General Anxiety Disorder or GAD is one of the common anxiety disorders marked by excessive fear and anxiety. It is a mental disorder that gives rise to persistent, excessive, and unrealistic worry about day-to-day affairs.

Close to 20% of adults are impacted by anxiety disorders each year. Further, the median age of presentation of GAD is 30 years. Despite GAD and other anxiety disorders being common, they are left underdiagnosed and undertreated. And living with generalized anxiety disorder can result in issues like substance abuse and severe depression.

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In addition to this, people with chronic anxiety have a poor quality of life. Therefore, GAD diagnosis and treatment are extremely important.

In this article, we will learn what is general anxiety disorder, general anxiety disorder in children, causes of GAD, signs of GAD, and GAD treatment.

What is General Anxiety Disorder?

General Anxiety Disorder or GAD is a mental disorder that is characterized by persistent, excessive, unreasonable, and uncontrollable worry. Such a worry is experienced each day for most of the day and concerns various aspects of daily life. These include finances, family, the health of their family member, work, future, etc.

Also, such a worry is challenging to control and makes the individual experience various physical and physiological symptoms.

Thus, individuals with GAD disorder can’t figure out ways to control the worry cycle. They feel that worry is something beyond their control and this is what comes in the way of their daily living.

Symptoms of GAD are clearly defined under generalized anxiety disorder DSM 5 (Diagnostic and Statistical Manual of Mental Disorders). Clinicians use the GAD DSM 5 diagnostic criteria to undertake GAD diagnosis and confirm signs of GAD in an individual.

Generalized Anxiety Disorder Symptoms

Following are the symptoms of GAD as defined in DSM 5.

1. Excessive Anxiety and Worry

Excessive worry about a host of activities is one of the important characteristics of GAD. In addition to this, the period, intensity, and recurrence of such a worry are disproportionate to the actual probability or effect of the expected event.

Thus, the individual gets excessively worried about affairs associated with routine life. These may include anxiety about finances, the health of family members, appointments, household work, the misfortune of children, etc. This is different from usual, non pathological anxiety. In that, the worry about routine affairs is considered manageable and is not intense, or excessive.

2. Difficult to Control Worry

In addition to persistent worry about multiple issues, the individual with GAD finds such worry uncontrollable. In other words, he finds it challenging to prevent anxious thoughts from interfering with his focus on the task at hand.

3. Showing Physical Symptoms

As mentioned earlier, people with GAD experience worries that are more prevalent, intense, and distressing. Further, they are experienced for a longer duration and without any reason. This makes the individual feel nervous and anxiety-ridden most of the time. The person with GAD is not able to keep calm and relax. Thus, GAD brings along at least three of the following physical symptoms.

• being on the edge
• getting fatigued easily
• Irritability
• muscle tension
• finding difficulty in concentrating
• experiencing sleep issues like disturbed sleep, insomnia, hypersomnia, etc.

Apart from the above signs of GAD, some people show the following additional GAD signs. These include:

• feeling shaky, trembling, and generalized muscle pain
• somatic symptoms like sweating, nausea, diarrhea
• overstated startling response
• signs of hyperarousal like pacing heartbeat, dizziness, shortness of breath. However, these are more common in other anxiety disorders such as panic disorder than in GAD.
• issues associated with stress like headaches, irritable bowel syndrome, etc.

Causes of GAD

The causes of GAD are not properly understood. In other words, the etiology of generalized anxiety disorder is not well known. However, various environmental and genetic factors could be the causes of GAD.

1. Environmental Factors

As per DSM-5, hardships faced during childhood and overprotection by patients have been linked to general anxiety disorder. These childhood hardships could include:

• chronic illness
• sexual abuse
• general abuse and neglect
• death of a loved one
• severe injuries
• financial challenges
• divorce of parents, etc

However, some people are surrounded by a positive environment. This may include strong social connectivity, a supportive learning environment, effective coping strategies, strong bonding with loved ones, etc. And such an environment brings strength even if there exists a genetic risk.

2. Genetic Factors

Genetic factors account for 33% of the risk of experiencing a general anxiety disorder. GAD coincides with the risk of neuroticism and other anxiety disorders. These include mood disorder, major depressive disorder, etc.

3. Temperamental Factors

Much like environmental and genetic factors, temperamental factors too have been responsible for GAD. For instance, avoiding harm, neuroticism, behavioral hesitation, etc.

4. Gender Differences

GAD is more frequently diagnosed in females as compared to males. Accordingly, 55%-60% of females are diagnosed with general anxiety disorder. Further, where both males and females show similar GAD symptoms, both showcase different patterns of comorbidity.

For instance, comorbidity in females is limited to anxiety disorders and unipolar depression. However, comorbidity in males has a probability to extend to substance use disorders.

