Generalized Anxiety Disorder

Learning Objectives

  • Describe the symptoms of generalized anxiety disorder
  • Distinguish between a normal fear response and an anxiety disorder

Generalized Anxiety Disorder

A photograph shows a woman biting her fingernails.

Figure 1. Worry is a defining feature of generalized anxiety disorder. (credit: Freddie Peña)

What makes a person with generalized anxiety disorder (GAD) worry more than the average person? Research shows that individuals with generalized anxiety disorder (GAD) are more sensitive and vigilant toward possible threats than people who are not anxious (Aikins & Craske, 2001; Barlow, 2002; Bradley, Mogg, White, Groom, & de Bono, 1999). This sensitivity may be related to early stressful experiences, which can lead to a view of the world as an unpredictable, uncontrollable, and even dangerous place. Some have suggested that people with generalized anxiety disorder (GAD) worry as a way to gain some control over these otherwise uncontrollable or unpredictable experiences and against uncertain outcomes (Dugas, Gagnon, Ladouceur, & Freeston, 1998). By repeatedly going through all the possible “what if?” scenarios in their mind, the person might feel less vulnerable to an unexpected outcome, giving them the sense that they have some control over the situation (Wells, 2002).

Others have suggested people with GAD worry as a way to avoid feeling distressed (Borkovec, Alcaine, & Behar, 2004). For example, Borkovec and Hu (1990) found that those who worried when confronted with a stressful situation had less physiological arousal than those who didn’t worry, maybe because the worry distracted them in some way. The problem is, all this “what if?”-ing doesn’t get the person any closer to a solution or an answer and, in fact, might take them away from important things they should be paying attention to in the moment, such as finishing an important project. Many of the catastrophic outcomes people with GAD worry about are very unlikely to happen, so when the catastrophic event doesn’t materialize, the act of worrying gets reinforced (Borkovec, Hazlett-Stevens, & Diaz, 1999). For example, if a mother spends all night worrying about whether her teenage daughter will get home safe from a night out and the daughter returns home without incident, the mother could easily attribute her daughter’s safe return to her successful “vigil.” What the mother hasn’t learned is that her daughter would have returned home just as safe if she had been focusing on the movie she was watching, rather than being preoccupied with worries. In this way, the cycle of worry is perpetuated, and, subsequently, people with GAD often miss out on many otherwise enjoyable events in their lives.

Symptoms of Generalized Anxiety Disorder

People with GAD display excessive anxiety or worry on most days for at least six months about a number of things such as personal health, work, social interactions, and everyday routine life circumstances. The fear and anxiety can cause significant problems in areas of their life, such as social interactions, school, and work.

GAD symptoms include

  • feeling restless, wound-up, or on-edge
  • being easily fatigued
  • having difficulty concentrating; mind going blank
  • being irritable
  • having muscle tension
  • difficulty controlling feelings of worry
  • having sleep problems, such as difficulty falling or staying asleep, restlessness, or unsatisfying sleep

Alex: A narrative of worry

Alex was always worried about many things. He worried that his children would drown when they played at the beach. Each time he left the house, he worried that an electrical short circuit would start a fire in his home. He worried that his wife would lose her job at a prestigious law firm. He worried that his daughter’s minor staph infection could turn into a massive life-threatening condition. These and other worries constantly weighed heavily on Alex’s mind, so much so that they made it difficult for him to make decisions and often left him feeling tense, irritable, and worn out. One night, Alex’s wife was to drive their son home from a soccer game. However, his wife stayed after the game and talked with some of the other parents, resulting in her arriving home 45 minutes late. Alex had tried to call her cell phone three or four times, but he could not get through because the soccer field did not have a signal. Extremely worried, Alex eventually called the police, convinced that his wife and son had not arrived home because they had been in a terrible car accident.

Alex suffers from generalized anxiety disorder (GAD): a relatively continuous state of excessive, uncontrollable, and pointless worry and apprehension. People with generalized anxiety disorder often worry about routine, everyday things, even though their concerns are unjustified. For example, an individual may worry about her health and finances, the health of family members, the safety of her children, or minor matters (e.g., being late for an appointment) without having any legitimate reason for doing so (APA, 2013).

