Health A-Z

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Harvard Medical School

Generalized Anxiety Disorder

What Is It?

In generalized anxiety disorder, a person has frequent or nearly constant, nagging feelings of worry or anxiety. These feelings are either unusually intense or out of proportion to the real troubles and dangers of the person's everyday life.

The disorder is defined as persistent worry every day or almost every day for six months or more. In some cases, a person with generalized anxiety disorder feels he or she has always been a worrier, even since childhood or adolescence. In other cases, the anxiety may be triggered by a crisis or a period of stress, such as a job loss, a family illness or the death of a relative. Although the crisis eventually goes away and the stress passes, an unexplained feeling of anxiety may last months or years.

In addition to suffering from constant (or non-stop) worries and anxieties, people with generalized anxiety disorder may have low self-esteem or feel insecure because they see people's intentions or events in negative, intimidating or critical ways. They can have physical symptoms that may lead them to seek treatment from a primary care doctor, cardiologist, pulmonary specialist or gastroenterologist. Stress also can intensify the anxiety.

Experts believe that some people with this disorder have a genetic (inherited) tendency to develop it. The disorder probably stems from how a variety of brain structures manage the fear response:

• The amygdala receives information about threats in the environment, sizes up their significance and creates a response.

• The hypothalamus feeds the amygdala information about the body's reaction to stress (for example, heart rate and blood pressure)

• The cerebral cortex feeds the amygdala with a person's conscious observations about the environment

• The hippocampus is a storehouse of memories, some of which are fearful.

Anxiety problems may come from how these various brain regions talk to one another. The chemical messengers, gamma aminobutyric acid (GABA) and serotonin, transmit signals along the circuits connecting these regions. The medications used to treat anxiety affect these chemicals.

About 3% to 8% of people in the United States have generalized anxiety disorder. Women have the problem twice as often as men. The average adult patient first seeks medical attention between the ages of 20 and 30. However, the illness can occur at any age. Generalized anxiety disorder also has been diagnosed in young children, teenagers and elderly people. The illness is the most common anxiety disorder affecting people age 65 and older.

Of all psychiatric illnesses, generalized anxiety disorder is the least likely to occur alone. Between 50% and 90% of people with the disorder also have at least one other problem, usually panic disorder, a phobia, depression, dysthymia (a less severe form of depression), alcoholism or some other form of substance abuse.