GAD Treatment

General anxiety disorder and other anxiety disorders are the most prevalent of mental disorders. Yet, fewer individuals suffering from anxiety issues are diagnosed or treated for the same. Mostly, patients with GAD are treated without any hospitalization.

However, ones showing signs of suicide, comorbidity like major depressive disorder, substance abuse, etc are likely to be hospitalized.

Further, GAD treatment typically includes psychotherapy like CBT, medications, and the combination of the two.

1. Psychotherapy

People suffering from GAD and other anxiety issues need attention to the emotional issues they experience. Further, they need supportive talk therapies which include educating people with anxiety issues about its physical symptoms and the reason behind each of the available treatments.

CBT or Cognitive Behavioral Therapy is one of the most commonly used psychotherapy for GAD treatment. It is a technique that involves a therapist who helps the patient to identify and alter negative thought patterns, emotional responses, and behaviors.

This technique involves several strategies to help patients identify inappropriate patterns, concentrate on learning new skills, and solve issues. These may include journaling, role-playing, mental distractions, relaxation techniques, etc.

2. Pharmacotherapy

This involves the prescription of antidepressants, antipsychotics, etc by doctors for GAD treatment.

a) Antidepressants

1. Selective Serotonin Reuptake Inhibitors (SSRIs)

Some of the SSRIs are the first-line treatment for generalized anxiety disorder. The commonly prescribed SSRIs include Escitalopram (Lexapro), Paroxetine (Paxil), Fluoxetine (Prozac), and Sertraline (Zoloft).

2. Selective Norepinephrine Reuptake Inhibitors (SNRIs)

Much like SSRIs, some of the SNRIs are also first-line treatment for generalized anxiety disorder. These include Duloxetine (Cymbalta), Buspirone (Buspar), etc.

b) Antipsychotics

Much like antidepressants, antipsychotics are also helpful in treating GAD in some individuals. These are especially helpful in the case of people with behavior issues.

c) Benzodiazepines

Clonazepam and diazepam are benzodiazepines that act for a long period. These are used in the case of an individual who needs short-term treatment or needs to be treated immediately.

In addition to this, these specifically work in cases where individuals with GAD know their symptoms.

Further, the challenges linked to benzodiazepines include dependence on these and their misuse by the patients. That is why people who have experienced drug abuse or alcoholism are not prescribed benzodiazepines by medical professionals.

3. Complementary and Alternative Medicine (CAM)

The use of CAM has increased for treating anxiety and depression. These include botanical treatments that come from plants and herbs. St. John’s Wort or Hypericum perforatum is a plant that grows in the wild and has yellow flowers.

People use St John’s Wort for treating Generalized Anxiety Disorder and depression. St. John Wort is one of the top-selling supplements in the United States. However, there is a restricted study available on its safety and effectiveness.

Generalized Anxiety Disorder Test – GAD-7

GAD-7 is a self-administered 7 item screening tool and a severity measure for generalized anxiety disorder. This questionnaire makes use of the DSM-5 criteria to identify likely cases for GAD and measure the severity of symptoms.

This diagnostic tool was designed after the Patient Questionnaire (PHQ-9), a depression module. GAD-7 was designed so that it could be used quickly and efficiently in a primary care setting.

Further, using this assessment tool is very easy. It simply takes 2-5 minutes to complete. Also, the individuals taking the test are required to rate the recurrence of anxiety symptoms experienced by them in the last two weeks.

This is done on a Likert scale ranging from 0-3. The scoring is done as follows.

• 0 – not at all
• 1 = several days
• 2 = more than half of the says
• 3 = nearly every day

Further, the scores are interpreted in the following way.

Total Score	Anxiety Severity
1 – 4	Minimal symptoms
5 – 9	Mild symptoms
10 – 14	Moderate symptoms
15 – 21	Severe symptoms

You can find the GAD 7 test here for self-assessment.

General Anxiety Disorder ICD 10

F41.1 is the ICD 10 code for general anxiety disorder. ICD stands for the International Classification of Diseases 10the revision. It is a WHO authorized code that was executed for mortality coding and classification via death certificates in 1999 in the U.S.

Further, ICD codes are used by healthcare professionals like physicians and nurses. This helps them to record, analyze, interpret, and compare mortality and morbidity data across different countries in the world.

In addition to this, it also enables them to interoperate and reuse the recorded data for various purposes. These may include allocating resources, giving guidelines, etc.

Now, as per the F41.1 diagnosis in ICD 10, general anxiety disorder:

• is the one that is characterized by too much worry and fear, uneasiness, and dread from the past six months or more.
• includes other symptoms like muscle tension, irritability, restlessness, difficulty in concentrating, sleep issues, sweating, dizziness, faster heartbeat, etc.
• is marked by excessive worry about several aspects of life that are difficult to control. This occurs along with other symptoms like the ones mentioned above, which last for at least six months.
• is characterized by free-floating, continuous, excessive worry for more than six months.
• contains worry about the danger and dread together with restlessness, tension, difficulty in breathing (dyspnea), and heartbeat more than 100 beats per minute (tachycardia). These symptoms occur without any identifiable triggers.

