ICD-10 Code F41.1
Generalized anxiety disorder (GAD) is part of a cluster of diagnoses called the anxiety disorders. Anxiety disorders are a group of psychiatric conditions that include:
These disorders are characterized primarily by the experience of excessive fear and anxiety. People with generalized anxiety disorder spend a lot of time worrying about a lot of different things. People with social anxiety disorder feel very anxious around other people because they are afraid of embarrassing themselves or being disliked. People with panic disorder have sudden rushes of intense fear or discomfort called panic attacks. They often worry about having another panic attack and might avoid certain situations that might trigger a panic attack. People with agoraphobia are afraid of going into certain situations because they are afraid it might be difficult to escape or because they might experience panic-like or other embarrassing symptoms. Commonly avoided situations are using public transportation, being in open spaces like parking lots, being in enclosed places like movie theaters, or being in a crowd. People with a specific phobia are afraid of a certain object or situation, such as flying, heights, animals, or seeing blood. People with separation anxiety disorder are afraid of being away from a certain person, usually because they are afraid that something bad might happen to them or the other person if they are separated.
The anxiety disorders are characterized by excessive fear and anxiety, along with behavioral disturbances, like avoiding certain places, people, or situations. The anxiety disorders differ from each other in the target or focus of the fear. In some anxiety disorders, like specific phobia, the person is only excessively fearful of a very specific object or situation. In other anxiety disorders, like GAD, the person may feel anxious a great deal of the time or about a lot of different things.
GAD is a relatively common psychiatric disorder that affects approximately 2-5% of adults. GAD is characterized primarily by worry that is excessive (out of proportion to the actual threat) and uncontrollable (unwanted or hard to stop).
Worry involves thinking about things that could go wrong in the future, usually in a way that makes the person anxious. Some common worry topics are listed below:
People with GAD also experience other symptoms besides worry. To be diagnosed with GAD, a person needs to have three or more of the following six symptoms:
To be diagnosed with GAD, a person needs to have these symptoms more days than not for six months or more. The worry and symptoms also need to be distressing (upsetting) or impairing (getting in the way of the person's life).
GAD severity can range from mild to very impairing. In severe cases, GAD can lead to serious problems at work or school, and can cause major problems in relationships. Many people with GAD also have other psychiatric conditions, most commonly depression and other anxiety disorders.
We are beginning to learn about the neurobiology of GAD. GAD seems to be characterized by abnormalities in certain brain regions, particularly regions related to self-reflection (precuneus) and error processing (anterior cingulate cortex), which are thought to contribute to symptoms. In addition, using worry as a "coping strategy" is thought to be part of the reason that some people develop GAD. The disorder has a genetic component, although having a genetic predisposition to GAD does not necessarily mean that someone will develop GAD.
GAD is treatable. Published treatment guidelines for GAD include those from the Society of Clinical Psychology and the Anxiety and Depression Association of America.
First Line Treatments
For more information about drug prescribing in GAD, click here.
Second Line Treatments
In cases of nonresponse to first-line treatment, alternative treatments with reasonable evidence of efficacy include:
Additional Treatments to Consider
Preliminary evidence suggests that the following strategies, while not a substitute for the more well-validated treatments described above, might be considered.
Anxiety disorders involve persistent, excessive worry that can affect thoughts, emotions, and daily life for at least six months. This video from Psych Hub explains how anxiety impacts mental health and offers resources for support.
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Psych Hub is an educational service. The information provided in this video is not a substitute for professional advice, diagnosis, or treatment. If you believe you or someone you know may be experiencing mental health symptoms, please seek help from a qualified medical or behavioral health professional.
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