Everyone worries sometimes. Worry before an exam, a job interview or a medical test is normal and can even be useful. Generalized anxiety disorder (GAD) is different: the worry is excessive, hard to control, spills over into many areas of life, and goes on for months. GAD is common and highly treatable, but many people live with it for years before getting help.
What generalized anxiety disorder looks like
GAD is diagnosed when excessive worry about everyday things, such as work, health, money or family, happens on more days than not for at least six months, is hard to control, and comes with at least three of these symptoms (one for children):
- Restlessness or feeling on edge
- Getting tired easily
- Difficulty concentrating, or the mind going blank
- Irritability
- Muscle tension
- Sleep problems, such as difficulty falling or staying asleep
People with GAD often know their worry is out of proportion but feel unable to switch it off.
Physical symptoms
Anxiety is not only in the mind. GAD often causes:
- Headaches and muscle aches, especially in the neck and shoulders
- Stomach problems, nausea or irritable bowel symptoms
- A racing heart or palpitations
- Sweating and trembling
- Shortness of breath
- Feeling dizzy or light-headed
Because these symptoms overlap with physical illness, many people see doctors repeatedly before anxiety is recognized.
How it affects daily life
GAD can lead to avoiding situations, seeking constant reassurance, over-planning, checking, procrastinating, and difficulty making decisions. It often occurs alongside depression, panic disorder, insomnia or alcohol use problems.
Causes and risk factors
GAD usually results from a mix of factors:
- Genetics and family history of anxiety
- Temperament, such as being more sensitive to threat or uncertainty
- Life experiences, including childhood adversity, trauma and long-term stress
- Health conditions and some medicines
- Substances, including caffeine, alcohol withdrawal and stimulant drugs
Conditions such as an overactive thyroid, heart rhythm problems and anemia can mimic anxiety, so your doctor may check for them.
Keep reading
The rest of this guide is free. Watch a short ad to unlock it and support independent health writing.
Preparing your ad…
Screening and diagnosis
Doctors often use the GAD-7, a short seven-question questionnaire, to measure anxiety severity. The U.S. Preventive Services Task Force recommends screening adults under 65 for anxiety, including during pregnancy and after childbirth.
Treatments that work
Cognitive behavioral therapy (CBT)
CBT is one of the most effective treatments for GAD. It helps you:
- Recognize patterns of worry and challenge catastrophic thinking
- Tolerate uncertainty rather than trying to eliminate it
- Reduce avoidance and reassurance-seeking
- Learn practical skills such as problem-solving and relaxation
Therapy typically involves 12 to 20 sessions. Online and app-based CBT programs are also effective for many people. Acceptance and commitment therapy (ACT) and mindfulness-based approaches have good evidence too.
Medication
- SSRIs (such as escitalopram and sertraline) and SNRIs (such as venlafaxine and duloxetine) are first-line medicines. They usually take two to six weeks to help and are generally continued for at least 6 to 12 months after you feel better.
- Buspirone is another option that does not cause dependence.
- Benzodiazepines (such as alprazolam or lorazepam) work quickly but carry risks of dependence, withdrawal and drowsiness. They are generally used only short term, if at all.
- Pregabalin and hydroxyzine are sometimes used.
Do not stop medication suddenly. Your doctor can help you reduce it gradually when the time is right.
Combining treatments
For moderate to severe GAD, therapy plus medication often works better than either alone.
Self-help strategies
- Exercise regularly. Aerobic exercise reduces anxiety symptoms and improves sleep.
- Cut back on caffeine, which can trigger or worsen anxiety.
- Limit alcohol. It may relieve anxiety briefly but makes it worse over time.
- Practice slow breathing and progressive muscle relaxation.
- Schedule “worry time.” Set aside 15 minutes a day to write down worries, and postpone them outside that window.
- Keep a regular sleep routine.
- Stay connected with people you trust.
- Limit news and social media if they fuel your worry.
When to get help
See a doctor or mental health professional if worry is affecting your work, relationships or sleep, if you are avoiding things you used to do, or if you are relying on alcohol or drugs to cope. If you are in crisis or thinking about harming yourself, call or text 988 to reach the 988 Suicide & Crisis Lifeline in the United States.
The bottom line
Generalized anxiety disorder is more than ordinary worry. It is a common, real condition that responds well to treatment. CBT, medication or both help most people feel significantly better, and simple daily habits support recovery. You do not have to wait until anxiety is unbearable to ask for help.
This article is for general information and does not replace professional advice. If you are in crisis, call or text 988 in the U.S.