Generalized Anxiety Disorder (GAD): Symptoms, Causes & Effective Treatments
Anxiety has become a mainstay in our vernacular over the years, and yet, maintains an almost mystical quality in its definition, symptoms, and best ways of dealing with it. I think it is high time to look at it closer from a clinical lens. If you were in my office discussing the topic of anxiety, we wouldn’t start with subjective, pop-culture language on what it is, we would be digging into exactly what you were experiencing, classifying it, and then making a plan to overcome it. We would start with your current lived experience, whether that is lying awake at 2 a.m., replaying something you said three years ago at that party, already rehearsing tomorrow’s meeting, mentally inventorying your bank account, your relationships, your health, and your to-do list all at once; If that feels a little too familiar, you might be dealing with Generalized Anxiety Disorder (GAD). This is a very treatable condition that shows up differently than a big panic attack, rather it shows up as a constant background hum of “what if?” In this article, I want to walk you through the foundational pieces I wish everyone with GAD (or suspected GAD) knew: what it actually is, what causes it, and what really helps.
What Is Generalized Anxiety Disorder?
Generalized Anxiety Disorder is one of the most common anxiety disorders individuals seek treatment for. In the U.S., about 2–3% of adults experience GAD in any given year, and a significant portion of those adults describe their anxiety as moderate to severe in terms of the severity of negative impact on their daily life. The National Institute of Mental Health can help us understand that anxiety disorders,, as a group, are widespread, and yet only about one in four people with an anxiety disorder get any kind of treatment.
To go into a little more detail, and to provide some further understanding, let’s run through the Generalized Anxiety Disorder 7 item screen (GAD-7), which is a tool the vast majority of mental health clinicians will ask their clients to fill out on a semi-regular basis. If you want to mess around with a freely accessible version of it, I found this one when searching around, which may help make this article feel a little more real to you.
What I find most helpful when I am walking clients through GAD, is to break down the diagnostic criteria one by one, and to clarify things as we go, so why not do the same process here. Within the DSM-5, you need to hit certain criteria to qualify for the diagnosis. Here are those explained as it is stated within the DSM-5 (if you’re really adventurous and have the DSM-5 with you, go ahead and crack that bad boy open to page 222 and follow along):
A: Excessive worry and anxiety that happens more days than it does not, for at least 6 months in a row. This worry and anxiety can be about any number of events or activities.
B: The person finds it difficult to control the worry that comes their way.
C: The anxiety and worry you are experiencing are associated with at least 3 of these (only 1 is required for all of my peeps under 18):
A sense of restlessness, or a feeling of being on edge, or on guard.
You get fatigued easily.
It is very hard to concentrate, or you feel like your mind just goes blank.
Irritability.
Your muscles as all tense and tight.
Sleep disturbance, which could be falling asleep, staying asleep, sleeping too little, or sleeping way too much.
D: All of the above symptoms of worry, anxiety, or physical disturbances are causing clinically significant distress or impairment in your social life, at your place of work, or any other very important areas of your life.
E: The above disturbances are not because of some other issue, like alcohol, ADHD, or some underlying medical condition, etc.
F: The above disturbances are not because of any other mental health related disorder, like depression, panic disorder, BDP, etc.
How Generalized Anxiety Disorder (GAD) Actually Feels
Now that we have a baseline understanding of what clinicians are looking for on paper, let’s dig into what I personally start to look for in sessions intuitively. If a client is coming into my office and they are experiencing symptoms like catastrophizing, rapid conclusion making, rumination (especially around their performance), a feeling of impending doom, hypervigilance, blowing small decision up into huge decisions, or they describe themselves as “too aware” I know I have a great candidate for GAD on my hands. So many of my clients express that they feel like they can get through things, but they’re exhausted all the time, to which I can empathize with as a former high anxiety individual who used to crunch the magical, fantastical numbers of probability over things I could not control constantly. A lot of people experiencing the above symptoms may even appear like they are operating at an extremely high capacity, and they might be, but I will wager that their internal systems are all running around like they are on fire.
