What Is Generalized Anxiety Disorder (GAD)?

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Worrying is a part of life. It's natural to worry about the stressful things in our lives. But what happens when that worry becomes invasive and persistent? For people with generalized anxiety disorder (GAD), worrying can take over their lives, becoming excessive and exaggerated.

A person with GAD doesn't simply have rational worries based on actual risk—they worry regardless of outside stressors, exaggerate the perceived level of risk, and cannot rationalize away the worry.

Portrait of young woman with anxiety

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What Is Generalized Anxiety Disorder?

GAD is a common mental illness that is characterized by excessive, chronic worry that interferes with a person's ability to function normally.

It is estimated that about 6.8 million adults—or 3.1% of the U.S. population—are affected in any given year.

People with GAD do not have one focused fear of a specific nature, such as with a phobia, but rather their anxiety changes from one thing to another repeatedly.

For example, someone without GAD may notice that a friend has not answered their text and make a mental note to follow up with them. Someone with GAD may see this unanswered text and picture their friend hurt or even dead from an accident. They may wonder if their friend is angry with them, or does not want to continue their friendship. They are likely to check and recheck their phone constantly until that friend answers the text.

Often times, a person with GAD is aware that their fear is irrational or disproportionate to the situation, but cannot turn off the worry. Because the anxiety is not based in reality, confronting it with logic or reassurance is not enough to quell it.

Is My Worrying Normal?

A person with GAD may be worried about the same things as a person without GAD, but their worries are persistent, difficult to control, accompanied by physical symptoms, and cause significant distress and impairment in their lives.

Paradoxically, for many people with GAD, worrying feels productive. Though they usually recognize it as magical thinking, people with GAD can feel like worrying wards off bad things from happening, and that if they stop worrying about it, their fears will come true.

GAD is exhausting mentally and physically. It impacts nearly every aspect of a person's life, and can be very overwhelming.


To meet the DSM-5's criteria for GAD, the following must be met:

  • Excessive anxiety and worry about a number of activities or events, occurring more days than not for at least 6 months
  • Difficulty controlling your worry
  • Three (or more) of the following six symptoms (one or more for children), with at least some symptoms having been present for more days than not for the past 6 months:
  1. Restlessness, feeling keyed up or on edge
  2. Being easily fatigued
  3. Difficulty concentrating or mind going blank
  4. Irritability
  5. Muscle tension
  6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep)
  • Significant distress or impairment in social, occupational, or other important areas of functioning, caused by worry or anxiety
  • Symptoms are not caused by a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism)
  • Symptoms are not better explained by another mental illness or disorder

Some other symptoms of GAD include:

  • Nervousness or irritability
  • Feeling a sense of impending danger, panic, or doom
  • Increased heart rate
  • Hyperventilation (rapid breathing)
  • Sweating
  • Trembling
  • Feeling weak or tired
  • Gastrointestinal (GI) problems
  • Headaches and other unexplained pains

It's important to note the differences between typical worrying with the disordered worrying that comes with GAD.

How Does GAD Look Different From "Normal" Worrying?
"Normal" Worrying Generalized Anxiety Disorder
 Doesn't get in the way of responsibilities or daily functioning. Significantly interferes with functioning, including relationships, job, and activities.
 You can control your worrying. You cannot control your worrying.
 Worries are unpleasant, but not significantly distressing. Your worries are very upsetting and cause great distress.
 Your worries are realistic, and limited to a small number of specific concerns. Your worry extends to a wide variety of things, and you tend to focus on worst case scenarios.
 Your worries last for short bouts of time. You've been worrying almost every day for at least six months.

Anxiety Triggers Are Not Universal

Both children and adults can experience excessive worry about any area, activity, or concept—or they may experience feelings of anxiety not attached to anything specific. These triggers also do not have to be logical or make sense to other people.

People with GAD may engage in behaviors to try to control their excessive worrying, such as:

  • Avoiding news on TV, online, or in newspapers
  • Limiting or skipping out on participation in activities that cause them worry
  • Seeking excessive reassurance or approval (particularly in children).
  • Over-planning or preparing
  • "Rehearsing" or replaying scenarios in their mind


GAD is more often diagnosed and treated by family physicians and primary care providers than by psychiatrists.

