Anxiety in adults - Generalized anxiety disorder (GAD)



Anxiety is an excessive worry, or fear, which can manifest itself in a mild or severe way. Anxiety can invade many aspects of life and be difficult to control.

Every person experiences anxiety at some point in their life, such as when they have to take an exam, undergo a medical examination or a job interview. At times like these, feeling anxious is perfectly normal. However, some people have a hard time controlling it. In this case, the anxiety becomes excessive or persistent and can lead to affect daily life causing discomfort and impaired functioning of the person in social, work or other important areas.

The main anxiety disorders according to the Diagnostic and Statistical Manual of Mental Disorders (fifth edition DSM5), are the following:

  • separation anxiety disorder
  • selective mutism
  • phobia specific
  • social anxiety disorder (social phobia)
  • panic disorder
  • agoraphobia
  • generalized anxiety disorder (GAD)

Generalized anxiety disorder (GAD) is characterized by the presence of anxiety disorders (symptoms), both psychic and physical, not linked to a specific event or situation but, in fact, "generalized".

While in specific phobias anxiety or fear is associated with an object or situation (for example flying, animals, syringes, etc.), people with AGD worry about daily and routine circumstances such as work responsibilities, economic issues, health of the family or small things such as doing housework or being late for appointments (read the Hoax). Also, people with DAG do not always recognize the reasons that cause anxiety and this uncertainty only increases their anxiety by making them believe that there is no solution People with AGD tend to be constantly alert, to worry excessively about everything and, over time, to have a significant reduction in quality of life (Video).

Disorders (symptoms) can vary from person to person and include:

  • fatigue
  • worry
  • concentration problems
  • sleep disorders
  • feeling tense, restless "with nerves on edge"
  • irritability
  • muscle tension

Many people with DAG may also have:

  • tremor
  • sweating
  • dizziness
  • increased heart rate

While the cause of DAG is not fully known, scientific research suggests that multiple factors are involved, including:

  • super-activity of certain areas of the brain, involved in emotions and behavior
  • hormonal imbalance of serotonin and noradrenaline, two hormones produced by the brain whose function is to control and regulate a person's mood
  • genes inherited from parents, it is estimated that the probability of having a DAG is 5 times higher if you have a close relative with this disorder
  • personal history with stressful or traumatic experiences, for example having been the victim of domestic violence or child abuse or bullying
  • chronic disease, accompanied by physical pain such as, for example, arthritis
  • drug or alcohol abuse

The DAG affects women to a greater extent than men in the age group between 35 and 59 years of age. In the Italian population, the prevalence of DAG is 1.9%, if estimated over the entire course of life (source: ESEMeD project, Prevalence of Mental Disorders in Italy, 2003).

In the presence of disorders (symptoms), it is important to contact the general practitioner and evaluate the opportunity for a specialist visit.

There are several treatments that can be used to improve symptoms of DAG:

  • psychological therapies, for example the cognitive behavioral therapy performed by a psychotherapist
  • drugs, such as for example called anxiolytics or antidepressants Selective Serotonin Re-uptake Inhibitors (IRSS)

Other useful measures to reduce the level of anxiety are:

  • attend a self-help group
  • engage in regular sporting activity
  • stop smoking
  • reduce the usual amount of alcohol or caffeine

The treatments are effective in helping to control anxiety. In some cases it may be necessary to carry them out for a long time and during this period there may also be episodes of worsening of the disorder.


Psychological disorders (symptoms)

Generalized anxiety disorder (GAD) can cause a change in the way you think, behave or feel (Video).

Disorders (symptoms) caused by DAG include the following:

  • sense of dread
  • feeling of being constantly hanging by a thread
  • difficulty concentrating
  • irritability or restlessness

These symptoms can limit the person's social life (such as hanging out with family or friends).Since, often, even going to work can become difficult and stressful, you may be forced to take sick days. All this only increases the malaise and the lack of self-esteem.

