Generalized anxiety disorder

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Everyone is afraid sometimes. When danger threatens, anxiety has an important protective function: it puts the body on alert so that it can react quickly. But worries and fears about the future, work or family can also be protective: For example, from acting carelessly and getting into a difficult situation.

However, when fears get out of hand, they can become a burden. Affected people then worry almost constantly and about all kinds of things. If anxiety overshadows everything and doesn’t go away at all, a generalized anxiety disorder (GAS) may have developed. Those who have this anxiety disorder usually know that their fears exceed a natural level, but are unable to control them. It is difficult to overcome this condition on one’s own. However, various treatments can help.

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Generalized anxiety disorder can manifest both psychologically and physically. Psychological complaints include persistent, unrealistic and exaggerated fears. Anxiety affects different areas of life. They are not a reaction to a threat, nor are they limited to specific things or situations. Because the anxiety can relate to all kinds of things or can no longer be associated with specific occasions, experts speak of "generalized" anxiety.

For example, people with generalized anxiety disorder may feel anxious that their partner might have an accident on the way to work. The next moment, they fear that their child will get run over on the way to school; then, that they might lose their keys; and finally, that they will have a heart attack the next day. You worry about practically everything – both big and small, and even about completely trivial things. Many also fear anxiety itself or worry about worrying all the time. The constant fears significantly limit daily life and can darken the mood. Especially if there is concurrent depression, an anxiety disorder can increase feelings that life is no longer worth living.

In response to anxiety, the adrenal gland releases the hormone adrenaline. It speeds up many bodily functions – usually to increase alertness and responsiveness in the short term: The heart beats faster, breaths become short and shallow. In people with generalized anxiety disorder, this usually brief physical state of alarm, with palpitations or heart palpitations and shortness of breath, often lasts longer. It is then experienced as very unpleasant.

Possible other symptoms include lightheadedness, nervousness or dizziness. Trembling, sweating, muscle tension and stomach problems are also common.

Being constantly anxious is exhausting and can lead to concentration and sleep problems.

If anxiety only occurs in certain situations, it is probably not generalized anxiety disorder. Sudden-onset panic attacks are also not a feature of generalized anxiety disorder, but they can sometimes be added to it.

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The causes of generalized anxiety disorder are not yet fully understood. Probably both physical and psychological factors play a role. Some people with an anxiety disorder have experienced severe trauma, loss, or many stressful experiences in childhood or later in life, such as severe family stress or ongoing extreme workloads.

Sometimes a life crisis can cause anxiety that develops into generalized anxiety disorder. There is also evidence that anxiety disorders are more common in some families. Sometimes an anxiety disorder is a consequence of another disorder – such as depression or panic disorder , or it is related to an addictive disorder. However, it can also occur for no apparent reason.

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Generalized anxiety disorder is a common anxiety disorder. It is estimated that about 5% of all people will receive this diagnosis in their lifetime . Women are affected twice as often as men. Anxiety disorders usually begin in middle adulthood – but sometimes also in childhood or in old age.

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Normally, a generalized anxiety disorder develops slowly. Anxiety and possible physical symptoms, such as rapid heartbeat, do not initially stand out as signs of illness. Only gradually do the complaints increasingly restrict everyday life and well-being.

A full-blown anxiety disorder can be very persistent. It often takes many months or years to overcome it. Until then, however, sufferers also experience periods of less severe anxiety.

In one study, about one in four patients had overcome the anxiety disorder after two years. In the long run, however, many people manage to overcome their anxiety. It often declines with age anyway.

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The symptoms of generalized anxiety disorder can resemble those of other mental illnesses such as phobias, panic disorders or obsessive-compulsive disorders. In addition, many sufferers also have symptoms that are more consistent with depression.

The possible physical symptoms of generalized anxiety – such as palpitations – also occur in conditions such as hyperthyroidism or can be triggered by certain medications and drugs such as amphetamines ("speed").

Therefore, diagnosing a generalized anxiety disorder can be difficult and take some time – especially if you first seek help for the physical symptoms, perhaps even in the emergency room. Sometimes only a physical symptom of the disorder is then treated, or only a single symptom such as sleep disturbances. However, through initial discussions in the context of psychotherapy, professionals are able to make the correct diagnosis. A "generalized anxiety disorder" is diagnosed when fears are

  • last for at least six months and persist most days during this time,
  • become uncontrollable,
  • are so distressing that they interfere with everyday life and
  • when associated with at least three physical symptoms-such as accelerated pulse, tremors, muscle tension, or stomach upset.

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There are various ways to get a better grip on an anxiety disorder over time. These include:

  • Psychological and psychotherapeutic treatments: This includes methods such as cognitive behavioral therapy . With their help, you can learn to control and change your thoughts and fears.
  • Relaxation procedures such as autogenic training or progressive muscle relaxation, as well as Breathing exercises can help to relax and cope better with stress. They are also often used as part of psychotherapeutic treatments.
  • MedicationFor anxiety disorders, certain antidepressants may be used. Some people also use herbal sedatives based on valerian or chamomile.
  • Self-helpSelf-help groups offer the opportunity to exchange information with other sufferers. Some people also find it helpful to be well informed about the condition – whether with books, brochures, or on the Internet.

Although no treatment method can be expected to provide a quick and easy "cure" – the various procedures can ensure that symptoms are alleviated and that one can cope better with anxiety. This is often noticeable after a few weeks. With patience and the help of a therapist, many people are able to overcome their anxiety disorder over time.

More knowledge

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Many people with generalized anxiety disorder experience the disorder affecting their daily work and personal relationships. For some, anxiety causes them to call in sick more often, for example. Many try to hide their anxiety and therefore withdraw from other people. Some then stay at home a lot, where they feel safe. They thus try to avoid situations that could increase their anxiety and trigger or intensify physical symptoms.

It is often very difficult to deal openly with an anxiety disorder. Many hardly succeed, or only with a trusted person. With therapeutic support, however, it is often possible to open up to family members, for example, and to inform them about one’s own illness. Seeking professional support, as well as help in a personal environment, is felt by many to be an important step in coping with anxiety. Many people also find it helpful to remain as active as possible in everyday life despite anxiety – for example, by exercising or taking care of other people.

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Bandelow B, Boerner RJ, Kasper S et al. Generalized anxiety disorder: diagnosis and treatment . Dtsch Arztebl Int 2013; 110(17): 300-310.

German Society for Psychosomatic Medicine and Medical Psychotherapy (DGPM). S3 guideline: treatment of anxiety disorders . AWMF Register No.: 051-028. 2021.

Gale CK, Millichamp J. Generalised anxiety disorder . BMJ Clin Evid 2011: pii: 1002.

Hoge EA, Ivkovic A, Fricchione GL. Generalized anxiety disorder: diagnosis and treatment . BMJ 2012; 345: e7500.

National Institute for Health and Care Excellence (NICE). Generalised anxiety disorder and panic disorder in adults: management . (NICE Clinical guidelines; No. CG113). 2019.

IQWiG health information is intended to help people understand the advantages and disadvantages of important treatment options and health care offerings.

Whether one of the options we have described is actually useful in an individual case can be clarified in a conversation with a physician. Health can support, but not replace, talking with doctors and other professionals. We do not provide individual advice.

Our information is based on the results of high quality studies. They are written by a team of authors from the fields of medicine, science and editing, and peer-reviewed by experts outside IQWiG. How we develop our texts and keep them up to date is described in detail in our methods .

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Updated on 16. June 2021
Next planned update: 2024

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