Generalized anxiety disorder (GAD)

Everyone worries. Worry can even help, because it pushes you to pay a bill or see a doctor. Generalized anxiety disorder, or GAD, is different. The worry is strong, it comes most days, and it is very hard to switch off. It often jumps from one topic to the next, even when nothing is wrong.^1,7

GAD is common and very treatable. Most people get better with talk therapy, medicine or both.⁷ This page explains the signs, a short self-check called the GAD-7, the main treatments, and a simple skill called "worry time" you can start this week.

What GAD feels like

People with GAD often say their mind will not rest. They know the worry is out of proportion, but they cannot stop it.⁷ Common worries are about health, money, family, work, being late and household tasks.¹ One worry ends and another starts.

GAD is not only in the head. It shows up in the body too. Symptoms often get worse during stressful times.¹

Mind and mood:^1,7

• Worry that is hard to control, on most days
• Feeling restless, keyed up or on edge
• Getting irritated easily
• Trouble concentrating, or your mind going blank
• Expecting the worst

Body:^1,7

• Tight, aching muscles
• Feeling tired or worn out
• Trouble falling or staying asleep
• Headaches or stomachaches
• Shaking, sweating or feeling lightheaded
• Feeling short of breath or needing to urinate often

Because so many symptoms are physical, many people first see a doctor for headaches, poor sleep or stomach trouble. Older adults in particular may go to the doctor seeking reassurance about body symptoms, and the worry underneath can be missed.⁵

How doctors diagnose GAD

There is no blood test or scan for GAD. A clinician makes the diagnosis by asking about your symptoms and your health.⁷ In general, a person has GAD when:¹

• Worry is hard to control on more days than not, for at least 6 months, and
• At least three of these are present: restlessness, tiring easily, trouble concentrating, irritability, muscle tension, or sleep problems, and
• The worry gets in the way of daily life.

Your doctor may do a physical exam or lab tests. This is to rule out other causes that can look like anxiety.^1,7 Thyroid problems, some medicines, caffeine and alcohol are examples. See What causes anxiety for more.

GAD often comes with other problems. These include depression, other anxiety problems, PTSD, long-term pain, heart problems, and alcohol or drug misuse.¹ It helps to treat them together.

How common is GAD?

In a large national survey, about 1 in 37 U.S. adults (2.7%) had GAD in the past year. About 1 in 18 (5.7%) had it at some point in life.² Women were nearly twice as likely as men to have it in the past year (3.4% vs 1.9%).²

GAD usually starts slowly, often in early adulthood, but it can begin at any age.¹ In that survey, adults 60 and older reported it less often than middle-aged adults.² But anxiety in later life can be harder to spot. It may hide behind health worries or physical symptoms. See Anxiety in later life.

The GAD-7: a quick self-check

The GAD-7 is a short questionnaire used in many doctors' offices. It was tested in more than 2,700 primary care patients.³ It asks how often, over the past 2 weeks, you have been bothered by things like feeling nervous, not being able to stop worrying, trouble relaxing, restlessness, irritability, and fear that something awful might happen.

Each answer scores from 0 ("not at all") to 3 ("nearly every day"). The total runs from 0 to 21.³

Source for the score ranges: the original GAD-7 study.³

What a score of 10 or more means. In the original study, a cutoff of 10 picked up about 9 in 10 people who had GAD (89%). It also correctly ruled out about 8 in 10 who did not (82%).³ So the test misses some people and flags some who do not have GAD. A score is a reason to talk with a clinician, not a diagnosis.

The GAD-7 was built to look for GAD. It does not cover every type of anxiety, so tell your doctor about panic attacks, fears or past trauma too.³

You can take the GAD-7 privately on our check-in page. It is scored in your browser, and nothing is sent anywhere. Print or write down your score to bring to your doctor.

