Department of Psychiatry

Penn Behavioral Health

Generalized Anxiety Disorder


Generalized anxiety disorder, or GAD as it is more commonly referred to, is an anxiety disorder characterized by excessive worry or apprehension displayed across a variety of everyday situations or activities. Patients with GAD worry about things that most people will from time to time worry about, such as health, finances, work difficulties, or family problems. However, while most people are able to control their anxiety regarding these issues, those with GAD are unable to stop focusing on these everyday issues, often fearing the worst outcome for every situation for which they’re experiencing anxiety. Quite often the worry of GAD patients is out of proportion to the actual likelihood of their feared outcome. For instance, someone might be unable to stop worrying that they are not performing well at work and will soon be fired from their position, despite a complete lack of evidence that their job performance has been poor. GAD patients describe their anxiety as being constantly present in their daily lives. In addition to the uncontrollable worry, GAD patients also experience a variety of arousal symptoms, such as restlessness, difficulty concentrating, irritability, and being easily fatigued. Sometimes, GAD patients experience physiological symptoms as a result of their constant state of apprehension. These can include nausea, headaches, and dry mouth among others. Generalized anxiety disorder causes its sufferers great distress and trouble functioning in several different areas, such as at work, at home with family, or when out socially with friends.

Common Symptoms

According to the Diagnostic and Statistical Manual, Fifth Edition (DSM-5), the following criteria must be met in order for a person to receive a diagnosis of generalized anxiety disorder.

  • Excessive anxiety and worry (apprehensive expectation) occurring more days than not for at least six months, about a number of different events or activities (such as work or school performance)
  • The individual finds it difficult to control the worry
  • The worry is associated with at least 3 of the following 6 symptoms (only 1 is required for children)
    • Restlessness or feeling keyed up or on edge
    • Being easily fatigued
    • Irritability
    • Muscle tension
    • Sleep disturbance (difficulty falling asleep or staying asleep, or restless, unsatisfying sleep)
    • Difficulty concentrating or mind going blank
  • The disturbance cannot be better explained by substance effects or another mental disorder
GAD in Children

For children suffering from GAD, the worries tend to be focused on either competence or quality of performance at school or in sporting events. Occasionally, children may focus their anxiety on the occurrence of catastrophic events such as earthquakes or nuclear war. Children with GAD may be appear to be perfectionists and might require excessive reassurance or approval from adults regarding the quality of their work.

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Onset and Course

While generalized anxiety disorder can occur at any age, many individuals with GAD report feeling anxious all their lives. While no there is no known specific cause for the disorder, research suggests that there may be a genetic component involved in GAD, with individuals having family members with the disorder more likely to develop GAD than those in the general population. While no specific causing gene has been located, research now indicates that biology, environment, and life experience may all play a role in the development and course of GAD.

While the median age of onset is 30 years, a very broad range exists for the spread of age at time of onset. Patients reporting a later onset of their GAD typically will say their symptoms developed in response to a significant stressful event in their lives. Once an individual develops GAD, the course of the disorder is most often chronic. The severity of symptoms may fluctuate and worsen during times of stress.

Epidemiological Information

The 12-month prevalence of generalized anxiety disorder is 0.9% among adolescents and 2.9% among adults in the general community of the U.S. The 12-month prevalence for the disorder in other countries ranges from 0.4% to 3.6%. Individuals of European descent tend to experience GAD more frequently than do individuals of non-European descent (i.e. Asian, African, Native American and Pacific Islander). Furthermore, individuals from developed countries are more likely than individuals from developing countries to report that they have experienced symptoms that meet criteria for GAD in their lifetime.

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Co-Occurrence with Other Disorders

Generalized anxiety disorder often may be accompanied by other anxiety or unipolar depressive disorders, such as major depression, dysthymia, panic disorder, or social anxiety disorder. Recent research on co-occurring anxiety and depression has shown that individuals suffering from both disorders are more likely to have greater symptom severity and a lower response to treatment than those presenting with only one disorder. Also, patients with dual diagnoses show greater impairment in social function and quality of life. Research has also demonstrated an overlap in genetic and environmental risk factors between these disorders; however, independent pathways are also possible. Co-occurrence with substance use, conduct, and psychotic disorders is less common.

In addition to occurring alongside other mental disorders, patients with GAD may also suffer from other physical conditions as a result of their constant anxiety, such as irritable bowel syndrome. Doctors seeing patients with chronic physical complaints who also report continuous feelings of worry and anxiety may be likely to recognize this as GAD and make an appropriate mental health referral.

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