To determine a diagnosis of GAD, your healthcare provider may:

  • Do a physical exam to look for signs that your anxiety might be linked to medications or an underlying medical condition
  • Order blood tests, urine tests, or other tests, if another medical condition is suspected
  • Ask detailed questions about your symptoms and medical history
  • Use psychological questionnaires to help determine a diagnosis
  • Use the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

Is It GAD, Or Something Else?

Generalized anxiety disorder can mimic other psychiatric disorders and vice versa. As well, GAD often occurs at the same time as other psychiatric disorders (this is called comorbidity). It's important to get a comprehensive diagnosis in order to make a treatment plan that addresses your unique needs.


Scientists are not yet sure of the specific causes of GAD, but they believe it arises from a combination of biological and environmental factors. These might include:

  • Differences in brain chemistry and function
  • Genetics
  • Differences in the way threats are perceived
  • Development and personality

Risk Factors

  • Gender: Women are diagnosed with GAD more often than men.
  • Age: GAD can develop at any time, but the risk is highest between childhood and middle age, with the median age being 30.
  • Personality: Those who are timid, have negative affectivity and harm avoidance may be more prone to generalized anxiety disorder.
  • Genetics: GAD appears to run in families and one-third of the risk of GAD is thought to be due to genetics.
  • Experiences: A history of significant life changes, traumatic or negative experiences during childhood, or a recent traumatic or negative event may increase the risk of developing GAD. Chronic medical illnesses or other mental health disorders may also increase risk.


As with any psychiatric disorder, finding a successful treatment for GAD can take some trial and error. What works for one person with GAD may not work as well as another treatment for someone else with GAD. If the first treatment you try is not successful or has side effects you can't tolerate, don't assume your GAD is untreatable—go back to your healthcare provider with your concerns and work together to try a new plan.

GAD is primarily treated with either therapy, medication, or a combination of both.


The most common form of therapy used to treat generalized anxiety disorder is cognitive-behavioral therapy (CBT). CBT helps analyze the way we think in order to recognize and correct distortions. Using CBT, people with GAD can change their automatic thinking processes that lead to anxiety and replace them with healthier ways of thinking.

The five components of CBT for anxiety are:

  • Education: Before re-training your thinking processes, it's important to learn both how anxiety works and how the process of CBT works. In this stage, you will focus on gaining an understanding of GAD and how it affects your thinking and your behavior. You will also learn what to expect from CBT treatment.
  • Monitoring: You will be taught ways to monitor your anxiety. What triggers it? What specific things do you worry about? How intense are your episodes and for how long do they last? Monitoring your anxiety gives you an overall view of what GAD looks like for you. Being aware of how your anxiety manifests and what triggers it will help you implement ways to change it. It may help to keep a diary for this part of therapy.
  • Physical control strategies: Anxiety elicits a "fight or flight" response. In this stage of CBT, you will learn techniques to combat this physical over-arousal.
  • Cognitive control strategies: This is where the "thinking about thinking" comes in. These strategies help you to realistically examine and evaluate the thinking patterns that contribute to GAD, and alter them to be more productive. Challenging these negative thoughts helps to lower your anxiety.
  • Behavioral strategies: Avoidance is a common reaction to anxiety, but not usually a productive one. This stage focuses on learning to tackle your anxiety and face your fears head-on instead of avoiding the things that make you anxious.


The medications prescribed for generalized anxiety disorder are often the same ones prescribed for other mental illnesses or medical conditions.

Be Careful of Interactions

Medications used to treat anxiety can have negative effects when taken with some other medications. This includes some herbal and "natural" treatments. Always tell your healthcare provider and your pharmacist what other medications—prescription or not—you are taking.

These medications can also interact with alcohol. Check with your healthcare provider or pharmacist about whether or not it is safe to drink alcohol while taking your medication.

Antidepressant drugs

These drugs act on neurotransmitters involved in many regions of the brain that affect anxiety, mood, and arousal.

