Generalized Anxiety Disorder

People with generalized anxiety disorder (GAD) display excessive anxiety or worry, most days for at least 6 months, about a number of things such as personal health, work, social interactions, and everyday routine life circumstances. The fear and anxiety can cause significant problems in areas of their life, such as social interactions, school, and work.

Generalized anxiety disorder symptoms include:

• Feeling restless, wound-up, or on-edge
• Being easily fatigued
• Having difficulty concentrating; mind going blank
• Being irritable
• Having muscle tension
• Difficulty controlling feelings of worry
• Having sleep problems, such as difficulty falling or staying asleep, restlessness, or unsatisfying sleep

Panic Disorder

People with panic disorder have recurrent unexpected panic attacks. Panic attacks are sudden periods of intense fear that come on quickly and reach their peak within minutes. Attacks can occur unexpectedly or can be brought on by a trigger, such as a feared object or situation.

During a panic attack, people may experience:

• Heart palpitations, a pounding heartbeat, or an accelerated heartrate
• Sweating
• Trembling or shaking
• Sensations of shortness of breath, smothering, or choking
• Feelings of impending doom
• Feelings of being out of control

People with panic disorder often worry about when the next attack will happen and actively try to prevent future attacks by avoiding places, situations, or behaviors they associate with panic attacks. Worry about panic attacks, and the effort spent trying to avoid attacks, cause significant problems in various areas of the person’s life, including the development of agoraphobia (see below).

Phobia-related disorders

A phobia is an intense fear of—or aversion to—specific objects or situations. Although it can be realistic to be anxious in some circumstances, the fear people with phobias feel is out of proportion to the actual danger caused by the situation or object.

People with a phobia:

• May have an irrational or excessive worry about encountering the feared object or situation
• Take active steps to avoid the feared object or situation
• Experience immediate intense anxiety upon encountering the feared object or situation
• Endure unavoidable objects and situations with intense anxiety

There are several types of phobias and phobia-related disorders:

Specific Phobias (sometimes called simple phobias): As the name suggests, people who have a specific phobia have an intense fear of, or feel intense anxiety about, specific types of objects or situations. Some examples of specific phobias include the fear of:

• Flying
• Heights
• Specific animals, such as spiders, dogs, or snakes
• Receiving injections
• Blood

Social anxiety disorder (previously called social phobia): People with social anxiety disorder have a general intense fear of, or anxiety toward, social or performance situations. They worry that actions or behaviors associated with their anxiety will be negatively evaluated by others, leading them to feel embarrassed. This worry often causes people with social anxiety to avoid social situations. Social anxiety disorder can manifest in a range of situations, such as within the workplace or the school environment.

Agoraphobia: People with agoraphobia have an intense fear of two or more of the following situations:

• Using public transportation
• Being in open spaces
• Being in enclosed spaces
• Standing in line or being in a crowd
• Being outside of the home alone

People with agoraphobia often avoid these situations, in part, because they think being able to leave might be difficult or impossible in the event they have panic-like reactions or other embarrassing symptoms. In the most severe form of agoraphobia, an individual can become housebound.

Separation anxiety disorder: Separation anxiety is often thought of as something that only children deal with; however, adults can also be diagnosed with separation anxiety disorder. People who have separation anxiety disorder have fears about being parted from people to whom they are attached. They often worry that some sort of harm or something untoward will happen to their attachment figures while they are separated. This fear leads them to avoid being separated from their attachment figures and to avoid being alone. People with separation anxiety may have nightmares about being separated from attachment figures or experience physical symptoms when separation occurs or is anticipated.

Researchers are finding that both genetic and environmental factors contribute to the risk of developing an anxiety disorder. Although the risk factors for each type of anxiety disorder can vary, some general risk factors for all types of anxiety disorders include:

• Temperamental traits of shyness or behavioral inhibition in childhood
• Exposure to stressful and negative life or environmental events in early childhood or adulthood
• A history of anxiety or other mental illnesses in biological relatives
• Some physical health conditions, such as thyroid problems or heart arrhythmias, or caffeine or other substances/medications, can produce or aggravate anxiety symptoms; a physical health examination is helpful in the evaluation of a possible anxiety disorder.

Anxiety disorders are generally treated with psychotherapy, medication, or both. There are many ways to treat anxiety and people should work with their doctor to choose the treatment that is best for them.

