G eneralized Anxiety Disorder (GAD) is a disruption in how your brain controls the signals it uses to identify danger and initiate action to help you avoid it. However, in GAD, this signalling mechanism does not work as it should and you experience the danger signal when there is no danger. GAD is excessive anxiety and worry about everyday events that occurs over a prolonged period of time. Someone with GAD worries excessively about many different things and is not able to control his or her worry. The worrying and anxiety causes serious emotional distress, and causes problems at school, at work, and in relationships. These feelings of anxiety usually also have physical components, including headaches, aches and pains, nausea, shaking and sweating.
Feeling anxious in response to danger or in new situations is a perfectly normal response. It’s called the fight-or-flight response and helps us survive in dangerous situations. But these typical feelings are different from GAD. A person with GAD constantly feels tense and on edge, even when there is no danger present.
Up to about 9 percent of people will develop Generalized Anxiety Disorder in their lifetime, with women twice as likely as men. GAD rarely starts before adolescence, although some children who later develop the disorder have always been perceived as overly anxious. There is no one specific cause for GAD – multiple genetic and environmental causes play a role and it is not caused by the usual stresses of everyday life. Some medical conditions (e.g., thyroid disease) can mimic an Anxiety Disorder, and some medications can also cause anxiety-like symptoms.
Generalized Anxiety Disorder, and other mental disorders, should only be diagnosed by a medical doctor, clinical psychologist, or other trained health provider who has spent time with the teenager and has conducted a proper mental health assessment. Diagnoses are complicated with many nuances. Please do not attempt to diagnose someone based on the symptoms you read in magazines or on the internet. If you are concerned, speak to a trained health professional.
Someone with GAD will worry excessively and persistently about many different things. Their worry is out of proportion to the concern/event, is greater than that experienced by most people, and is not something they can control. The person usually knows that they worry too much, but has great difficulty controlling the worry. Often the worry will be accompanied by a number of physical complaints, such as headaches, fatigue, muscle aches, and upset stomach. Other symptoms include:
- Restlessness, feeling on edge
- Difficulty swallowing
- Difficulty concentrating
- Trouble falling asleep (mind will not “shut off”)
- Trembling, twitching
- Hot flashes
- Going to bathroom frequently
- Air hunger – feeling as if you cannot get enough air
- Difficulty relaxing
- Easily startled
- Anticipating the worst outcome for any situation
- Excessive concerns and worries about usual daily activities
These symptoms tend to be chronic, lasting at least 6 months and interfere with a person’s everyday life.
*In accordance with the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition.
Remember, you cannot diagnose someone with Generalized Anxiety Disorder without a proper mental health assessment conducted by a properly trained health provider.
- Encourage the person to seek help (or take them to a trained health professional yourself, if appropriate).
- Ask the person a few questions to get a better sense of what is going on:
- Do you feel very anxious more often than not?
- Is there anything you can do to control your worry?
- Do you have difficulty concentrating when you feel anxious?
- Do you feel anxious about a lot of different things? Or only certain things?
Physical, emotional and behavioural responses to perceived danger, new situations, or life challenges are normal reactions that people experience every day. Anxiety responses are often automatic, and are a key way that we protect ourselves from danger. In healthy amounts, anxiety can also be a key motivational tool, helping us to focus on and accomplish important tasks (e.g., studying for an important exam). Indeed, the right amount of anxiety is necessary for developing new skills or for doing your best. It’s the brain signal that drives success!
Anxiety becomes a problem when:
- It is more intense or lasts longer than typically expected
- It causes impairment or disability at school, at work, or in social environments
- Daily activities are avoided in an attempt to lessen the anxiety
If someone in your life has been diagnosed with GAD, here’s what you can do:
- Be well-informed. Learn about GAD and the treatment options available. Read books, trusted websites (like this one!), and discuss any concerns or questions with a health care provider. Check out Evidence Based Medicine for information on how to critically evaluate the information you read and Communicating With Your Health Care Provider for a list of questions to ask your health care provider.
