, signs of stroke or heart attack, when a person needs immediate help.

This material is for reference: it helps to navigate the topic but does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer