When Your Brain Won’t “Just Relax”: Understanding GAD
Generalized anxiety disorder (GAD) is a condition marked by ongoing, excessive worry about many areas of life—work, health, family, finances—that lasts for at least six months and feels difficult or impossible to control. The worry tends to feel disproportionate to the actual situation and often gets in the way of daily functioning.
How Common Is GAD?
GAD is fairly common, affecting about 6% of people at some point in their lives in the United States. For many, symptoms are chronic and can significantly impact quality of life. It also frequently occurs alongside depression, substance use, and various medical conditions. Individuals with GAD may also face higher risks for suicidal thoughts and certain medical problems, including cardiovascular issues.
What GAD Looks and Feels Like
To meet criteria for GAD, adults typically experience excessive worry plus at least three additional symptoms, such as:
Restlessness or feeling on edge
Fatigue
Trouble concentrating
Irritability
Muscle tension
Sleep problems
Children only need one additional symptom to meet criteria.
People with GAD often worry about everyday responsibilities or future possibilities. Physical symptoms can include a racing heart, shortness of breath, dizziness, headaches, stomach issues, muscle tension, back pain, and insomnia.
What Causes GAD
GAD develops through a mix of genetics, life experiences, personality traits, and brain-based patterns.
Genetics play a role. About one-third of a person’s risk for GAD is inherited, and these genetic tendencies often overlap with traits like high sensitivity, emotional reactivity, or a general tendency toward anxiety or low mood.
Life experiences matter too. People who experience childhood adversity—such as physical or emotional abuse, neglect, unstable or unsafe home environments, or harsh or inconsistent parenting—have a higher risk of developing GAD later on. Stressful events in adulthood, chronic stress, and lower socioeconomic resources can also increase vulnerability. Women are diagnosed with GAD more often than men.
Personality traits make a difference as well. Individuals who are naturally more cautious, sensitive, or prone to anticipating worst-case scenarios may be more likely to develop GAD. A key trait linked specifically to GAD is intolerance of uncertainty, meaning it feels especially uncomfortable not to know what will happen next.
Brain patterns also contribute. Research shows that people with GAD may have heightened activity in areas of the brain that process threat and worry (like the amygdala) and lower activity in the regions that help regulate and calm those responses. This imbalance can make everyday situations feel more overwhelming or difficult to manage.
Together, these genetic, psychological, environmental, and biological factors weave into the experience of chronic worry, which helps explain why GAD feels so persistent and hard to shake without support.
Treatment Options
The most effective first-line treatments for GAD are cognitive behavioral therapy (CBT) and medications such as SSRIs or SNRIs.
Psychotherapy
CBT has the strongest evidence base and helps people reduce worry by changing unhelpful thinking patterns and behaviors. It can be delivered individually, in groups, or through guided self-help, including virtual formats. “Third-wave” CBT approaches, like mindfulness-based therapies, also show good effectiveness.
Medications
SSRIs (like sertraline / Zoloft or escitalopram / Lexapro) and SNRIs (like venlafaxine / Effexor or duloxetine / Cymbalta) are commonly used and have been shown to reduce symptoms. They are considered first-line medication options.
Complementary Approaches
Exercise, yoga, acupuncture, and repetitive transcranial magnetic stimulation (rTMS) have emerging evidence and can be helpful additions for some patients. Treatment choices ultimately depend on personal preference, past treatment response, comorbidities, reproductive planning, cost, and access.
Final Thoughts
Living with generalized anxiety disorder can feel exhausting, overwhelming, and isolating, but it is also highly treatable with the right support. Whether through therapy, medication, lifestyle changes, or a combination of approaches, many people find meaningful relief and regain a greater sense of ease and control in their lives. If you recognize yourself in these symptoms, reaching out to a doctor can be the first step toward feeling better. You don’t have to navigate persistent worry alone: help is available, and healing is absolutely possible.
As a psychiatrist who treats GAD every single day in her practice and has treated hundreds of patients with GAD, I can tell you that most people do improve with the right treatment.
