Generalized anxiety disorder, or GAD, is an anxiety disorder that affects an estimated 1 in 12 people in their lifetime, according to a recent Canadian survey. People with GAD worry excessively and uncontrollably about numerous daily life events and activities rather than specific triggers. They often experience uncomfortable physical symptoms, including fatigue and sore muscles, and they can also have trouble with sleeping, concentrating, and getting easily irritable. Individuals with GAD are often described as being "allergic" to uncertainty, and will take significant effort to avoid certain triggers or use certain strategies to "make sure" their fear does not come true.
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Recognizing generalized anxiety disorder: Do I have it?
Trina is a 28-year-old accountant who recently started her first job after graduating with good marks and high performance evaluations. She lives with her 2 cats and her best friend. Trina has always been an anxious person. She describes herself as a "worry wart", and her friends and family often tell her she worries too much. During high school, she found it very difficult to control her worries, which included worrying about being on time for class or appointments, her grades, losing her friends, making her parents angry, her appearance, whether her teachers liked her, and which university she would attend. Since then, she has also worried a great deal about whether her boyfriend will leave her, the health of her cats, her work performance, her weight, and having enough time in the day to get everything done.
Trina has great difficulty controlling these worries, and they often intrude when she is trying to relax alone at the end of each day, during down time at work, and when out with friends. She always feels exhausted and has constant muscle tension and body aches. She notices that she is frequently irritable (e.g., she snaps at her roommate and boyfriend inappropriately).
Trina can't remember when she last felt relaxed, since she seems to always feel jumpy, tense, and on guard for something bad to happen. For the past 6 months, she hasn't been sleeping very well. She often lies in bed worrying for several hours, wakes frequently during the night, or wakes up too early and can't fall back asleep. On days when her worrying is really bad, she has difficulty concentrating at work and several friends have commented that she often seems distracted.
Trina also checks her work excessively even though it means she often has to work late. She also asks her friends or family what they think about her appearance or other worries until they get frustrated with her. Trina knows her worry is a problem but is concerned that if she stopped worrying, everything would fall apart or get worse.
Donald's story
Donald is a 54-year-old pulp and paper mill employee who lives with his wife of 30 years. He has 3 adult children and 7 grandchildren. Donald started having problems with worry early on in his marriage after he and his wife started having children. At that time, he would worry excessively and uncontrollably about his children and their futures, but also about money, his job security and performance, repairs around the house, and his parent's health. Since then, he has also worried about the car breaking down, his grandchildren being harmed, saving enough for retirement, his own health, and his wife's health.
Donald's worry has interfered with his ability to enjoy his life, including holidays and special occasions. He says that he always feels tense, restless, and on guard, and that his back and neck constantly ache from the tension. He has turned down multiple promotions at work because of his worry, since he feels that he couldn't handle the increased stress and responsibilities. His worrying has also prevented him from exploring other jobs outside of the mill; he worries about potentially failing at another job, and losing the family home as a result.
Donald's worrying has also led to long-term problems falling sleep. He has become dependent upon sleeping pills, and still feels fatigued most days. Friends and family complain that he is always on the go and never sits still, but he says that this is the only way he knows to block the worries from his mind. Sometimes when worrying, he thinks about his grandchildren being injured or harmed. On a few occasions, these worries have been so upsetting that they triggered a panic attack.
During times of stress, such as his daughter's recent divorce, Donald finds that his worries not only increase in frequency and intensity, but that they are also more severe than the worries of other people. After a bad period of worry, he often feels depressed for weeks afterward, and can lose interest in activities that he normally enjoys. Donald feels envious of the enjoyment and relaxation that other people seem to get from life, and he often feels hopeless when it comes to managing his worry. He is very concerned that he might develop health problems because of his worry and anxiety.
What does "worry" look like?
Worry involves thoughts about negative events that might happen in the future. It usually begins as a "what if" question:
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What if I'm caught in traffic and late for work? My boss might be angry with me, and he might even fire me! What if I can't find another job and my friends and family think that I'm a failure?
