Generalized Anxiety Disorder Symptoms and Signs
Generalized anxiety disorder is worry that runs most days for six months or more, across several parts of life, with physical signs such as restlessness, fatigue, poor concentration, irritability, muscle tension and disturbed sleep.
Also called: GAD, Generalised anxiety disorder, Chronic anxiety.
ICD-10 F41.1 · ICD-11 6B00
The worry is not the fault. The worry is the defence.
Everybody worries. Generalized anxiety disorder is not more of that. It is worry that has stopped being about anything in particular. It now runs on its own power.
People usually describe it as a mind that cannot stop. That is what it looks like from outside. From inside it feels more like a job you are doing badly, with no breaks, and you cannot put it down.
FROM INSIDE
What it is actually like
The body goes first, and the body stays. Shoulders and jaw stay tight all day. The stomach will not settle. Sleep takes two hours to arrive and then breaks at four.
Most people with GAD do not go to a doctor saying they feel anxious. They go because their body hurts. Painful physical symptoms are about twice as common in GAD as in people without it. That is why so many of these years get spent being tested for something else.
The worry itself keeps moving. Money on Monday. A relationship on Tuesday. A symptom on Wednesday. Solve one and the worry does not stop. It simply moves to the next thing. That is the part that convinces people it is a personality, not an illness.
The braced passenger
Someone who has been in one bad crash sits differently in every car afterwards. They are not screaming. They are quietly braced, for the whole journey, every journey. Bracing made sense once. Now it does nothing, and it costs the same whether anything happens or not.
WHAT IT DOES
Four things it takes
None of these is the worry itself. They are what holding the worry costs you.
Sleep
Falling asleep is hard. Waking early is common, with the worry already running. Losing sleep then raises the anxiety the next day. That is the loop closing.
The body
Muscle tension, headaches, stomach trouble and tiredness all come with it. These are part of the diagnosis, not side issues. They are usually what sends a person to the doctor.
Decisions
Any choice with an unknown answer becomes expensive. So choices get put off, handed to someone else, or dodged. Life then narrows down to what is already known.
Other people
Reassurance has to be asked for again and again, because it never holds. That wears out the people closest to them. Those people can tell it is not working, and they do not know why.
301M — GLOBAL
4.5% — PREVALENCE
32 — MEDIAN ONSET
11 — YEARS
When it tends to begin
Peak age of onset: 16.
Median age of onset: 32.
GAD starts late compared with most mental illness. The median age is around 32. For depression it is 30, and for social anxiety it is the mid-teens. But the temperament it grows out of appears much earlier. That is why so many people say they have always been this way, and still did not meet the criteria until their thirties.
How it is actually diagnosed
The diagnosis needs excessive worry about several different things. It must happen on more days than not, for at least six months. Three or more of the following must also be present.
- Restlessness, or feeling keyed up and on edge
- Being easily fatigued
- Difficulty concentrating, or the mind going blank
- Irritability
- Muscle tension
- Sleep disturbance
- The worry is difficult to control
- It causes real distress or impairment
- It is not better explained by another condition or a substance
The six months matters most of all. It is what separates an illness from a bad few weeks, and nearly everyone has a bad few weeks.
If it is worse than that right now
Anxiety this heavy often comes with low mood. Sometimes it comes with thoughts of not wanting to be here. That is more common than people expect, and it can be treated.
If you are thinking about harming yourself, contact emergency services or a crisis line now.