Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) presents as painful, pervasive worry about many topics, often centering around fear of failure, uncertainty, safety, or loss.

GAD often emerges in middle childhood to early adolescences as children are increasingly expected to be independent, competent and assessed.

Symptoms

  • Excessive worry and apprehensiveness
  • Feeling restless, keyed-up or on edge 
  • Fatigued at end of school day
  • Concentration problems “choking on tests”
  • Sleep problems (falling asleep)
  • Tense and irritable
  • Unable to control the worry
  • Impairment or distress

Kids with GAD worry excessively and cannot control the worry, leading to impairment and distress. They are tense, restless, sometimes irritable and fatigued. They may not be able to concentrate on a test because they are so worried about how they will do on the test. Kids with generalized anxiety disorder can worry about anything, but each tends to have several specific themes of anxiety. Common fears in generalized anxiety disorder include failure, uncertainty, imperfection, danger, and the future.

DSM-5 Criteria

Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance). 

The person finds it difficult to control the worry. 

The anxiety and worry are associated with three or more of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months). 

  • Restlessness or feeling keyed up or on edge
  • Being easily fatigued
  • Difficulty concentrating or mind going blank
  • Irritability
  • Muscle tension
  • Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)

The focus of the anxiety and worry is not confined to features of an Axis I disorder (e.g., the anxiety or worry is not about having a panic attack [as in panic disorder], being embarrassed in public [as in social phobia], being contaminated [as in obsessive-compulsive disorder], being away from home or close relatives [as in separation anxiety disorder], gaining weight [as in anorexia Nervosa], or having a serious illness [as in hypochondriasis]), and the anxiety and worry do not occur exclusively during posttraumatic stress disorder.  

The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. 

The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism) and does not occur exclusively during a mood disorder, a psychotic disorder, or a pervasive developmental disorder. 

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC

Disorder-Specific Treatment Strategies

Evidence-based treatment for GAD includes exposure-based Cognitive Behavioral Therapy (CBT) and treatment with a selective serotonin reuptake inhibitor (SSRI).