Generalized Anxiety Disorder (GAD) is a psychiatric condition characterized by persistent and excessive worry that pervades many areas of an individual’s life. This state of worry is often disproportionate to real-life events and may be difficult to control. The person is frequently in a constant expectation that something bad will happen, which can lead to impairments in various domains ranging from social relationships to occupational functioning.

Unlike other anxiety disorders, GAD is not tied to a specific object or situation but presents as ongoing anxiety regarding general life events. The disorder may manifest with both psychological and somatic symptoms and often significantly reduces quality of life.

DSM-5 Criteria for Generalized Anxiety Disorder

According to DSM-5, the diagnosis of GAD is based on the following criteria:

• Excessive anxiety and worry about various events or activities occurring more days than not for at least six months.
• The individual finds it difficult to control the worry.
• Anxiety and worry are associated with at least three of the following symptoms (only one is required in children):
  • Restlessness or feeling keyed up
  • Being easily fatigued
  • Difficulty concentrating or mind going blank
  • Irritability
  • Muscle tension
  • Sleep disturbance (difficulty falling or staying asleep)
• The anxiety, worry or physical symptoms cause significant distress or impairment in social, occupational or other important areas of functioning.
• The symptoms are not attributable to substance use or another medical condition.

Generalized Anxiety Disorder Symptoms

Symptoms of GAD manifest on both psychological and physical levels. A persistent state of unease, combined with a feeling of lack of control over events, creates intense stress. This anxiety may appear as hypervigilance, catastrophic thinking and inability to relax.

Physical symptoms may include muscle tension, headaches, gastrointestinal discomfort, shortness of breath and fatigue. Sleep disturbances such as difficulty falling asleep or frequent awakenings are also common. Cognitive symptoms include impaired concentration, distractibility and difficulty making decisions.

These symptoms may disrupt both inner experiences and interactions with the external environment.

What Causes Generalized Anxiety Disorder?

GAD arises from an interplay of genetic, biological, psychological and environmental factors. Because of this multidimensional structure, no single cause can be identified.

Genetic predisposition plays a significant role. Individuals with a family history of anxiety disorders may be at increased risk. At the neurobiological level, imbalances in neurotransmitter systems such as gamma-aminobutyric acid (GABA) and serotonin have been implicated in anxiety symptoms.

Psychological theories suggest that inadequate coping with environmental stressors may contribute to the development of anxiety. Perfectionism, intolerance of uncertainty and negative thinking patterns are also associated with GAD.

Childhood experiences such as neglect, abuse, early losses or overprotective parenting may shape stress responses later in life and predispose to anxiety disorders.

Risk Factors for Generalized Anxiety Disorder

Several risk factors have been identified that may facilitate the development of GAD:

• Family history of anxiety disorders
• Female gender (GAD may be more prevalent in women)
• Early-life psychological trauma
• Chronic stress or traumatic life events
• Substance or alcohol use
• Low socioeconomic status
• Comorbid medical conditions (for example thyroid dysfunction)
• Personality traits such as high neuroticism

The coexistence of these factors may increase the likelihood of developing GAD, though their presence does not guarantee its occurrence.

How Is Generalized Anxiety Disorder Diagnosed?

Diagnosis of GAD requires evaluation of the duration, pervasiveness and impact of anxiety on quality of life. The diagnostic process includes a detailed psychiatric interview and history of symptoms. DSM-5 criteria form the diagnostic foundation.

Symptoms of GAD overlap with those of other anxiety disorders, depression and some medical conditions, making differential diagnosis important. Conditions such as thyroid disorders, anemia, vitamin deficiencies and substance use must be ruled out. Laboratory tests, neuroimaging and psychometric assessments may be employed when necessary.

Early diagnosis is crucial for treatment effectiveness and for preventing chronicity.

Generalized Anxiety Disorder Treatment

GAD can be managed with appropriate treatment. The treatment plan is personalized according to symptom severity, life circumstances and individual preferences. Management usually requires an integrated approach involving pharmacotherapy, psychotherapy and lifestyle modifications.

1. Pharmacotherapy

Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are considered first-line medications for GAD. Commonly used agents include paroxetine, sertraline, venlafaxine and duloxetine.

Benzodiazepines may provide short-term relief but are not recommended for long-term use due to dependence risk. The type, dose and duration of medication must be determined by a psychiatrist.

2. Psychotherapy

Cognitive Behavioral Therapy (CBT) is the most frequently used and empirically supported psychotherapy for GAD. CBT focuses on identifying maladaptive thought patterns, challenging distorted cognitions and developing functional coping strategies.

Other therapies may include Acceptance and Commitment Therapy (ACT), mindfulness-based therapies (MBCT) and psychodynamic approaches.

3. Lifestyle and Supportive Interventions

Regular exercise, balanced nutrition and adequate sleep may help alleviate anxiety symptoms. Stress management, relaxation techniques and mindfulness practices may also be beneficial.

Social support strengthens coping capacity. Family education and support groups can improve treatment adherence and long-term outcomes.

Impact on Daily Life

GAD can significantly affect quality of life in the long term. Persistent anxiety may lead to reduced academic performance, decreased occupational productivity and impaired social relationships. Daily tasks may become difficult to complete, as ongoing mental preoccupation interferes with concentration.

GAD frequently co-occurs with depression and other anxiety disorders. It may also be associated with psychosomatic conditions such as irritable bowel syndrome, migraine and fibromyalgia. If untreated, it may become chronic and lead to profound functional impairment.

Therefore, early diagnosis, integrated treatment and psychosocial support are essential for improving quality of life in individuals with GAD.