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I have to buy new curtains for the kitchen; what if I buy some curtains and then I find better ones or cheaper ones later on? What if I buy new furniture at some point and the curtains I bought don't match the furniture anymore?
What is "excessive and uncontrollable" worry?
Obviously, everybody worries from time to time. This is normal. But worry becomes a problem when it happens almost every day, and becomes "excessive" and "uncontrollable". What this means is that people with GAD worry too much, they worry more than others would, and they find it hard to stop worrying once they start. Some good questions to ask yourself if you think you might have GAD include:
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Do I worry a lot more than other people do?
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Do people tell me that I worry too much?
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Do I worry even when everything is OK? (For example, do I worry about my family's health even when no one is sick?)
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Do I often try to keep busy or distract myself as a way to avoid worrying?
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Is it very difficult for me to stop worrying once I start?
What do people with GAD worry about?
For the most part, people with GAD worry about the same things that others worry about, they just worry more and more often than other people.
Some common GAD worries include:
Worries about minor matters, such as punctuality and small decisions
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"What if I'm late for my appointment?"
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"What if I go see this movie and I don't like it? What if there is a movie that I would like better?"
Worries about work or school, such as exams, performance at work or in class
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"What if I failed my test?"
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"What if I choose the wrong career path?"
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"What if I don't finish this report on time?"
Worries about friends and family, such as relationships, getting along with others
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"What if my parents get divorced?"
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"What if my child gets injured while playing hockey?"
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"What if I choose an outing for some friends and no one enjoys themselves? What if they blame me for not having a good time?"
Worries about health; for example, personal health or the health of loved ones
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"What if I get cancer or some other serious disease?"
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"What if my husband gets into a car accident?"
Worries about the future and the world; such as the environment, war in the world
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"What if there is a hurricane in my city?"
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"What if in 20 years I don't have enough money to retire?"
What does GAD feel like in the body?
Although the main symptom of GAD is worry, most people first notice the discomfort they feel in their bodies, rather than the worrisome thoughts. In fact, many people with GAD will visit their family doctors because of their physical discomfort, and they often will not even mention that they worry excessively.
Some of the physical feelings that worry can lead to are:
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Physical feelings of anxiety (e.g., heart racing, sweating, stomach discomfort)
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Feeling fidgety, restless, or unable to sit still
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Feeling irritable, getting easily upset, snapping at people for minor reasons
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Sleep problems: this can include having a hard time falling asleep, waking up frequently during the night, or having a restless and unsatisfying sleep
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Difficulty paying attention or concentrating
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Being easily fatigued
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Muscle pains (often in the neck and shoulders)
How else can I know if I might have GAD?
1. A common feature of GAD is that the worries often have a "chaining"effect, that is, one worry will lead to many others. For example, you might start off by thinking,
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"I have a report to write for work; what if I don't do it well?" This could lead to other worries, such as,
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"What if my boss fires me? What if I can't find another job?" You would see a chaining effect of worry if these new worries then led to other related worries, such as,
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"What if I don't have enough money to pay the bills?"
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"What if I can't pay the mortgage for the house? Where would we live?"
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"What if I can't afford to send the kids off to university?"
It's easy to see how one worry, in this case about a work report, can lead to a chain of other worries that can last for hours.
TIP: GAD worry can also be described as "scenario building". That is, worry is often an attempt to try to think about every possible scenario in the future, and then trying to plan for it. For example: "What if I don't have enough money to pay the bills? Well, I could probably borrow money from family or from the bank; but what if no one lends me the money? I might get another job; but what if I don't find another job that pays more, etc.
2. Another way to recognize whether GAD may be a problem for you is to think about how long you have been worrying excessively. GAD is considered a chronic problem. That is, people with GAD have been feeling anxious and worrying excessively almost every day for at least 6 months.
