Generalised Anxiety Disorder

Generalised Anxiety Disorder (GAD) is a common condition where people experience excessive, persistent worry about everyday situations for six months or more, often accompanied by physical symptoms such as restlessness, muscle tension, poor sleep and difficulty concentrating.

Unlike short periods of anxiety in response to specific stresses, GAD involves ongoing anxiety on most days, which can significantly affect work, relationships, health and day-to-day life.

At The Royal Buckinghamshire Hospital, we frequently see GAD alongside long-term neurological conditions, Functional Neurological Disorder (FND), chronic pain, fatigue and cognitive problems. In these settings, specialist inpatient neurorehabilitation can support both physical function and emotional wellbeing.

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What Is Generalised Anxiety Disorder?

Generalised Anxiety Disorder is characterised by:

• Excessive, hard-to-control worry about a wide range of everyday issues (health, family, work, finances, safety)
• Anxiety and worry occurring more days than not for at least six months
• Associated physical symptoms and distress that impair daily functioning

People with GAD often describe:

• Constant “what if?” thoughts and worst-case scenarios
• Feeling “on edge” or keyed up much of the time
• Finding it very difficult to switch off, even when nothing specific is wrong

GAD is not a sign of personal weakness. It reflects a combination of biology, life experiences and learned patterns in how the brain responds to stress and uncertainty. It is also treatable, with effective psychological and medication options.

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Causes and Risk Factors

There is rarely a single cause. GAD usually develops from a mix of factors:

• Genetic and biological vulnerability – a family history of anxiety or mood disorders
• Personality traits such as high responsibility, perfectionism or a tendency to worry
• Stressful or traumatic experiences, including illness, injury or significant life changes
• Long-term physical health conditions (e.g. chronic pain, fatigue, neurological illness)
• Ongoing social or occupational stress, caring responsibilities or financial difficulties

GAD commonly coexists with:

• Depression
• Other anxiety disorders (panic disorder, phobias, PTSD, OCD)
• Functional Neurological Disorder (FND), fibromyalgia, chronic pain and post-concussion symptoms

This does not mean symptoms are “all psychological” – rather, mind and body are closely linked, and persistent anxiety can amplify physical symptoms (and vice versa).

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Symptoms of Generalised Anxiety Disorder

People with GAD may experience a combination of psychological and physical symptoms.

Psychological Symptoms

• Constant worry or nervousness that is hard to control
• Feeling on edge, keyed up or unable to relax
• Racing thoughts, “what if?” thinking, fear of something bad happening
• Difficulty concentrating or feeling that your mind “goes blank”
• Irritability or becoming easily overwhelmed

Physical Symptoms

• Restlessness or feeling unable to sit still
• Muscle tension, aches and pains (often neck, shoulders, jaw, back)
• Fatigue and low energy despite poor sleep
• Sleep disturbance – trouble falling asleep, staying asleep, or restless, unsatisfying sleep
• Heart palpitations, sweating, shaking or feeling short of breath
• Stomach discomfort, nausea or diarrhoea

Over time, GAD can lead to:

• Avoidance of situations that trigger anxiety
• Reduced participation in work, study, social activities or hobbies
• Worsening of existing physical symptoms (e.g. pain, dizziness, fatigue)

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How Is Generalised Anxiety Disorder Diagnosed?

GAD is typically diagnosed by a GP, psychiatrist, psychologist or other trained clinician based on a detailed assessment. There is no single blood test or scan for GAD.

Assessment usually includes:

• A clinical interview about your worries, physical symptoms and how long they have been present
• Questions about impact on daily life, work, relationships and self-care
• Screening questionnaires (e.g. GAD-7) to estimate severity
• Review of medical history and medications
• Physical examination and investigations where needed to rule out physical causes (e.g. thyroid disease, anaemia, cardiac problems)

GAD is diagnosed when:

• Excessive anxiety and worry have been present on most days for at least six months
• The anxiety is difficult to control
• There are three or more associated symptoms in adults (e.g. restlessness, fatigue, poor concentration, irritability, muscle tension, sleep disturbance)
• Symptoms cause significant distress or impairment in important areas of life

Your clinician will also consider other conditions, such as depression, panic disorder, PTSD or physical illnesses, which may need parallel treatment.