- Help the person get medical attention or supportive counselling. Some questions you can ask that will help determine if the anxiety is GAD include:
- Can you tell me about your worries?
- Do you or others see you as someone who worries much more than they do?
- Do you have difficulty ‘letting go’ of your worries?
- Do you feel sick with worry sometimes? In what way?
- Are there things that you would like to do or enjoy doing that you avoid because of your worries?
- Is there anything that makes you feel better when you’re worried? Does it make you feel better for a short amount of time or for a long amount of time?
- Listen. When you listen to and acknowledge their feelings, it sends the message that you care. Knowing that you have people who care about you is an important part of coping with a mental disorder.
- Be patient. Sometimes it can be frustrating when the person you care about acts differently than they used to. Take a deep breath and remember that GAD is making them feel this way. They can’t just “snap out of it.” Getting impatient will only make the situation worse. Stay positive and be patient.
- Help the person learn time management skills. Planning out your time and understanding what you have to do and how long you have to do it can help keep you from feeling overwhelmed.
- Pay close attention to their behaviour. Some people with GAD may develop Clinical Depression. Others may abuse alcohol or drugs, especially nicotine, in an effort to control their anxiety. These problems can become quite serious and should be addressed by a health professional.
- Remember that reassurance about fears is not usually helpful and may encourage avoidance or clingy behaviour. It can be challenging but try not to shield or protect the person from normal situations that cause them anxiety. Be supportive but encourage the person to face their worries. When someone frequently avoids situations that make them anxious, it can actually make the anxiety worse over time and can cause the person to feel isolated and withdrawn. Be sensitive to the fact that they are genuinely fearful, but try not to enable their avoidance behaviour.
A variety of treatment options exist for GAD. Determining which course of action is appropriate for each individual should be done with the guidance of a trained health professional. Treatment options for GAD may include one (or a combination) of the following:
- Psychological Treatments: Psychotherapy or “talk therapy” works by helping your brain better control your thoughts and emotions. The type of psychotherapy that has been found to be most effective for treating GAD in teenagers is called Cognitive Behaviour Therapy (CBT). CBT helps people learn how to overcome their fears. It includes several components, including Cognitive Restructuring (e.g., changing the way someone thinks about their fears) and Exposure (e.g., gradually exposing the person to their fears while keeping them safe and teaching them effective strategies for coping with fear). Sometimes this therapy is provided in groups.
- Medication: A variety of medications can be prescribed to relieve symptoms of GAD, including Serotonin Specific Reuptake Inhibitors (SSRIs) and some types of benzodiazepines. If medications are prescribed, they are usually used to help after psychotherapy has been started but results are not at expected levels. For more information on how to properly use medications, check out MedEd.
- Arousal Decreasing Techniques: Numerous techniques for decreasing physical arousal (that means: anxious feelings, rapid heart rate, rapid breathing) can help. These include: biofeedback, mindfulness, deep muscle relaxation, meditation, etc.
- School Supports: Sometimes certain adaptations can be made by the school to assist a student in coping with and managing their symptoms.
- Community Supports: Community supports can include peer support groups for teenagers, support groups for families, and other helpful resources.
- Regular Routine: Maintaining a healthy, regular daily routine is very important for a person with GAD. For help maintaining the kind of healthy lifestyle that should accompany professional treatment for GAD, check out Taking Charge of Your Health.
Remember, all treatments have the same goals: decrease symptoms and improve functionality; decrease risk of relapse; and promote recover. Think about it this way: Get well; Stay well; Be well.
It’s not uncommon for people to have more than one mental illness. Other common co-occurring disorders with GAD (also called comorbid disorders) include:
- Other Anxiety Disorders (such as Panic Disorder or Agoraphobia)
- Substance Use Disorders; in particular, alcohol abuse and cigarettes