Generalized Anxiety Disorder (GAD)

  • Basics

    Generalized anxiety disorder (GAD) is chronic excessive worry about an array of activities or events. The anxiety of GAD is characterized by disproportionate unease, fear, or dread. The anxiety is not limited to one specific worry or concern, and it lasts longer than 6 months. Paying bills or doing laundry might trigger anxious feelings in some, whereas others will feel anxious about duties at work, or will fear that something bad will happen to a loved one. During any given year, about 3% to 5% of the adult population will suffer from GAD; however, few people with the disorder seek treatment.

    People with GAD have a sustained “fight or flight” response to stressful situations. Anxiety is a healthy response to a stressful situation. When people are in danger, their brains release hormones that prepare them to fight or run away—commonly called the “fight or flight” response. To prepare the body for action, the heartbeat quickens and the muscles tense up; blood becomes more likely to clot in case of an injury. Normally, this reaction subsides once a person no longer feels threatened. In people with GAD, however, this response is sustained over months, which can cause a host of negative effects for physical health and mental well-being.

  • Causes

    A mix of genetic and environmental factors are involved in GAD. Twin studies have shown that genes account for about 37% of the cause of GAD, while environmental factors account for about 62% of the cause.

    GAD is thought to occur when certain chemical receptors in the brain do not function properly. The brain chemical gamma-aminobutyric acid (GABA) has an anti-anxiety effect when it binds with certain receptors in the limbic system, the region of the brain that regulates emotions. If these receptors don’t allow GABA to bind, a feeling of anxiety results. Abnormalities in other neurotransmitters, such as serotonin, the catecholamines, and cholecystokinin, have also been implicated in GAD.

    An underlying psychological conflict, medical problems, or certain drugs can also cause generalized anxiety Table 01. Patients may be highly insecure and self-critical, which can lead to anxiety. Medical problems such as head trauma, brain infections, heartbeat irregularities, thyroid dysfunction, and asthma have also been linked to GAD. Prescription drugs, illegal drugs, alcohol, and caffeine can also produce symptoms of GAD.

    Table 1.  Medical and Substance-related Causes of Anxiety

    Cardiovascular Metabolic Neurologic Respiratory Medications Substances
    Heart rhythm irregularitiesHeart failure Overactive thyroid glandUnderactive thyroid glandLow blood sugar Brain infectionHead traumaSeizures Allergic reactionAsthmaChronic obstructive pulmonary disease Blood-pressure-lowering medicationsThyroid medicationsInsulin and other diabetes medications AlcoholCaffeineCocaineAmphetamines

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