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Treatment and Management

GAD is highly treatable. NICE recommends a stepped-care approach, starting with the least intrusive, most effective options and increasing support if symptoms persist.

Step 1: Identification, Information and Active Monitoring

For people with milder symptoms:

• Psychoeducation – understanding what GAD is and how it is treated
• Advice on sleep, activity, caffeine/alcohol and stress reduction
• Active monitoring by the GP or clinician to see how things evolve

Step 2: Low-Intensity Psychological Interventions

If symptoms continue, NICE recommends low-intensity interventions, often accessed through NHS Talking Therapies services in the community.

These may include:

• Guided self-help using CBT-based workbooks or digital programmes
• Non-facilitated self-help with structured materials
• Psychoeducational groups teaching anxiety management strategies

Step 3: High-Intensity Psychological Therapy and/or Medication

For moderate to severe GAD, or when lower-intensity approaches have not helped, NICE recommends:

High-intensity psychological therapies, such as:

• Cognitive Behavioural Therapy (CBT) – typically 12–15 sessions, focusing on:
  • Reducing excessive worry and “what if?” thinking
  • Challenging unhelpful beliefs about anxiety and risk
  • Gradually facing, rather than avoiding, feared situations
  • Developing practical coping strategies
• Applied relaxation – learning structured relaxation techniques and applying them to daily life

Medication, if appropriate:

• Selective serotonin reuptake inhibitors (SSRIs) are first-line (e.g. sertraline), with SNRIs as alternatives if needed
• Medication choice should be individualised, considering side-effects, other conditions and patient preference
• Benzodiazepines are not recommended for long-term management of GAD, except short-term use in crises, due to dependence and poorer long-term outcomes

Step 4: Complex or Treatment-Refractory GAD

For people with severe, long-standing anxiety, marked functional impairment or multiple conditions (e.g. FND, chronic pain, major physical illness), more specialist, multidisciplinary care may be needed, sometimes within a rehabilitation or specialist mental health setting.’

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GAD, Long-Term Conditions and Functional Neurological Disorder (FND)

GAD commonly coexists with neurological and functional conditions:

• People with long-term neurological conditions (stroke, brain injury, neuroinflammation, Parkinson’s, MS) frequently experience clinically significant anxiety and low mood.
• GAD is common in FND, where heightened worry, hypervigilance and avoidance can increase functional symptoms such as weakness, gait difficulties, dissociative seizures or dizziness.
• Anxiety can amplify pain, fatigue and cognitive symptoms, creating a vicious cycle for people living with conditions like fibromyalgia, chronic widespread pain, post-concussion syndrome and neuroinflammation.

Treating GAD does not mean physical symptoms are “all in the mind”. Instead, it recognises that better anxiety management can reduce distress, improve engagement in rehabilitation and support overall recovery.

You can read more on related pages such as:

• Functional Neurological Disorder (FND) – Conditions & Symptoms and Rehab Centre
• Fibromyalgia, Functional Cognitive Disorder, Functional Limb Weakness, Neuroinflammation

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When to Seek Medical or Urgent Help

This page provides general information and does not replace individual medical advice.

You should speak to your GP or another healthcare professional if:

• You feel anxious or worried most days, for weeks or months
• Worry is difficult to control and is affecting work, relationships or daily life
• Physical symptoms (e.g. palpitations, poor sleep, muscle tension) accompany persistent anxiety

You should seek urgent help (999, 111 or your local emergency service) if:

• You have thoughts of harming yourself or ending your life
• Anxiety is accompanied by sudden chest pain, breathlessness, severe dizziness, weakness or other concerning physical symptoms – these may indicate a physical emergency and need immediate assessment

Your GP or specialist can help confirm the diagnosis, recommend appropriate treatment and advise whether a rehabilitation-focused programme, as part of a wider care plan.