Risk Factors for Anxiety

Researchers are finding that both genetic and environmental factors contribute to the risk of developing an anxiety disorder. Although there have been few investigations aimed at determining the heritability of generalized anxiety disorder, a summary of available family and twin studies suggests that genetic factors play a modest role in the disorder (Hettema et al., 2001). The risk factors for each type of anxiety disorder can vary, some general risk factors for all types of anxiety disorders include the following:

  • temperamental traits of shyness or behavioral inhibition in childhood
    A young girl is being carried by a man and peeks shyly over her arm at the camera.

    Figure 2. Shyness is a risk factor for some anxiety disorders.

  • exposure to stressful and negative life or environmental events in early childhood or adulthood
  • a history of anxiety or other mental illnesses in biological relatives
  • some physical health conditions, such as thyroid problems or heart arrhythmias, or caffeine or other substances/medications, can produce or aggravate anxiety symptoms; a physical health examination is helpful in the evaluation of a possible anxiety disorder

Diagnosis of Generalized Anxiety Disorder

A diagnosis of GAD requires that the diffuse worrying and apprehension characteristic of this disorder—what Sigmund Freud referred to as free-floating anxiety—is not part of another disorder, occurs more days than not for at least six months, and is accompanied by any three of the following symptoms: restlessness, difficulty concentrating, being easily fatigued, muscle tension, irritability, and sleep difficulties.

About 5.7% of the U.S. population will develop symptoms of GAD during their lifetime (Kessler et al., 2005), and females are twice as likely as males to experience the disorder (APA, 2013). GAD is highly comorbid with mood disorders and other anxiety disorders (Noyes, 2001), and it tends to be chronic. Also, generalized anxiety disorder appears to increase the risk for heart attacks and strokes, especially in people with pre-existing heart conditions (Martens et al., 2010).

Watch It

Watch this video to learn about the causes, symptoms, and treatments for GAD.

You can view the transcript for “Generalized anxiety disorder (GAD) – causes, symptoms & treatment” here (opens in new window).

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Watch It

This video explains Tasha’s experience with GAD and how treatment helped her to identify and cope with her anxiety.

You can view the transcript for “Generalized Anxiety Disorders” here (opens in new window).

Cognitive Theory

Explaining GAD Diagnosis

Some people who are cognitive theorists suggest that worry represents a mental strategy to avoid more powerful negative emotions that perhaps may stem from earlier unpleasant or traumatic experiences (Aikins & Craske, 2001). Indeed, one longitudinal study found that childhood maltreatment was strongly related to the development of this disorder during adulthood (Moffitt et al., 2007); worrying might distract people from remembering painful childhood experiences.

Treatment for GAD

Both psychotherapies, predominately cognitive-behavioral therapy (CBT), and medications (such as SSRIs) have been shown to be effective in reducing anxiety. A comparison of overall outcomes of CBT and medication on anxiety did not show statistically significant differences (i.e., they were equally effective in treating anxiety).

To combat the cognitive and emotional aspects of GAD, psychologists often include some of the following key treatment components in their intervention plan: self-monitoring, relaxation techniques, self-control desensitization, gradual stimulus control, cognitive restructuring, worry outcome monitoring, present-moment focus, expectancy-free living, problem-solving techniques, processing of core fears, socialization, discussion and reframing of worry beliefs, emotional skills training, experiential exposure, psychoeducation, mindfulness, and acceptance exercises.

Daily experiences of a person with GAD

  • Before Treatment“I was worried all the time and felt nervous. My family told me that there were no signs of problems, but I still felt upset. I dreaded going to work because I couldn’t keep my mind focused. I was having trouble falling asleep at night and was irritated at my family all the time.”
  • After Treatment: “I saw my doctor and explained my constant worries. My doctor sent me to someone who knows about GAD. Now I am working with a counselor to cope better with my anxiety. I had to work hard, but I feel better. I’m glad I made that first call to my doctor.”

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Key Takeaways: Generalized Anxiety Disorder

On each page in the course that introduces a mental disorder, you’ll find a Key Takeaway box like this one with a small, ungraded, exercise allowing you to check your understanding of the content presented above. Try your best to guess the missing word. Once you fill in each blank, you can click “Show Solution” to reveal the correct answers.


cognitive-behavioral therapy (CBT): a form of psychotherapy that is shown to be effective for people with generalized anxiety disorder

generalized anxiety disorder (GAD): characterized by a continuous state of excessive, uncontrollable, and pointless worry and apprehension