Psychotherapy

Psychotherapy or “talk therapy” can help people with anxiety disorders. To be effective, psychotherapy must be directed at the person’s specific anxieties and tailored to his or her needs.

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) is an example of one type of psychotherapy that can help people with anxiety disorders. It teaches people different ways of thinking, behaving, and reacting to anxiety-producing and fearful objects and situations. CBT can also help people learn and practice social skills, which is vital for treating social anxiety disorder.

Cognitive therapy and exposure therapy are two CBT methods that are often used, together or by themselves, to treat social anxiety disorder. Cognitive therapy focuses on identifying, challenging, and then neutralizing unhelpful or distorted thoughts underlying anxiety disorders. Exposure therapy focuses on confronting the fears underlying an anxiety disorder to help people engage in activities they have been avoiding. Exposure therapy is sometimes used along with relaxation exercises and/or imagery.

CBT can be conducted individually or with a group of people who have similar difficulties. Often “homework” is assigned for participants to complete between sessions.

Medication

Medication does not cure anxiety disorders but can help relieve symptoms. Medication for anxiety is prescribed by doctors, such as a psychiatrist or primary care provider. Some states also allow psychologists who have received specialized training to prescribe psychiatric medications. The most common classes of medications used to combat anxiety disorders are anti-anxiety drugs (such as benzodiazepines), antidepressants, and beta-blockers.

Anti-Anxiety Medications

Anti-anxiety medications can help reduce the symptoms of anxiety, panic attacks, or extreme fear and worry. The most common anti-anxiety medications are called benzodiazepines. Although benzodiazepines are sometimes used as first-line treatments for generalized anxiety disorder, they have both benefits and drawbacks.

Some benefits of benzodiazepines are that they are effective in relieving anxiety and take effect more quickly than antidepressant medications often prescribed for anxiety. Some drawbacks of benzodiazepines are that people can build up a tolerance to them if they are taken over a long period of time and they may need higher and higher doses to get the same effect. Some people may even become dependent on them.

To avoid these problems, doctors usually prescribe benzodiazepines for short periods of time, a practice that is especially helpful for older adults, people who have substance abuse problems, and people who become dependent on medication easily.

If people suddenly stop taking benzodiazepines, they may have withdrawal symptoms, or their anxiety may return. Therefore, benzodiazepines should be tapered off slowly. When you and your doctor have decided it is time to stop the medication, the doctor will help you slowly and safely decrease your dose.

For long-term use, benzodiazepines are often considered a second-line treatment for anxiety (with antidepressants being considered a first-line treatment) as well as an “as-needed” treatment for any distressing flare-ups of symptoms.

A different type of anti-anxiety medication is buspirone. Buspirone is a non-benzodiazepine medication specifically indicated for the treatment of chronic anxiety, although it does not help everyone.

Antidepressants

Antidepressants are used to treat depression, but they can also be helpful for treating anxiety disorders. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has manageable side effects. A medication that has helped you or a close family member in the past will often be considered.

Antidepressants can take time to work, so it’s important to give the medication a chance before reaching a conclusion about its effectiveness. If you begin taking antidepressants, do not stop taking them without the help of a doctor. When you and your doctor have decided it is time to stop the medication, the doctor will help you slowly and safely decrease your dose. Stopping them abruptly can cause withdrawal symptoms.

Antidepressants called selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly used as first-line treatments for anxiety. Less-commonly used — but effective — treatments for anxiety disorders are older classes of antidepressants, such as tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs).

Beta-Blockers

Although beta-blockers are most often used to treat high blood pressure, they can also be used to help relieve the physical symptoms of anxiety, such as rapid heartbeat, shaking, trembling, and blushing. These medications, when taken for a short period of time, can help people keep physical symptoms under control. They can also be used “as needed” to reduce acute anxiety, including as a preventive intervention for some predictable forms of performance anxieties.

Choosing the Right Medication

Some types of drugs may work better for specific types of anxiety disorders, so people should work closely with their doctor to identify which medication is best for them. Certain substances such as caffeine, some over-the-counter cold medicines, illicit drugs, and herbal supplements may aggravate the symptoms of anxiety disorders or interact with prescribed medication. Patients should talk with their doctor, so they can learn which substances are safe and which to avoid.

