Generalized Anxiety Disorder (GAD)

The central defining feature of GAD is excessive and uncontrollable worry. People with GAD worry about a wide range of things, including personal safety, finances, relationships, and their health. Whatever the focus of their worries, the form of the thoughts remains the same: "What if…(fill in imagined negative outcome here)." The worry is persistent, and tends to wear the person out, resulting in difficulty sleeping, fatigue, muscle pain, and a variety of other problems.

GAD is regarded as the most "basic" of the anxiety disorders, and studies of its prevalence have found that about 5 percent of people will meet the criteria for GAD at some time in their lives. According to the DSM-IV, you meet the criteria for GAD if you:

  1. Experience excessive anxiety and worry more days than not for at least 6 months about a number of events or activities.
  2. Find it difficult to control the worry.
  3. Experience three or more of these symptoms in association with the worry:
    • restlessness or feeling keyed up or on edge
    • being easily fatigued
    • problems concentrating
    • irritability
    • muscle tension
    • sleep disturbance

In order to meet the criteria for GAD, it is also necessary that the focus of your worries not be limited to the symptoms of some other disorder (for example, only worrying about weight gain as in Anorexia or only worrying about having a serious illness as in Hypochondriasis). In addition, the anxiety and worry or the physical symptoms must cause "clinically significant" distress or impairment in important areas of day-to-day functioning. Finally, GAD is only diagnosed if these problems are not better explained as the result of drugs or medications or of some other medical or mental condition.

Research suggests that people with GAD have a low tolerance for uncertainty, and that worry may be an attempt to reduce uncertainty about the future by anticipating and rehearsing the future in their thoughts. Rather than focusing on one worry topic for an extended period of time, people with GAD often move from one topic to another. It seems that when anxiety about topic A becomes intolerable, the person with GAD will escape from that anxiety by switching to topic B, and worrying about that. People with GAD may also engage in "meta-worry", which is worry about worrying.

Most individuals with GAD report that they avoid certain situations which they associate with worry. This might include social situations, separation from loved ones, or traveling. People who meet the criteria for GAD tend to visit their family doctors and medical specialists more often, and are more likely to have other anxiety and mood problems, like social anxiety, panic attacks, and depression. Researchers have found that GAD is unlikely to go away on its own, and is more chronic and enduring than other anxiety disorders. The Worry Trap is a step-by-step guide to understanding GAD and applying skills derived from CBT and ACT to change the role of worry in your life.