Generalized Anxiety - Dr Jonathan Haverkampf

Generalized anxiety disorder (GAD) is more than ordinary worry. It is a pattern of excessive, hard-to-control apprehension about everyday events — worry that can feel out of proportion to the situation, yet is very real and often exhausting for the person living with it. [1] This kind of worry can quietly take over daily life. People with GAD often anticipate the worst about health, money, family, friendships, relationships, or work, even when there is little outward reason for concern. [2][3] In the United States, GAD is among the leading causes of workplace disability.[6]

Anxiety is not only in the mind. Many people with GAD also notice physical symptoms, such as:

fatigue
fidgeting
headaches
nausea
numbness in hands and feet
muscle tension
muscle aches
difficulty swallowing
excessive stomach acid buildup
stomach pain, vomiting
diarrhea
bouts of breathing difficulty
difficulty concentrating
trembling
twitching
irritability
agitation
sweating
restlessness
insomnia
hot flashes
rashes, and
a sense of not being able to fully control the anxiety

(ICD-10).[4] The last point — the sense of not being able to switch the worry off — can be especially distressing, because the feeling of losing control can itself feed the anxiety, turning it into a self-sustaining cycle.

Around two percent of adults in Europe and the United States experience GAD in any given year, [7] [8] and roughly 4% live with it at some point in their lifetime. [9] It is about twice as common in women as in men, and it is more frequent where there is a personal history of substance use or a family history of anxiety. [10] Once GAD develops it can become long-lasting, but with the right treatment it is very manageable — and for many people the symptoms ease significantly or resolve.[11]

Key points

Generalized anxiety is more than ordinary worry when it is persistent, difficult to control, and starts to interfere with life, work, sleep, relationships, or health.
Physical symptoms can be real and distressing, but they can also overlap with medical conditions, medications, caffeine, alcohol, sleep problems, panic, depression, trauma, or OCD.
Helpful treatment often includes understanding the worry cycle, reducing avoidance and reassurance loops, improving recovery and sleep, and sometimes discussing medication with a qualified prescriber.
Seek professional help promptly if anxiety is severe, persistent, impairing, medically worrying, linked with substance use, or accompanied by hopelessness or self-harm thoughts.

Useful next steps: anxiety support pathway, anxiety treatment, Dublin and online therapy.

Start here for generalized anxiety

Generalized anxiety can make everyday life feel uncertain, unsafe, or impossible to switch off from. The starting points below are here to help you find a next step that fits where you are right now — without treating anxiety as weakness, and without assuming that every anxious feeling is a disorder.

If there is immediate risk
Use urgent-help guidance first if anxiety comes with self-harm thoughts, inability to stay safe, heavy substance use, or frightening physical symptoms.
If worry is taking over daily life
Start with the anxiety support pathway for practical next steps.
If you want the broader anxiety hub
Use the anxiety hub for related anxiety patterns and service links.
If you are looking for treatment options
Read about anxiety treatment, including psychotherapy and medication questions to discuss with a qualified prescriber.
If you want self-help first
Use the anxiety self-help page for structured exercises and coping ideas.
If panic attacks are happening
Use the panic-attack plan when symptoms come in sudden waves or feel physically alarming.
If social situations are the main trigger
Read the social anxiety hub if anxiety centres on being seen, judged, or embarrassed.
If intrusive thoughts or checking are prominent
Compare anxiety with OCD when worries become repetitive, sticky, or linked with rituals and reassurance loops.
If low mood or burnout is also present
Look at depression and burnout, because chronic anxiety can overlap with exhaustion, sleep problems, and hopelessness.
If relationships are affected
Use the relationship hub when worry, reassurance, conflict, or avoidance is shaping closeness.
If you are considering therapy
See what a first psychotherapy session can involve.
If you want Dublin or online therapy
Read about in-person psychotherapy in Dublin and online sessions by Zoom.

If symptoms are sudden, severe, medically unexplained, or include chest pain, fainting, confusion, self-harm thoughts, or heavy substance use, please seek urgent medical or crisis support rather than waiting for a routine appointment.

Where does it come from?