Further, people with anxiety issues may face other types of anxiety disorders. These include OCD, PTSD, panic disorder, and phobias apart from GAD.

General Anxiety Disorder in Children

Anxiety disorders like general anxiety disorder are common psychiatric disorders in children. As per ADAA, one in eight children experience anxiety disorders. General anxiety disorder in pediatric patients poses the threat of comorbidity and interference in the routine functioning of children, impacting their social and academic performance.

Now, usual anxiety is normal and compatible among children. For instance, being anxious when meeting strangers (also called stranger anxiety) is common. It is a phase in the development of children that is at its highest between 6 – 12 months.

Also, stranger anxiety assists the infant’s growth and helps in developing a strong relationship between the infant and the caregiver.

But, such anxiety becomes pathological when it is continuous, way too much, and occurs to children in inappropriate settings. Such excessive worry impairs the routine functioning of the youth.

For instance, it can make your child feel hesitant about making friends, participating in-class activities, etc.

Thus, a general anxiety disorder in children is characterized by excessive worries about various domains of life which are difficult to control. These may relate to performance in school, future, the health of oneself and family, etc.

Further, if left untreated, pose an increased risk of suicide attempts, self-injurious behaviors, future anxiety disorders, depression, substance abuse, and psychiatric hospitalization.

Also, these anxiety disorders can occur along with other disorders like eating disorders, depression, ADHD, etc.

Common Signs of GAD in Children

Some of the common anxious behaviors seen in children and adolescents are as follows.

• avoiding eye contact
• seeking reassurance from parents
• fidgeting
• mutism or not speaking
• lack of attention and increased distraction
• hesitation in meeting the assessor separately or independently
• irritation in case of adolescents
• crying
• taking longer time in responding
• avoiding activities when performance is not perfect
• physical symptoms like headaches sleep issues, etc

Causes of General Anxiety Disorder in Children

The median age of anxiety disorders in children ranges between 6-11 years. Among all the anxiety disorders, GAD, social phobia, and separation anxiety have the highest prevalence among children.

As per medical professionals, the following are the causes of GAD in children.

1. Biological Makeup

The chemical messengers called the neurotransmitters to play a critical role in how an individual feels. Lower levels of neurotransmitters like serotonin and dopamine are responsible for mood disorders like anxiety and depression.

2. Surrounding Environment

Likewise, a child’s surrounding environment may also result in anxiety issues. For instance, the death of a loved one, some major illness, the divorce of parents, etc are some of the environmental factors leading to anxiety disorders in children.

3. Child’s Temperament

A shy child who is fearful too has a higher probability of experiencing GAD. However, other children who have a bold temperament have lesser odds of experiencing anxiety issues.

4. Genetic Makeup

GAD in children can also be due to what they inherit from their parents. If any of the parents suffer from anxiety issues themselves, the children likely inherit the same from their parents.

MDD and GAD

Major Depressive Disorder and General Anxiety Disorder are extremely comorbid. In other words, there’s an increased likelihood for both MDD and GAD to co-exist in an individual.

There are a host of explanations for the high comorbidity of anxiety disorders and MDD. One of them is that some of the symptoms defined in the diagnostic criteria for MDD and GAD overlap with each other. For instance, the excessive worry or overthinking in GAD resembles the depressive ruminations in MDD.

Likewise, difficulty in concentrating on the task at hand and sleep issues occur in both GAD and MDD.

Another reason for their comorbidity can be that the symptoms are triggered by environmental factors or life stressors that are closely related. For example, threat in anxiety and loss in depression.

Still, another reason could be the similar underlying biologies of both depression and anxiety. Now, there are several biological indicators studied to come up with this conclusion of similar biologies. Researchers have studied indicators like HPA (Hypothalamus-Pituitary-Adrenal Axis) and serotonergic function. Other indicators studied include sleep which is an issue in both the disorders, lactate infusion, a problem with anxiety, thyroid axis activity which is abnormal in depression, and cardiovascular function, an issue in both anxiety and depression.

As per research, the occurrence of comorbid anxiety disorder and MDD is as high as 60%.

Conclusion

Anxiety is a normal emotional response to various stressors of life. It enables you to prevent yourself from harmful situations and prepares you for important events. It encourages you to take action. However, it turns pathological when it becomes persistent, excessive, and difficult for you to control. Such anxiety interferes with your routine functioning and if left untreated can disrupt social activities, work, relationships, and life in general. Therefore, proper diagnosis and seeking treatment from a medical professional are very much necessary.

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