Treatment: what works

GAD responds well to treatment. Guidelines use stepped care. You start with the lightest help that fits your needs and add more if you are not improving.⁵

Therapy and medicine work about equally well for GAD that is getting in the way of life. The choice can depend on what you prefer.⁵ Some people use both.⁷

Other medicines. Buspirone is not sedating and is less habit-forming, but it takes 3 to 4 weeks to work fully.¹ Doctors sometimes use hydroxyzine as needed.⁷ Benzodiazepines (sedatives such as alprazolam or lorazepam) calm anxiety fast. But the body gets used to them and dependence can build, so they are usually only for short periods, if at all.^1,5

Talk with your doctor or pharmacist before you start, stop or change any medicine. Older adults should also ask about bleeding risk with SSRIs, especially if they take aspirin or pain relievers like ibuprofen.⁵

For more on choosing and starting care, see Treatment for anxiety.

Worry time: a skill you can try this week

Over time, worry in GAD gets linked to many everyday cues: the time of day, where you are, what you are doing. That is part of why it pops up everywhere.⁶ Worry time works by giving worry its own set time and place, and keeping it there.

In one small study, 53 people who worried a lot practiced a daily 30-minute worry period for two weeks. Compared with a group that simply worried as usual, they had less worry, anxiety and trouble sleeping.⁶ This was early research, and the authors saw it as one part of a larger treatment plan. Still, it is safe and free to try.

1. Pick a time and place. Choose the same 20 to 30 minutes each day, in the same chair or room.⁶ Avoid your bed and the hour before sleep.
2. Notice worry during the day. When a worry shows up outside worry time, notice it. Jot one or two words on a small notepad or your phone.
3. Postpone it. Tell yourself, "I will think about this at 5 o'clock." Then gently bring your attention back to what you were doing. Use the grounding practice if it helps.
4. Use your worry time fully. At the set time, sit down with your list and worry on purpose. Write the worries out if you like.
5. Sort the worries. For each one, ask: Is this a problem I can act on now? If yes, write one small next step. If not, practice letting it be. The thought check tool can help you test worst-case thinking.
6. Stop when time is up. End on time, even if worries are left over. They can wait until tomorrow. Do something pleasant or physical right after.

Everyday habits that help

Healthy habits work best alongside treatment, not instead of it.¹

• Cut back on caffeine. Coffee, tea, energy drinks and some sodas can feed jittery feelings.^1,7
• Go easy on alcohol. Avoid heavy drinking and street drugs. Never drink while taking a sedating medicine.⁷ See Alcohol in later life.
• Move every day. Regular exercise, even walking or tai chi, is part of good self-care.^1,7
• Protect your sleep. Keep a steady schedule. See Insomnia.
• Calm the body. Try slow breathing, muscle relaxation or a body scan.
• Stay connected. Keep a daily routine, get out of the house each day, and consider a support group.⁷

You can put your favorite skills on one page with our calm plan.

When to get help

Talk with your doctor or a mental health professional if worry is hard to control most days, or if it affects your sleep, work, relationships or health.⁷ Your primary care doctor is a good place to start. They can check for medical causes and refer you to a psychologist, psychiatrist or clinical social worker.¹ See Finding geriatric mental health care and What Medicare covers for mental health.

Is GAD the same as being a "worrier"?

No. Many people worry a lot without having GAD. GAD is worry that is hard to control, lasts at least 6 months, and comes with symptoms like tension, tiredness and poor sleep that get in the way of life.¹

How is GAD different from health anxiety or OCD?

In GAD, worry spreads across many parts of life. In health anxiety, fear centers on having a serious illness. In OCD, unwanted thoughts usually lead to rituals or repeated actions.

Will I need medicine forever?

Not always. Many people do well with therapy alone. If you take medicine, your doctor can help you decide how long to stay on it and how to come off slowly when the time is right.^5,7

Can GAD come back?

Symptoms often flare during stressful times.¹ Skills from CBT, like worry time and thought checking, are tools you keep. Using them early can stop a small flare from growing. See CBT week 6: staying well.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.