Selective serotonin reuptake inhibitors (SSRIs) prescribed for anxiety include:

  • Fluoxetine (Prozac)
  • Sertraline (Zoloft)
  • Citalopram (Celexa)

Serotonin-norepinephrine reuptake Inhibitors (SNRIs) may also be prescribed. They include:

  • Venlafaxine (Effexor)
  • Duloxetine (Cymbalta)

Sometimes an antidepressant works well for GAD symptoms but has side effects. Common side effects of antidepressants might include, but are not limited to:

  • Sexual problems
  • Drowsiness
  • Insomnia
  • Gastrointestinal issues


Buspirone (BuSpar) is an anti-anxiety medication that works using a different mechanism than SSRIs and SNRIs.

Buspirone takes some time and dosage adjustments to be effective.

Some common side effects of buspirone include:

  • Nausea
  • Headache
  • Changes in dreams
  • Feeling dizzy
  • Drowsiness
  • Lightheadedness

Tricyclic antidepressants

Some people with GAD find tricyclic antidepressants work better for them than other medications.

These medications may be prescribed:

  • Imipramine (Tofranil)
  • Nortriptyline (Pamelor)
  • Desipramine (Norpramin)
  • Clomipramine (Anafranil)

For some people, tricyclic antidepressants have unpleasant side effects like:

  • Dizziness
  • Constipation
  • Blurred vision
  • Trouble urinating

Never Stop Treatment "Cold Turkey"

Many medications used to treat mental illness, including ones for GAD, can have side effects when stopped abruptly. Some of these side effects can be serious. Always consult your healthcare provider before stopping your medication. Your provider can help you make a plan to taper off.

Over time, generalized anxiety is associated with an increased risk of developing or worsening:

  • Digestive or bowel problems, such as irritable bowel syndrome or peptic ulcers
  • Headaches and migraines
  • Chronic pain
  • Sleep problems and insomnia
  • Heart-health issues

GAD often occurs alongside other mental illnesses, including:

These coexisting conditions can make treatment more difficult, but not impossible.

Help Is Available

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

Treatment success varies by person and both therapy and medication can take a while to become effective. If you don't notice an improvement right away, give it a little bit of time. Your healthcare provider can give you an idea of how long to wait before trying something else. Your provider is likely to want you to come in for regular follow-ups when you begin a new medication until you reach a type and dose that works well for you.

If at any time you feel your treatments are no longer as effective, talk to your healthcare provider to see if adjustments can be made.


While treatment such as therapy and/or medication is often needed to manage GAD, there are lifestyle changes you can make to help ease some of your anxiety and support your treatment plan.

  • Make connections with others: Reach out to friends or join a support group. Having the company and support of others can ease anxiety.
  • Learn how to self-soothe: When you are in a moment of high anxiety, engaging your senses can help ground you. These senses include look, listen, smell, taste, touch, and move.
  • Relaxation techniques: Practicing things like deep breathing, progressive muscle relaxation, and meditation. helps to fight the physical responses your body has to anxiety.
  • Health body habits: Eat healthy foods, get enough sleep, and avoid or limit substances that may aggravate your anxiety.
  • Get organized: Seek help early, keep a journal or diary, and prioritize your needs.

A Word From Verywell

GAD can be difficult and frightening to live with. If you are feeling the effects of GAD, see your healthcare provider right away. While finding the right treatment might take a bit of work and experimentation with the help of your healthcare provider, GAD can be managed, and living a life free of excessive and intrusive anxiety is possible.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Anxiety and Depression Association of America. Generalized anxiety disorder (GAD).

  2. HelpGuide. Generalized anxiety disorder: GAD.

  3. American Psychiatric Association. DSM-5 criteria for diagnosing generalized anxiety disorder.

  4. Center For Addiction and Mental Health. Generalized anxiety disorder.

  5. Gliatto MF. Generalized anxiety disorder. AFP. 2000;62(7):1591-1600.

  6. Harvard Health. Generalized anxiety disorder.

  7. National Alliance on Mental Illness. Buspirone (BuSpar).

By Heather Jones
Heather M. Jones is a freelance writer with a strong focus on health, parenting, disability, and feminism.