Another very important thing to note is that GAD is not just your run of the mill instance of anxiety. I think that because we are flooded with information constantly, we have come to think that we may have an anxiety disorder just because we experience some anxiety, which is far from the case. We need to do a better job as clinicians at helping people understand that diagnoses like these are reserved for chronic or acute cases (in the case of GAD anyway, remember, it has to be for at least 6 months or more ongoing). For example, all of us will and have experienced normal worrisome tasks in our life, whether that be a big exam, or a work deadline to name a couple. But those worries come and go, they are very contextually constrained, and once they are over, so is the worry… or at least mine was, especially in college, but that’s neither here nor there. In comparison, something like GAD almost feels sticky. It’s hard to get off, you feel like you cannot quite shake it. It is a new roommate up in your head, and it really likes to tag along to almost everything you do.
I also want to note here that Generalized Anxiety Disorder (GAD) is just one of many anxiety-based disorders out there, and we also need to do a better job of separating diagnoses from one another for our clients, as they all present with their own unique flavor of symptomology, timeline, etc. For example, let’s take a look at other anxiety-based disorders, Panic disorder, Social anxiety disorder and Obsessive-compulsive disorder (OCD). For the sake of this article, I am only going to point out a few differences, but they are to illustrate that even if we change one variable, all of a sudden the diagnosis will change. For Panic disorder, we would see much more acute instances of fear (panic attacks), that would include heightened physical symptoms like chest pain, difficulty breathing, or an acute fear of dying. For Social anxiety disorder, we would see someone that is really struggling with fear related to outside judgment, embarrassment, or rejection from different social settings and groups. Finally, from the OCD crowd, we would see individuals dealing with a situation in which if they were not able to complete their compulsion, something awful is going to happen, which creates this sequence of obsessing over the compulsions. Now, can GAD overlap with these issues? Absolutely. But I usually explain to people that Generalized anxiety disorder is just that, highly generalized, chronic, and feels like your nervous system is constantly turned on.
Where Does Generalized Anxiety Disorder Come From?
If anyone ever tries to give you a single answer for any questions like this, including me, don’t listen. There is way too much nuance regarding how these types of disorders form over time to say with any sort of authority that there is one singular genesis point. Instead, I always try to think of these disorders as a grand collection of times where our nervous systems perceived danger within our environments, whether that was at home, at school, at grandmas, etc., and felt like to feel fear for those things was the answer so that we could distance ourselves from that danger. To nerd out a little, I want to go ahead and expand on this for my fellow more information kind of people, and by the way, if you consider yourself one of those, it might not be an accident you’re here.
If there is no one single way GAD forms, where can we start to look to help us understand our issue? Great question. Where I always start with clients is by giving them the difficult answer that there is no way for me to really know that with any sort of certainty, as we are all different, but… we can try our best to look at where yours, the client’s, would be coming from. I start that investigation with my clients in the age old concept of nature vs. nurture, genetics vs. environment, and well, I have always very much yelled, WHY NOT BOTH?!
Excuse my outburst, here’s some actually helpful information… it is our current understanding that genetics and biological factors definitely play a part in an individual’s likelihood of being predisposed to develop Generalized anxiety disorder. Let’s start with genetics. What we know about GAD, currently, is that it tends to run within families. There are currently some very interesting studies on twin siblings and within families that suggest GAD is at least moderately heritable (Ohi et al, 2025), with around 30-40% of the risk of developing GAD was linked to genetic factors that are also shared with other anxiety and mood disorders (Gottschalk & Domschke, 2017), (Hettema, et al., 2001).
Secondly, I wanted to spend some time speaking on potential psychological factors that can effect the likelihood of developing Generalized anxiety disorder. It is no secret that a large number of us do not like the feeling of uncertainty. It is this void that keeps us up at night. That discomfort we feel, if left unchecked, can manifest itself into an intolerance of that uncertainty in life. If this intolerance develops, fear is there to try and protect you from all of the frightening outcomes it can imagine, and then it tries to sell you on the potency of the danger ahead of you. Another psychological marker I look for when people come into my office is when they are very cognitive people. Highly cognitive people are one foot in the door to anxiety already, and if left vulnerable to things like all or nothing thinking, catastrophizing, or a learned sense of high pressure of their performance, it becomes extremely hard to turn that off, as we become reliant on that anxiety to give us answers.
