-- "I always thought I was just a worrier. I'd feel keyed up and unable to
relax. At times it would come and go, and at times it would be constant. It
could go on for days. I'd worry about what I was going to fix for a dinner
party, or what would be a great present for somebody. I just couldn't let
something go."

-- "I'd have terrible sleeping problems. There were times I'd wake up
wired in the morning or in the middle of the night. I had trouble
concentrating, even reading the newspaper or a novel. Sometimes I'd feel a
little lightheaded. My heart would race or pound. And that would make me
worry more.

"Generalized anxiety disorder (GAD) is much more than the normal anxiety
people experience day to day. It's chronic and exaggerated worry and
tension, even though nothing seems to provoke it. Having this disorder means
always anticipating disaster, often worrying excessively about health, money,
family, or work. Sometimes, though, the source of the worry is hard to
pinpoint. Simply the thought of getting through the day provokes
anxiety.People with GAD can't seem to shake their concerns, even though they
usually realize that their anxiety is more intense than the situation
warrants. People with GAD also seem unable to relax. They often have
trouble falling or staying asleep. Their worries are accompanied by physical
symptoms, especially trembling, twitching, muscle tension,headaches,
irritability, sweating, or hot flashes. They may feel lightheaded or out of
breath. They may feel nauseated or have to go to the bathroom frequently.
Or they might feel as though they have a lump in the throat. Many individuals
with GAD startle more easily than other people. They tend to feel tired,
have trouble concentrating, and sometimes suffer depression, too.

SIDEBAR: Depression -- Depression often accompanies anxiety disorders and,
when it does, it needs to be treated as well. The feelings of sadness,
apathy, or hopelessness, changes in appetite or sleep, and difficulty
concentrating that often characterize depression can be effectively treated
with antidepressant medications, or, depending on their severity, by
psychotherapy. Some people respond best to a combination of medication and
psychotherapy. Treatment can help the majority of people with
depression.Usually the impairment associated with GAD is mild and people with
the disorder don't feel too restricted in social settings or on the job.
Unlike many other anxiety disorders, people with GAD don't characteristically
avoid certain situations as a result of theirdisorder. However, if severe,
GAD can be very debilitating, making it difficult to carry out even the most
ordinary daily activities.GAD comes on gradually and most often hits people
in childhood or adolescence, but can begin in adulthood, too. It's more
common in women than in men and often occurs in relatives of affected
It's diagnosed when someone spends at least 6 months worried excessively
about a number of everyday problems.In general, the symptoms of GAD seem to
diminish with age. Successful treatment may include a medication called
buspirone. Research into the effectiveness of other medications, such as
benzodiazepines and antidepressants, is ongoing. Also useful are
cognitive-behavioral therapy, relaxation techniques, and biofeedback to
control muscle tension.


This brochure was written by Marilyn Dickey, a freelance writer in
Washington, DC. Scientific information and review was provided by NIMH staff
members Hagop Akiskal, M.D.; Jack Maser, Ph.D.; Barry Wolfe,Ph.D.; and Susan
Solomon, Ph.D. Also providing review and assistance were Jim Broatch,
M.S.W., OC Foundation; Stephen Cox, M.D., National Anxiety Foundation; Jack
Gorman, M.D., Columbia University; Alec Pollard,Ph.D., St. Louis University;
Jerilyn Ross, M.A., L.I.C.S.W., Anxiety Disorders Association of America; and
Sally Winston, Psy.D., Anxiety and Stress Disorders Institute of Maryland.
Editorial direction was provided by Lynn J. Cave, NIMH.

National Institutes of Health
National Institute of Mental Health