Anxiety, generalized
Overview
It's common 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.
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."
Staying away from situations that cause anxiety.
Seeking reassurance from others when feeling anxious.
Physical signs and symptoms may include:
Being very tired.
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.
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
Anxiety is common. But see your healthcare professional 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.
Diagnosis
To help diagnose generalized anxiety disorder, your doctor or mental health professional may:
Do a physical exam to look for signs that your anxiety might be linked to medications or an underlying medical condition.
Order blood or urine tests or other tests, if a medical condition is suspected.
Ask detailed questions about your symptoms and medical history.
Use psychological questionnaires to help determine a diagnosis.
Treatment
Treatment decisions are based on how significantly generalized anxiety disorder is affecting your ability to function in your daily life. The two main treatments for generalized anxiety disorder are psychotherapy and medications. You may benefit most from a combination of the two. It may take some trial and error to discover which treatments work best for you.
Psychotherapy
Also known as talk therapy or psychological counseling, psychotherapy involves working with a therapist to reduce your anxiety symptoms. Cognitive behavioral therapy is the most effective form of psychotherapy for generalized anxiety disorder.
Generally a short-term treatment, cognitive behavioral therapy focuses on teaching you specific skills to directly manage your worries and help you gradually return to the activities you've avoided because of anxiety. Through this process, your symptoms improve as you build on your initial success.
Medications
Several types of medications are used to treat generalized anxiety disorder, including those below. Talk with your doctor about benefits, risks and possible side effects.
Antidepressants. Antidepressants, including medications in the selective serotonin reuptake inhibitor (SSRI) and serotonin and norepinephrine reuptake inhibitor (SNRI) classes, are the first line medication treatments. Examples of antidepressants used to treat generalized anxiety disorder include escitalopram (Lexapro), duloxetine (Cymbalta), venlafaxine (Effexor XR) and paroxetine (Paxil, Pexeva). Your doctor also may recommend other antidepressants.
Buspirone. An anti-anxiety medication called buspirone may be used on an ongoing basis. As with most antidepressants, it typically takes up to several weeks to become fully effective.
Benzodiazepines. In limited circumstances, your doctor may prescribe a benzodiazepine for relief of anxiety symptoms. These sedatives are generally used only for relieving acute anxiety on a short-term basis. Because they can be habit-forming, these medications aren't a good choice if you have or had problems with alcohol or drug abuse.