Choosing the right medication, medication dose, and treatment plan should be done under an expert’s care and should be based on a person’s needs and their medical situation. Your doctor may try several medicines before finding the right one.

You and your doctor should discuss:

• How well medications are working or might work to improve your symptoms
• Benefits and side effects of each medication
• Risk for serious side effects based on your medical history
• The likelihood of the medications requiring lifestyle changes
• Costs of each medication
• Other alternative therapies, medications, vitamins, and supplements you are taking and how these may affect your treatment; a combination of medication and psychotherapy is the best approach for many people with anxiety disorders
• How the medication should be stopped (Some drugs can’t be stopped abruptly and must be tapered off slowly under a doctor’s supervision).

For more information, please visit Mental Health Medications Health Topic webpage. Please note that any information on this website regarding medications is provided for educational purposes only and may be outdated. Diagnosis and treatment decisions should be made in consultation with your doctor. Information about medications changes frequently. Please visit the U.S. Food and Drug Administration website for the latest information on warnings, patient medication guides, or newly approved medications.

Support Groups

Some people with anxiety disorders might benefit from joining a self-help or support group and sharing their problems and achievements with others. Internet chat rooms might also be useful, but any advice received over the internet should be used with caution, as Internet acquaintances have usually never seen each other and what has helped one person is not necessarily what is best for another. You should always check with your doctor before following any treatment advice found on the internet. Talking with a trusted friend or member of the clergy can also provide support, but it is not necessarily a sufficient alternative to care from a doctor or other health professional.

Stress Management Techniques

Stress management techniques and meditation can help people with anxiety disorders calm themselves and may enhance the effects of therapy. Research suggests that aerobic exercise can help some people manage their anxiety; however, exercise should not take the place of standard care and more research is needed.

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions, including anxiety disorders. During clinical trials, treatments might be new drugs or new combinations of drugs, new surgical procedures or devices, new psychotherapies, or new ways to use existing treatments. The goal of clinical trials is to determine if a new test or treatment works and is safe.

Although individual participants may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future. Decisions about whether to apply for a clinical trial and which ones are best suited for a given individual are best made in collaboration with a licensed health professional.

To learn more about clinical trials, please visit the NIH Clinical Research Trials and You website. To find a clinical trial, visit ClinicalTrials.gov.

Free Brochures and Shareable Resources

• Generalized Anxiety Disorder (GAD): When Worry Gets Out of Control: A brochure on GAD that explains the signs, symptoms, and treatment
• I’m So Stressed Out!: This fact sheet intended for teens and young adults presents information about stress, anxiety, and ways to cope when feeling overwhelmed.
• Obsessive-Compulsive Disorder: When Unwanted Thoughts Take Over: A brochure on OCD that explains the signs, symptoms, and treatments
• Panic Disorder: When Fear Overwhelms: A brochure on panic disorder that explains the signs, symptoms, and treatments
• Social Anxiety Disorder: More Than Just Shyness: This brochure discusses symptoms, causes, and treatments for social anxiety disorder (also called social phobia).
• Shareable Resources on Anxiety Disorders: Help support anxiety awareness and education in your community. Use these digital resources, including graphics and messages, to spread the word about anxiety disorders.

Multimedia

• Watch: Bullying Exerts Psychological Effects into Adulthood: Once considered a childhood rite of passage, bullying is no longer seen as benign. Its effects linger well into adulthood. Bullies and victims alike are at risk for psychiatric problems such as anxiety, depression, substance misuse, and suicide when they become adults, according to a study partially funded by the NIMH that was published in the April 2013 issue of JAMA Psychiatry.
• See: Multimedia about Anxiety Disorders

Federal Resources

• Anxiety Disorders (MedlinePlus – also en Español)
• Specific Phobias (U.S. Department of Veterans Affairs)

Research and Statistics

• Join a Study: Adults – Anxiety Disorders
• Join a Study: Children – Anxiety Disorders
• Journal Articles: References and abstracts from MEDLINE/PubMed (National Library of Medicine).
• Statistics: Anxiety Disorder: This webpage provides information on the statistics currently available on the prevalence and treatment of anxiety among people in the U.S.

Last Revised: July 2018
Unless otherwise specified, NIMH information and publications are in the public domain and available for use free of charge. Citation of the NIMH is appreciated. Please see our Citing NIMH Information and Publications page for more information.