Additionally, our environment and lifestyle can exacerbate all of these issues. If someone is experiencing a period of chronic stress, their nervous system is already taking a beating, and will have much less availability to be resilient in the face of anxiety over time. What if we amp up that chronic stress to 11/10 and we talk about emotional trauma, both shock and developmental in nature. When trauma is present, all bets are off, as we needed to survive that situation. Under those circumstances, our body is beyond the limits of what it can emotionally tolerate, and our body operates on instinct. That event can then live within us as a silhouette of danger we eternally protect ourselves from, and anxiety is the one stationed at the top of the watch tower, refusing to abdicate its post. If we take all of those factors and then layer on poor sleep, no exercise, low to no socialization, and eating like shit, oh yeah, Generalized anxiety disorder is eating very well.
Lastly, I feel it is also important to mention the social and cultural factors that can influence an individual’s susceptibility to Generalized anxiety disorder. The amount of influence our current socio-cultural climate has on our anxieties could not be higher. With the sheer volume of messaging we are intaking from social media and other media outlets, it almost feels inescapable. For example, right now, productivity culture is extremely popular. What is that does not work for you? What if you work in a completely different way? The potential for negative internalizations is extremely unsettling, and is one of the main concepts I battle against in sessions. This does not even begin to speak on different gendered aspects, as well as different sexual orientations. There are so many factors at play here that it would be too much to handle in this article alone, so more will be coming soon to flesh out these concepts a little more.
Evidence-Based Treatments for Generalized Anxiety Disorder
We have spent some time describing what GAD is, and where it can potentially come from, but what on earth can we do about it? Well, it turns out, there is a lot we can do from a clinical (maybe a little optimistically biased) lens. Now, there are hot debates all over the internet of what clinicians should and shouldn’t practice, but that does not matter, ignore them. They are all just trying to buy status points within their groups, and want your business. What we currently know and understand on mass is that Cognitive Behavioral Therapy (CBT) is the current poster child for Generalized anxiety disorder. The reason being is that CBT can help individuals tap into both top down level processing: mapping things out, making a plan to deal with the anxiety, confronting the negative thoughts that come into your life and trying to reason with them, or even drum up hypotheses to put them to the test, as well as, bottom-up processing which involves behavioral adjustments, attuning to your body and it's needs, and choosing to walk towards the anxiety, rather than avoid it at all costs.
Other approaches that people have found effective for Generalized anxiety disorder include approaches like Acceptance and Commitment Therapy (ACT), where the goal in sessions is to focus less on getting rid of your anxiety and trying to make it disappear, and to turn your focus towards making healthy room for your emotions while you move closer and closer to the congruent version of your authentic self. In reality, there are so many approaches that can help with anxiety, but these are the two most known. I personally use Dialectical behavioral therapy and Eye Movement Desensitization and Reprocessing (EMDR) to help people tackle their anxieties, but that’ s just what I like - everyone will have their preferences.
What about medication? Another question I get all the time, and a very important one to take some time to look at as well for treatment. Once again, before I say anything else, the reality is that if they help you, they help you, do not let someone rain on your parade just because of their biases. Anyways, for most of us, when any symptoms get too severe, to the point where they are disrupting your daily life, it is worth consulting an expert about it. Always consult a psychiatrist or your primary care provider about your anxiety symptoms if you are feeling them. What is the point of your choice to suffer through something that can be treated effectively with medication? What do we win at the end of that game? I am not here to give you medical advice, I am here to start poking your sense of curiosity, so… if you’re struggling, go ask for help.
Now lets talk a little about the boring stuff no-one, including myself actually want to do - lifestyle changes. Anxiety feeds off of disruptions and inconsistencies in your life. When it grows strong enough from them, it gains a voice, and that voice begins to channel fear and doubt into your life. I never want to see that happen to anyone, so, we have to talk about the mundane things we just gotta do. Firstly, you have to get good quality sleep. If you take nothing else from this article, and you just dump all the rest out, this is the only piece I would require you to keep. Without proper sleep, our brain cannot function, period. Every time you decide to forgo that quality sleep, your nervous system pays the price. Maybe I am just become a grumpy old man, but I cannot fathom sacrificing sleep for many things these days, as I know when I wake up, I expressed love towards myself by allowing all of me to recover and repair. If you’re not sleeping, you’re not recovering. If you’re not recovering, you cannot move around as well, which is our next mandatory habit. Your body was designed to move, it was not designed to resign itself to a sedentary lifestyle behind a computer screen where it sits and is in energy jail. My rule in the beginning for people is that every hour they should find a way to move, or at the very least, check in with their body.
