Generalised anxiety disorder, usually shortened to GAD, is an anxiety condition in which worry is present on most days, is difficult to control and is not attached to one particular thing. NICE states the worry should occur on a majority of days for at least six months, which separates GAD from a stressful few weeks.
Key points
- GAD is diagnosed when worry occurs on most days for at least 6 months, is hard to control, and moves between topics rather than fixing on one thing.
- Muscle tension, tiredness, poor sleep and stomach problems often reach a GP before the worry is named.
- The GAD-7 questionnaire scores anxiety from 0 to 21, with 5, 10 and 15 the cut-points for mild, moderate and severe.
- NICE sets out four steps of care, and at step 3 offers a choice between a high-intensity psychological intervention and drug treatment, by the person's preference.
- If drug treatment is chosen, NICE suggests sertraline first, and advises against benzodiazepines except short-term during a crisis.
Symptoms
- Worry on most days that is hard to switch off, moving between family, health, money and work.
- Trouble concentrating, irritability, low mood, feeling on edge.
- Muscle tension and aches, tiredness that rest does not fix, trouble sleeping.
- Stomach problems, a more noticeable or unusual heartbeat, lightheadedness or dizziness.
- Putting off decisions, checking, seeking reassurance, or avoiding what sets the worry off.
Causes and risk factors
- GAD usually has no obvious single cause.
- Another anxiety disorder, or depression; a family history of mental health conditions.
- Stressful or traumatic experiences, including domestic violence, child abuse or bullying.
- A painful long-term physical health condition, or a history of drug or alcohol misuse.
Treatment
- Step 1: education about GAD and active monitoring. Step 2: low-intensity psychological help. Step 3: a choice between CBT/applied relaxation and drug treatment. Step 4: specialist treatment.
- CBT or applied relaxation is usually 12 to 15 weekly sessions of 1 hour.
- Where medication is chosen, NICE suggests sertraline first, then an alternative SSRI or an SNRI if ineffective.
When to speak to a professional
- Worry has been present most days for months and is hard to control.
- Muscle tension, poor sleep or stomach problems are not settling.
- You think you may have GAD, or treatment already tried is not helping.
- You are using alcohol or drugs to take the edge off the worry.
If you need help now: Samaritans, call 116 123, free, 24/7. Shout, text SHOUT to 85258. NHS 111, then choose the mental health option. Call 999 if anyone is in immediate danger.