Generalized anxiety, like most mental health difficulties, usually grows out of a combination of factors rather than a single cause. Three areas tend to interact:

biology (e.g. genes)
psychology (e.g. life experiences and the strategies one has learned for handling stress)
social environment

Research suggests that around a third of the differences between people in their likelihood of developing GAD can be traced to genetic factors.[12] A genetic predisposition does not make anxiety inevitable, but it can mean that someone is more vulnerable to developing it after a significant life stressor. [13]

On the medication side, antidepressants — particularly the selective serotonin reuptake inhibitors (SSRIs) — are usually the first-line option, and any decisions about medication need to be discussed with a qualified prescriber who knows the person’s full history. Benzodiazepines, such as alprazolam (Xanax®), can ease symptoms in the short term, but long-term use can actually maintain or worsen the underlying anxiety,[14][15] and gradual reduction, under medical supervision, is often associated with a lessening of symptoms over time. [16] Long-term alcohol use shows a similar pattern: it is linked with anxiety disorders, [17] and prolonged abstinence can lead to a noticeable easing of symptoms.[18] Even so, in around a quarter of people recovering from alcohol dependence, anxiety can take up to two years to settle back to baseline.[19] In some cases the anxiety pre-dates the alcohol or benzodiazepine use, while the dependence then keeps the anxiety going and often makes it gradually worse.

Tobacco smoking is recognised as a risk factor for developing anxiety disorders,[20] and excessive caffeine intake has likewise been linked with higher anxiety levels. [21]

Brain-imaging research has linked generalized anxiety disorder to changes in how the amygdala — a region central to processing fear and threat — connects with other parts of the brain. [22] Sensory information enters the amygdala through the basolateral complex (the lateral, basal and accessory basal nuclei), where fear-related memories are processed and their importance is signalled to other regions such as the medial prefrontal cortex and sensory cortices. The adjacent central nucleus controls more automatic fear responses through its connections to the brainstem, hypothalamus and cerebellum. In people with generalized anxiety disorder, these pathways appear less functionally distinct, and there is more grey matter in the central nucleus. The amygdala also shows reduced connectivity with the insula and cingulate areas (involved in noticing what stands out), and increased connectivity with parietal and prefrontal regions involved in executive function.[22] This is often interpreted as a kind of compensation — the brain working harder, through thinking, to manage emotional responses that are not being regulated as smoothly further downstream. The pattern fits with cognitive accounts of GAD, which describe how chronic worry can become a way of trying to dampen difficult feelings.[22]

These links connect generalized anxiety with the questions readers often have next: worry, panic, social anxiety, OCD, depression, burnout, relationships, therapy, and local or online support.

Reliable generalized anxiety resources

The links below point to established health services, clinical guidelines, public-health bodies, and mental-health organisations. They are offered for further reading and as additional support options — not as a substitute for individual assessment, diagnosis, medication advice, psychotherapy, or emergency care.