To expand upon this a little further, I will just give you some things to do below. Try them for a week straight, if they don’t work, feel free to leave a comment as to why the advice sucked and why I am a shitty clinician.
No caffeine or other stimulants (unless medically prescribed) past 2:00 pm.
No alcohol
No screen-based technology in the bedroom, you’re there to rest and sleep, not be stimulated, unless, ya know, nvm… you know what I am saying, but that doesn’t involve screens anyway.
You get 1, and only 1 social media scroll session a day. Choose your time wisely, and limit it to around an hour at max.
No more using your phone as an alarm clock, go out and get an old, loud ass alarm clock and put it as far away from you as possible to where you have to physically get up and turn it off. We have to make your schedule consistent, and hitting snooze will kill your inertia for the day.
How to Support Yourself or Someone You Love Experiencing GAD
To support yourself, you have to make things visible and vulnerable. You have to begin naming the things that are affecting you in a negative way. The reason being is that stigma and shame live and grow within the darkness of our own avoidance. We have to put our own struggles into the world to be seen and heard by others. Once we allow ourselves that freedom, we can unshackle ourselves from the burden of shame and all its limitations on our progress. Once you have made that decision, seek out professional help. That does not have to be with me, that could be with anyone qualified to address this issue with you, as their whole job is to work themselves out of one (at least that’s what I am attempting to do with all of my clients, ironically enough). If you are looking for a place to start, go look at Psychology Today. They have a giant database of providers all over the country, you will find someone that fits.
What I would begin to encourage you to do, which I encourage all of my clients to think about eventually is that all of your emotions are at some level, trying to help you. You may think, much like I did when I first heard that, that there’s no way all of this anxiety could be trying to help me, I am miserable! Well, I never said it was doing a good job, but it is trying. Most of the time, the age at which we learn these emotional responses are so very young, and that version of yourself may be the one attempting to intervene. So, instead of treating your anxiety with hatred, frustration, shame and embarrassment, try to invite it into your life with curiosity and empathy instead. For example, instead of saying things like, “why the hell am I like this?” ask things like, how is anxiety attempting to help me right now? What does it think the danger is, and through who’s eyes are they seeing that?” Gain perspective on your experience with kindness and humility, not with fear and paranoia.
On the other hand, if someone else you know is going through this kind of anxiety in their life, so much of the above applies to them as well. However, I want you all to remember that it is cool to offer support, but don’t force yourself upon people, they will resent it, no matter the intention behind it. If someone you love tells you they are struggling with anxiety, you have just entered into a very important moment of vulnerability. I do not want to undersell what I am about to say, as this is sometimes the only chance you will get with some people when they open themselves up for help; but you need to believe them, and you need to let them have the space they need. Do not try to fix anything right now, unless they are asking that of you. In the beginning, your job is to hold space, and to validate their experience, that is all. If there is space to ask questions regarding how they are best supported, do that, let them tell you what is best for them, don’t ever assume. Believe me, you will get it wrong. Everyone gets it wrong, including me - hence why I have learned to stop guessing. If they are in a crisis situation, reach out for immediate assistance, that is what the professionals do, so don’t expect yourself to do things experts in the field don’t. You are only one person, but you can do so much to help people, but you should never be expected to handle a mental health crisis of any kind all alone.
Moving Forward
There are times that Generalized anxiety disorder can feel like it is a forever diagnosis, but I am here to tell you it is not. I work with people every day who are moving past their diagnoses and are at a place where they are not even close to meeting criteria for it again. With the right support, this too is just a temporary obstacle in your way. You are never your struggles, you are never your diagnosis, life is too large for simple definitions like that. You are a vastly unique and complex person that is dealing with an issue that attaches itself to that very complexity and tries to get it form via fear. We are here to help paint a different direction to go. Regardless, the final thing I would leave you with is that your life is a canvas of ever increasing complexity, instead of shying away from that, learn to dive into it, explore it for all of its potential. Then, and only then can you ever know what you are capable of.
