Generalized Anxiety Disorder

This disorder is characterized by chronic, excessive worry and fear about many aspects of life, including competence at work or school, finances, house repairs, etc. Worry may extend to family members' health or life difficulties. The individual often notices anxiety immediately upon awakening. The anxiety is so severe that it impairs the person's ability to function in social relationships or at work. Physical symptoms such as muscle tension are commonly a part of this disorder.

This diagnosis is made if other more specific diagnoses are eliminated, such as panic disorder, excessive caffeine intake, or a medical condition such as an overactive thyroid gland (hyper-thyroidism). The disorder is not caused by substance abuse; if drug or alcohol abuse is present, it is usually an attempt by the individual to self-treat the anxiety. Generalized anxiety disorder is not diagnosed if symptoms are seen only during another mood disorder or a psychotic episode. This disorder is seen approximately twice as often in females as in males. Onset in half of cases is in childhood or adolescence (overanxious disorder of childhood). It also commonly arises after age twenty. Many individuals state they have felt nervous all their lives.

History is of a high level of apprehension and fear that has been present most of the time for at least six months. The individual seems unable to control his or her worrying. In addition to anxiety, at least three of the following are reported: restlessness, becoming easily fatigued, difficulty with con-centration, irritability, muscle tension, and disturbed sleep. The symptoms result in significant impairment of occupational functioning or personal relationships.

Physical exam could reveal trembling, cold and sweaty hands, or an elevated heart rate and/or blood pressure.

Tests are not helpful in establishing this diagnosis.

Treatment can include psychotherapy, relaxation training, biofeedback, and drug therapy (usually a benzodiazepine).