For the most part, people with GAD report either that they "always worried" or that they "always worried after a stressful event". That is,
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Many people with GAD will say that they cannot remember a time when they did not worry too much: some people describe themselves as "born worriers", or they fear that they have "the worry gene".
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For other people, GAD started after a great deal of stress in life. Common stressors include getting married, moving, having children, a major job change, or an increase in responsibilities. For people whose GAD started later in life, they can remember a time when they did not worry excessively, but they feel currently unable to stop themselves from worrying about "anything and everything".
TIP TO KEEP IN MIND: Remember that it is normal to worry more when there is a lot of stress in your life, or if you are experiencing some significant changes or difficulties. It is NOT GAD if you only notice yourself worrying when you are experiencing major stresses in your life. Although people with GAD will worry more at those times, they still worry even when everything is going OK.
How do people with GAD act in daily life (other than worrying)?
Many adults with GAD are perfectionists. They can spend hours on a simple task, in an attempt to make sure that they have completed it perfectly. This might involve re-reading a school or work assignment repeatedly, or agonizing over small details at work or in the home (e.g., what kind of font to use in an e-mail, whether to try a new cleaning product at home).
People with GAD seem to be allergic to uncertainty. That is, they don't like it when they are not 100% sure of themselves, others, their actions and decisions, or the future. Because of this, they will often engage in tiring and time-consuming behaviours designed to make them feel more certain, including:
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Excessive reassurance-seeking (e.g. asking for several peoples' opinion before making a minor decision)
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Checking (e.g. calling a loved one's cell phone several times a day to make sure that they are OK; re-reading e-mails repeatedly to make sure that there are no spelling mistakes)
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Information seeking or list making (e.g. having to read every book on a subject before making a decision; being unwilling to do simple tasks such as grocery shopping without a list; making elaborate "to do" lists)
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Refusal to delegate to others (e.g. not allowing anyone else in the house to complete small chores in order to make sure that it is "done right")
At the same time, because of this "allergy" to uncertainty, people with GAD will often outright avoid situations or activities because they are not sure of the outcome. Some examples of this type of behaviour include:
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Avoidance/procrastination. This can include avoiding friendships or new opportunities, and procrastinating as long as possible before completing a task (in an attempt to have as little time as possible to worry about the task once it is finished)
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Having others make decisions for you. Because of the uncertainty of making decisions, some people with GAD will hand off the responsibility for decision making to others
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Distraction/keeping busy. Many people with GAD will try to "keep moving" all day long in order to keep their minds busy, and to avoid worrying. If you are always distracting yourself with other worries, you won't "have time" to think about all the uncertain things that are coming up in your life. The problem with this strategy is that it is tiring, and the worries and thoughts about uncertainty come back as soon as you try to relax (for example, when going to sleep at night).
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GAD often develops in childhood, usually around ages 11 to 12, although many adults with GAD describe being unable to remember a time when they didn't worry. For some adults, GAD develops anytime between their 20's and 40's, and in this case, it is almost always triggered by a major stressor in life.
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GAD is twice as common in women as in men.
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Research suggests that almost 90% of people with GAD will have another mood or anxiety disorder. The most common additional problems are major depression, social anxiety disorder, panic disorder, and specific phobia.
GAD:The facts!
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GAD often develops in childhood, usually around ages 11 to 12, although many adults with GAD describe being unable to remember a time when they didn't worry. For some adults, GAD develops anytime between their 20's and 40's, and in this case, it is almost always triggered by a major stressor in life.
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GAD is twice as common in women as in men.
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Research suggests that almost 90% of people with GAD will have another mood or anxiety disorder. The most common additional problems are major depression, social anxiety disorder, panic disorder, and specific phobia
Self-help strategies for GAD
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About the author
Anxiety Canada promotes awareness of anxiety disorders and increases access to proven resources. Visit www.anxietycanada.com.
Thank you to Anxiety Canada's Registered Clinical Counsellor and Clinical Educator Mark Antczak for reviewing this resource in 2022.
