Anxiety:

It's normal to feel anxious from time to time, especially if your life is stressful. However, anxiety and worry that are difficult to control and interfere with daily activities may be a sign of generalized anxiety disorder.

It's possible to develop generalized anxiety disorder as a child or an adult. Generalized anxiety disorder has symptoms that are similar to panic disorder, obsessive-compulsive disorder and other types of anxiety, but they're all different conditions.

Living with generalized anxiety disorder can be a challenge. Often it occurs with other anxiety or mood disorders. In most cases, generalized anxiety disorder improves with psychotherapy and/or medications. Making lifestyle changes, learning coping skills and using relaxation techniques can help.

Symptoms

• Persistent worrying
• Overthinking solutions to all possible worst-case outcomes
• Perceiving situations and events as threatening, even when they aren't
• Difficulty managing uncertainty
• Indecisiveness
• Inability to relax
• Difficulty concentrating

Physical signs and symptoms may include:

• Fatigue
• Trouble sleeping
• Muscle tension or muscle aches
• Trembling, feeling twitchy

Nervousness or being easily startled

• Sweating
• Nausea, diarrhea or irritable bowel syndrome
• Irritability

There may be times when your worries don't completely consume you, but you still feel anxious even when there's no apparent reason. For example, you may feel intense worry about your safety or that of your loved ones, or that something bad is about to happen.

Your anxiety or physical symptoms cause you significant distress in your personal or work life. Worries can shift from one concern to another and may change with time and age.

Causes

As with many mental health conditions, the cause of generalized anxiety disorder likely arises from a complex interaction of biological and environmental factors, which may include:

• Differences in brain chemistry and function
• Genetics
• Differences in the way threats are perceived
• Development and personality

Risk factors

The following factors may increase the risk of developing generalized anxiety disorder:

• A person whose personality is timid or negative or who avoids danger may be prone to generalized anxiety disorder than others are.
• Generalized anxiety disorder may run in families.

Experiences. People with generalized anxiety disorder may have a history of significant life changes, traumatic or negative experiences during childhood, or a recent traumatic or negative event. Chronic medical illnesses or other mental health disorders may increase risk.

Complications

Having generalized anxiety disorder can be disabling. It can:

• Impair your ability to perform tasks efficiently because you have trouble concentrating
• Take your time and focus from other activities
• Sap your energy
• Increase your risk of depression

Generalized anxiety disorder can lead to or worsen physical health conditions, such as:

• Digestive or bowel problems, such as irritable bowel syndrome or ulcers
• Headaches and migraines
• Chronic pain and illness
• Sleep problems and insomnia
• Heart-health issues

Generalized anxiety disorder often occurs with other mental health problems, which can make diagnosis and treatment more challenging. Some mental health disorders that commonly occur with generalized anxiety disorder include:

• Phobias
• Panic disorder
• Post-traumatic stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)
• Depression

Prevention

There's no way to predict what will cause someone to develop generalized anxiety disorder You can take steps to reduce the symptoms if you experience anxiety:

• Get help early. Anxiety, like many other mental health conditions, can be harder to treat if you wait.
• Keep a journal. Keeping track of your personal life can help you and your mental health professional identify what's causing you stress and what seems to help you feel better.
• Prioritize issues in your life. You can reduce anxiety by carefully managing your time and energy.
• Avoid unhealthy substance use. Alcohol and drug use and even nicotine or caffeine use can cause or worsen anxiety. If you're addicted to any of these substances, quitting can make you anxious. If you can't quit on your own, see your doctor or find a treatment program or support group to help you.

Diagnosis

To help diagnose generalized anxiety disorder, your doctor or mental health professional may:

• Do a physical exam to look for signs that your anxiety might be linked to medications or an underlying medical condition
• Order blood or urine tests or other tests, if a medical condition is suspected
• Ask detailed questions about your symptoms and medical history
• Use psychological questionnaires to help determine a diagnosis
• Use the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

Treatment

Treatment decisions are based on how significant generalized anxiety disorder affected your life. The two main treatments for generalized anxiety disorder are psychotherapy and medications. You may benefit most from a combination of the two. It may take some trial and error to discover which treatments work best for you.

Psychotherapy

Also known as talk therapy or psychological counseling, psychotherapy involves working with a therapist to reduce your anxiety symptoms. Cognitive behavioral therapy is the most effective form of psychotherapy for generalized anxiety disorder.

Cognitive behavioral therapy focuses on teaching you specific skills to directly manage your worries and help you gradually return to the activities you've avoided because of anxiety. Through this process, your symptoms improve as you build on your initial success.

Medications

Several types of medications are used to treat generalized anxiety disorder, including those below. Talk with your doctor about benefits, risks and possible side effects.

• Antidepressants, including medications in the selective serotonin reuptake inhibitor (SSRI) and serotonin and norepinephrine reuptake inhibitor (SNRI) classes, are the first line medication treatments. Examples of antidepressants used to treat generalized anxiety disorder include escitalopram (Lexapro), duloxetine (Cymbalta), venlafaxine (Effexor XR) and paroxetine (Paxil, Pexeva). Your doctor also may recommend other antidepressants.
• An anti-anxiety medication called buspirone may be used on an ongoing basis. As with most antidepressants, it typically takes up to several weeks to become fully effective.
• In limited circumstances, your doctor may prescribe a benzodiazepine for relief of anxiety symptoms. These sedatives are generally used only for relieving acute anxiety on a short-term basis. (Because they can be habit-forming, these medications aren't a good choice if you have or had problems with alcohol or drug abuse.)

Lifestyle and home remedies

While most people with anxiety disorders need psychotherapy or medications to get anxiety under control, lifestyle changes also can make a difference. Here's what you can do:

• Keep physically active. Develop a routine so that you're physically active most days of the week. Exercise is a powerful stress reducer. It may improve your mood and help you stay healthy. Start out slowly and gradually increase the amount and intensity of your activities.
• Make sleep a priority. Do what you can to make sure you're getting enough sleep to feel rested. If you aren't sleeping well, see your doctor.
• Use relaxation techniques. Visualization techniques, meditation and yoga are examples of relaxation techniques that can ease anxiety.
• Eat healthy. Healthy eating — such as focusing on vegetables, fruits, whole grains and fish — may be linked to reduced anxiety, but more research is needed.
• Avoid alcohol and recreational drugs. These substances can worsen anxiety.
• Quit smoking and cut back or quit drinking coffee. Both nicotine and caffeine can worsen anxiety.

Author

Michael Nunez, M.D. Dr. Michael Nunez is a primary care physician who treats patients living in the Scottsdale, Arizona area. Dr. Nunez attended the University of Arizona where he earned both his Bachelor's degree as well as his doctorate. He received his Board Certification through the American Board of Family Medicine. The doctor is an Arizona native who takes pride in working with the people of his community. The doctor began practicing medicine in 1998. In 2001, he opened Grayhawk Medical Group, PLLC, to better serve the area residents. Dr. Nunez continues to expand his education so he can better serve his patients in all aspects of treatment.