Generalised anxiety disorder: persistent excessive worry
Generalised anxiety disorder (GAD) is long-lasting, excessive worry (out of proportion to any real risk) about many everyday matters that the person finds hard to control.
Remember
Generalised anxiety disorder (GAD) is a steady background worry that is hard to control, covers many everyday matters and is there on most days over months. Panic disorder differs: it arrives as sudden, separate attacks of intense fear.
Memory aid
GAD is a dripping tap, steady worry on most days, whereas panic disorder is a thunderclap, a sudden attack that passes.
GAD is the dripping tap of steady worry, and panic disorder is the sudden thunderclap of an attack.
In generalised anxiety disorder (GAD), the worry itself is the defining feature. It is excessive, which means out of proportion to any real risk, and the person finds it difficult to control. It spreads across a number of everyday matters, such as health, money, work or family, and it is present on most days for months. It causes some impairment of function.
The worry is not tied to one object or situation, so it is sometimes called free floating. It shifts from topic to topic. It often comes with physical and mental features of ongoing anxiety: muscle tension, restlessness (feeling on edge), tiring easily, poor concentration and disturbed sleep. Formal criteria ask for symptoms to last at least 6 months.
The other anxiety disorders each have a more focused core. In panic disorder, anxiety comes in discrete (separate) attacks of sudden, intense fear, followed by worry about having another. In obsessive-compulsive disorder, unwanted thoughts (obsessions) trigger rituals (compulsions). In social phobia, the fear is of being judged.
Physical illnesses such as an overactive thyroid can mimic anxiety, so a normal examination is reassuring. Depression and anxiety often occur together, so a careful history and screening for depression are part of the assessment.
Key facts
- Core feature
- excessive worry about many everyday matters that is hard to control.
- Course
- present on most days for months, with formal criteria asking for at least 6 months of symptoms.
- Focus
- the worry is not tied to one object or situation, which is why it is sometimes called free floating.
- Physical and mental features
- muscle tension, restlessness, tiring easily, poor concentration and disturbed sleep often come with the worry.
- Contrast with panic disorder
- panic disorder is made of discrete, sudden attacks of intense fear, followed by worry about having another.
- Mimic
- physical illnesses such as an overactive thyroid can mimic anxiety.
Exam traps
- Intrusive (unwanted) thoughts that are relieved by repeated behaviours describe obsessive-compulsive disorder, not GAD, because GAD worries are about real-life concerns and are not neutralised by rituals.
- Sudden episodes of intense fear, often with palpitations (a pounding heart) and breathlessness, are panic attacks and describe panic disorder, in which anxiety comes in discrete bursts rather than as constant worry.
- Low mood with loss of interest describes depression, not GAD: the two often occur together, but low mood is not what defines GAD.
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