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Generalized Anxiety Disorder

It's natural to worry during stressful times. But some people feel tense and anxious day after day, even when there is little to worry about. When this lasts for six months or longer, it may be generalized anxiety disorder or GAD. This illness affects nearly seven million Americans. Unfortunately, many people don't know they have it. So they can miss out on treatments that may lead to a better life.

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GAD: Emotional Symptoms

The main symptom of GAD is a constant and exaggerated sense of tension and anxiety. You may not be able to pinpoint a reason why you feel tense. Or you may worry too much about ordinary matters, such as bills, relationships, or your health. All this worrying can interfere with your sleep and ability to think straight. You may also feel irritable due to poor sleep or the illness itself.

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GAD: Physical Symptoms

Physical problems usually come along with the excess worry. They can include:
•Muscle tension or pain
•Nausea or diarrhea
•Trembling or twitching

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GAD vs. Everyday Worries

Most people spend some time worrying about their troubles, whether money, job demands, or changing relationships. What sets GAD apart is the feeling that you can't stop worrying. You may find it impossible to relax, even when you're doing something you enjoy. In severe cases, GAD can interfere with work, relationships, and daily activities.

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Who Gets GAD?

People of any age can develop GAD, even children. The disorder tends to appear gradually, with the first symptoms most likely to occur between childhood and middle age. GAD affects twice as many women as men.

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What Causes GAD?

Genes passed down through a family may put some people at higher risk for anxiety, but that's not the whole picture. Scientists think that a mix of DNA, environment, and psychological factors are to blame. Researchers are looking at brain chemicals called neurotransmitters, as well as a pair of structures inside the brain called the amygdalae.

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Diagnosing GAD

There's no lab test for GAD, so the diagnosis is made based on your description of symptoms. It's important to be specific when telling your doctor about your anxiety. What do you worry about? How often? Does anxiety interfere with any activities? You may have GAD if you have been feeling anxious or worrying too much for at least six months.

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Treating GAD: Psychotherapy

One kind of talk therapy is very effective in treating anxiety. It's called cognitive behavioral therapy or CBT. A counselor helps you identify negative thoughts and actions. CBT may include homework, such as writing down the thoughts that lead to excess worry. You will also learn calming strategies. People can feel better in three to four months. A combination of medicine and CBT often works best.

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Treating GAD: Medicine

Some antidepressant drugs work well to lower anxiety. Brand names include Cymbalta, Effexor XR, Lexapro, and Paxil. It may take four to six weeks to feel better. Your doctor might prescribe a benzodiazepine for a short while. Brand names include Ativan, Klonopin, Valium, and Xanax. These drugs carry a risk of dependence. Another drug called Buspar can also treat GAD. Be sure to discuss the pros and cons of medications with your doctor.

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Self-Care for GAD

You can support your treatment for GAD by making a few simple changes in your habits. Avoid caffeine, street drugs, and even some cold medicines, which can boost anxiety symptoms. Try to get enough rest and eat healthy foods. Try relaxation techniques, such as yoga or meditation. And be sure to exercise; there's evidence that moderate physical activity can have a calming effect.

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Complementary Remedies for GAD

It hard to know whether any non-traditional remedies for GAD work because they have not been well researched. Massage is relaxing for most people. But one study found massage didn't control the symptoms of GAD any better than listening to your favorite music. Research into acupuncture as a treatment for anxiety has not yet shown whether it works.

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Herbal Remedies for GAD

Among herbal remedies, there is some evidence that kava may help ease mild to moderate anxiety. There's not enough evidence yet to say whether valerian or St. John's wort can help ease the symptoms of GAD. Be sure to talk with your doctor before starting any herbal remedy. Some have harmful side effects or interactions.

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GAD and Other Disorders

People who have GAD may also develop depression, alcoholism, or drug addiction. If one of these illnesses occurs, a second treatment plan may be needed. It's also common for people with GAD to have another anxiety disorder. These can include panic disorder, posttraumatic stress disorder, obsessive-compulsive disorder, and social phobia.

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Panic Disorder

People with panic disorder have sudden attacks of terror. Symptoms can include a pounding heart, sweating, dizziness, nausea, or chest pain. You may think you're having a heart attack, dying, or losing your mind. Panic disorder affects about six million American adults, and it's one of the most treatable of all anxiety disorders.

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Posttraumatic Stress Disorder

Some people develop posttraumatic stress disorder (PTSD) after living through a terrifying ordeal. Rape, abuse, physical assaults, accidents, or a natural disaster can lead to this type of anxiety. The symptoms include vivid flashbacks and a loss of interest in activities that were once enjoyable. People may also have trouble being affectionate. They may feel irritable or even become violent. PTSD affects almost eight million Americans. It's treated with medicine and counseling.

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Obsessive-Compulsive Disorder

People with obsessive-compulsive disorder (OCD) have troubling thoughts they can't control. Some people feel that they must perform senseless rituals. Common compulsions include excessive hand-washing and locking the door repeatedly. They may get dressed in a certain order or count objects for no apparent reason. Many people with OCD know their rituals don't make sense but can't stop doing them. OCD affects about two million Americans and is often treated with medication and psychotherapy.

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Social Anxiety Disorder

People with social phobia feel overly panicky and self-conscious in ordinary social situations. Symptoms include a sense of dread before social events and sweating, blushing, nausea, or difficulty talking during the events. In severe cases, people with social phobia may avoid school or work. The disorder affects 15 million American adults and can be treated with psychotherapy or medications.

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Other Phobias

A phobia is an intense fear of something that is not likely to cause you any harm. Common phobias include heights, closed-in spaces like elevators or tunnels, dogs, flying, and water. About 19 million Americans have specific phobias. Many don't seek help because the feared situation or object is easy to avoid. But phobias respond very well to a type of therapy involving desensitization.

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Where to Get Help for Anxiety

Start by discussing your anxiety with your family doctor. He or she can rule out other illnesses that can mimic GAD. If an anxiety disorder seems likely, your doctor may recommend medication and refer you to a mental health professional. This specialist should have training in psychotherapy. It's important to choose someone you're comfortable with to guide your progress as you work to feel better. 

Reviewed by Joseph Goldberg, MD on April 05, 2014

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