Ireland and UK

United States

Canada

Japan and global

References

Association, American Psychiatric (2013). Diagnostic and statistical manual of mental disorders : DSM-5. (5th ed.). Washington, D.C.: American Psychiatric Association. p. 222. ISBN 978-0-89042-554-1.
“What Is Generalized Anxiety Disorder?”, National Institute of Mental Health.
Torpy, Janet M.; Burke, AE; Golub, RM (2011). “Generalized Anxiety Disorder”. JAMA. 305 (5): 522. doi:10.1001/jama.305.5.522. PMID 21285432.
International Classification of Diseases) ICD-10
Spitzer, Robert L.; Kroenke, K; Williams, JB; Löwe, B (2006). “A Brief Measure for Assessing Generalized Anxiety Disorder”. Archives of Internal Medicine. 166 (10): 1092–7. doi:10.1001/archinte.166.10.1092. PMID 16717171.
Ballenger, JC; Davidson, JR; Lecrubier, Y; Nutt, DJ; Borkovec, TD; Rickels, K; Stein, DJ; Wittchen, HU (2001). “Consensus statement on generalized anxiety disorder from the International Consensus Group on Depression and Anxiety”. The Journal of Clinical Psychiatry. 62 Suppl 11: 53–8. PMID 11414552.
“The Numbers Count”, National Institute of Mental Health. Accessed 28 May 2007.
Lieb, Roselind; Becker, Eni; Altamura, Carlo (2005). “The epidemiology of generalized anxiety disorder in Europe”. European Neuropsychopharmacology. 15 (4): 445–52. doi:10.1016/j.euroneuro.2005.04.010. PMID 15951160.
Craske, MG; Stein, MB (24 June 2016). “Anxiety.”. Lancet (London, England). PMID 27349358.
“In The Clinic: Generalized Anxiety Disorder”. Annals Of Internal Medicine. 159 (11). 2013.
Rickels, K; Schweizer, E (1990). “The clinical course and long-term management of generalized anxiety disorder”. Journal of Clinical Psychopharmacology. 10 (3 Suppl): 101S–110S. doi:10.1097/00004714-199006001-00017. PMID 1973934.
Hettema, J. M.; Neale, MC; Kendler, KS (2001). “A Review and Meta-Analysis of the Genetic Epidemiology of Anxiety Disorders”. American Journal of Psychiatry. 158 (10): 1568–78. doi:10.1176/appi.ajp.158.10.1568. PMID 11578982.
Donner, Jonas; Pirkola, Sami; Silander, Kaisa; Kananen, Laura; Terwilliger, Joseph D.; Lönnqvist, Jouko; Peltonen, Leena; Hovatta, Iiris (2008). “An Association Analysis of Murine Anxiety Genes in Humans Implicates Novel Candidate Genes for Anxiety Disorders”. Biological Psychiatry. 64 (8): 672–80. doi:10.1016/j.biopsych.2008.06.002. PMC 2682432. PMID 18639233.
Galanter, Marc (1 July 2008). The American Psychiatric Publishing Textbook of Substance Abuse Treatment (American Psychiatric Press Textbook of Substance Abuse Treatment) (4 ed.). American Psychiatric Publishing, Inc. p. 197. ISBN 978-1-58562-276-4.
Ashton, Heather (2005). “The diagnosis and management of benzodiazepine dependence”. Current Opinion in Psychiatry. 18 (3): 249–55. doi:10.1097/01.yco.0000165594.60434.84. PMID 16639148.
Lindsay, S.J.E.; Powell, Graham E., eds. (28 July 1998). The Handbook of Clinical Adult Psychology (2nd ed.). Routledge. p. 173. ISBN 978-0-415-07215-1.
Cargiulo, T. (2007). “Understanding the health impact of alcohol dependence”. American Journal of Health-System Pharmacy. 64 (5 Supplement 3): S5–11. doi:10.2146/ajhp060647. PMID 17322182.
Wetterling, T; Junghanns, K (2000). “Psychopathology of alcoholics during withdrawal and early abstinence”. European Psychiatry. 15 (8): 483–8. doi:10.1016/S0924-9338(00)00519-8. PMID 11175926.
Cohen, SI (1995). “Alcohol and benzodiazepines generate anxiety, panic and phobias”. Journal of the Royal Society of Medicine. 88 (2): 73–7. PMC 1295099. PMID 7769598.
Morissette, Sandra Baker; Tull, Matthew T.; Gulliver, Suzy Bird; Kamholz, Barbara Wolfsdorf; Zimering, Rose T. (2007). “Anxiety, anxiety disorders, tobacco use, and nicotine: A critical review of interrelationships”. Psychological Bulletin. 133 (2): 245–72. doi:10.1037/0033-2909.133.2.245. PMID 17338599.
Bruce M. S., Lader M.; Lader (2009). “Caffeine abstention in the management of anxiety disorders”. Psychological Medicine. 19 (1): 211–4. doi:10.1017/S003329170001117X. PMID 2727208.
Etkin, Amit; Prater, Katherine E.; Schatzberg, Alan F.; Menon, Vinod; Greicius, Michael D. (2009). “Disrupted Amygdalar Subregion Functional Connectivity and Evidence of a Compensatory Network in Generalized Anxiety Disorder”. Archives of General Psychiatry. 66 (12): 1361–72. doi:10.1001/archgenpsychiatry.2009.104. PMID 19996041.
Möller, Hans-Jürgen; Bandelow, Borwin; Bauer, Michael; Hampel, Harald; Herpertz, Sabine C.; Soyka, Michael; Barnikol, Utako B.; Lista, Simone; Severus, Emanuel; Maier, Wolfgang (26 August 2014). “DSM-5 reviewed from different angles: goal attainment, rationality, use of evidence, consequences—part 2: bipolar disorders, schizophrenia spectrum disorders, anxiety disorders, obsessive–compulsive disorders, trauma- and stressor-related disorders, personality disorders, substance-related and addictive disorders, neurocognitive disorders”. European Archives of Psychiatry and Clinical Neuroscience. 265: 87–106. doi:10.1007/s00406-014-0521-9.

About this resource

This page is public educational information about generalized anxiety and worry. It cannot diagnose an anxiety disorder, rule out medical causes of physical symptoms, provide medication advice, replace psychotherapy, or respond to an emergency.

Reviewed May 2026. This page is educational information and is not a substitute for individual medical, psychological, medication, or emergency advice.

jonathanhaverkampf@gmail.com

Psychotherapy & Counselling, Communication, Medicine (Psychiatry); Dublin, Ireland

For psychotherapy, counselling and communication-focused therapy information, visit jonathanhaverkampf.com, read about psychotherapy and counselling in Dublin and online, or make an appointment.

This article is provided as a basis for academic discussion and general education. Nothing in it constitutes medical advice. Please consult a qualified professional if you believe you may be experiencing a physical or mental health condition.

Trademarks belong to their respective owners. They have not been verified.

Current helpful external links:

If someone close to you is caught in worry, reassurance loops or helplessness, how to help someone with anxiety offers supportive language, boundaries, and therapy routes.