Physical symptoms

Generalized anxiety disorder (GAD) can cause physical discomfort such as:

  • dizziness
  • tiredness
  • rapid heartbeat
  • muscle aches and tensions
  • tremors
  • dry mouth
  • excessive sweating
  • short breath
  • stomach pain
  • malaise
  • headache
  • difficulty falling asleep or staying asleep or restless and unsatisfactory sleep (insomnia)


Determining (diagnosing) generalized anxiety disorder (GAD) can be difficult. In some cases, in fact, distinguishing it from other mental health problems such as, for example, depression is not easy. It will therefore be necessary to visit the doctor. general practitioner to be directed to the most suitable specialist. The doctor will ask some questions about the physical or psychological disorders present, the date of their appearance and their duration. In addition, he can ask for information on present fears and worries and some data concerning life Although it can be difficult to talk about your personal life, to ascertain (diagnose) the causes of anxiety it is important that the doctor knows the context in which it develops. For example, you need to know if your concerns:

  • they heavily affect daily life, interfering in work and social life
  • they are extremely stressful
  • they concern everything and always assume the worst
  • they are difficult to control
  • they are present almost every day, for at least six months

You are more likely to have generalized anxiety disorder (GAD) if your anxiety has been around for six months or more and you have difficulty managing it.

It is possible that the doctor prescribes some clinical tests, to rule out other diseases that cause some problems including those of the DAG, such as:

  • anemia (lack of iron or Vitamin B12 and folate)
  • hyperactivity of the thyroid gland (hyperthyroidism)


Before starting any treatment for generalized anxiety disorder (GAD), the doctor will explain all the possible choices by providing information on the advantages and disadvantages of each and on any unwanted effects (side effects).

With the help of the doctor, therefore, it will be possible to decide on the most suitable treatment.

Initial therapy

As an initial treatment (therapy), the doctor may suggest attending a self-help group, to regularly meet people with similar problems, and a psychotherapist to learn ways to manage anxiety. If this is not enough, they may prescribe an individual psychological therapy (with the psychotherapist) or a pharmacological treatment under strict supervision of the neurologist or psychiatrist.

Drug-free (non-drug) therapy is usually recommended prior to treatment with drugs. Non-drug treatments for Generalized Anxiety Disorder include psychological therapy, such as cognitive-behavioral therapy (CBT). , and relaxation techniques.

Cognitive Behavioral Therapy (TCC)

It is one of the most effective treatments for generalized anxiety disorder (GAD). In fact, studies on the different psychological therapies for DAG have shown that the benefits of cognitive-behavioral therapy last longer than those related to drugs. , there is no one treatment that is suitable for all people. TCC is a therapy that helps the person to realize how problems, thoughts, feelings and behaviors are interconnected and influence each other. .It helps you to question your thoughts, negative and anxious, and to do things that you normally tend to avoid, because they create anxiety. TCC is performed by a psychotherapist, experienced and accredited to carry out the profession. Each session lasts about one hour and the overall duration of the therapy varies from person to person.

Relaxation techniques

Relaxation techniques they are based on relaxing the muscles, particularly during situations that usually cause anxiety. It is necessary to use an expert therapist to teach this technique which, in general, consists of:

  • learn how to relax your muscles
  • learning to relax muscles in response to a stimulus, for example to the word “relax” relax immediately
  • practice relaxing the muscles, in situations that generate anxiety

As for the Cognitive Behavioral Therapy, also the Relaxation Therapy includes meetings with the therapist of about 1 hour, for the duration set by the doctor.


Based on specific needs and requirements, the doctor may prescribe one or more drugs, among those available for the treatment of GAD. Some drugs are suitable for short-term treatments, while others are suitable for longer periods. Depending on the symptoms (symptoms) present, you may also need medications to treat physical symptoms. It is very important to discuss the different treatment options with your doctor before starting drug therapy, especially regarding the duration of treatment.


NHS. Generalized anxiety disorder in adults (English)

In-depth link

EpiCentro (ISS). The ESEMeD study

National Institute for Health and Care Excellence (NICE). Generalized anxiety disorder and panic disorder in adults: management

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