Generalized Anxiety Disorder in Adults

What does “worry” look like?

Worry involves thoughts about negative events that might happen in the future. It usually begins as a “what if” question:

• What if I’m caught in traffic and late for work? My boss might be angry with me and he might even fire me. What if I can’t find another job and my friends and family think I’m a failure?
• I have to buy new curtains for the kitchen: What if I buy curtains and then find better or cheaper ones later on? What if I buy new furniture at some point and the curtains I bought don’t match the furniture?

What is “excessive and uncontrollable” worry?

Obviously, everybody worries from time to time. This is normal. But worry becomes a problem when it happens almost every day, and becomes “excessive” and “uncontrollable”. What this means is that people with GAD worry too much, they worry more than others would, and they find it hard to stop worrying once they start. Some good questions to ask yourself if you think you might have GAD include:

• Do I worry a lot more than other people do?
• Do people tell me that I worry too much?
• Do I worry even when everything is OK? (For example, do I worry about my family’s health even when no one is sick?)
• Do I often try to keep busy or distract myself as a way to avoid worrying?
• Is it very difficult for me to stop worrying once I start?

What Do People with GAD Worry About?

For the most part, people with GAD worry about the same things that others worry about, they just worry more and more often than other people. Some common GAD worries include: Worries about minor matters, such as punctuality and small decisions:

• “What if I’m late for my appointment?”
• “What if I go see this movie and I don’t like it? What if there is a movie that I would like better?”

Worries about work or school, such as exams, performance at work or in class:

• “What if I failed my test?”
• “What if I choose the wrong career path?”
• “What if I don’t finish this report on time?”

Worries about friends and family, such as relationships, getting along with others:

• “What if my parents get divorced?”
• “What if my child gets injured while playing hockey?”
• “What if I choose an outing for some friends and no one enjoys themselves? What if they blame me for not having a good time?”

Worries about health, such as personal health or the health of loved ones:

• “What if I get cancer or some other serious disease?”
• “What if my husband gets into a car accident?”

Worries about the future and the world; such as the environment, war in the world

• “What if there is a hurricane in my city?”
• “What if in 20 years I don’t have enough money to retire?”

What Does GAD Feel Like in the Body?

Although the main symptom of GAD is worry, most people first notice the discomfort they feel in their bodies, rather than the worrisome thoughts. In fact, many people with GAD will visit their family doctors because of their physical discomfort, and they often will not even mention that they worry excessively.

Some of the physical feelings that worry can lead to are:

• Physical feelings of anxiety (e.g. heart racing, sweating, stomach discomfort)
• Feeling fidgety, restless or unable to sit still
• Feeling irritable, getting easily upset, snapping at people for minor reasons
• Sleep problems: this can include having a hard time falling asleep, waking up frequently during the night, or having a restless and unsatisfying sleep
• Difficulty paying attention or concentrating
• Being easily fatigued
• Muscle pains (often in the neck and shoulders)

How Else Can I Know If I Might Have GAD?

1. A common feature of GAD is that the worries often have a “chaining” effect, that is, one worry will lead to many others.

For example, you might start off by thinking,

• “I have a report to write for work; what if I don’t do it well?” This could lead to other worries, such as,
• “What if my boss fires me? What if I can’t find another job?” If this led to additional worries, like the ones below, we would call it chaining.
• “What if I don’t have enough money to pay the bills?”
• “What if I can’t pay the mortgage for the house? Where would we live?”
• “What if I can’t afford to send the kids off to university?”

It’s easy to see how one worry, in this case about a work report, can lead to a chain of other worries that can last for hours.

2. Another way to recognize whether GAD may be a problem for you is to think about how long you have been worrying excessively. GAD is considered a chronic problem. That is, people with GAD have been feeling anxious and worrying excessively almost every day for at least 6 months.

For the most part, people with GAD report either that they are “always worried” or that they “always worried after a stressful event”.

How Do People with GAD Act in Daily Life (Other than Worrying)?

Perfectionism: Many adults with GAD are perfectionists. They can spend hours on a simple task, in an attempt to make sure that they have completed it perfectly. This might involve re-reading a school or work assignment repeatedly, or agonizing over small details at work or in the home (e.g. what kind of font to use in an e-mail, whether to try a new cleaning product at home).

Intolerance of Uncertainty: People with GAD seem to be allergic to uncertainty. That is, they don’t like it when they are not 100% sure of themselves, others, their actions and decisions, or the future. Because of this, they will often engage in tiring and time-consuming behaviours designed to make them feel more certain, including:

• Excessive reassurance-seeking (e.g. asking for several peoples’ opinion before making a minor decision)
• Checking (e.g. calling a loved one’s cell phone several times a day to make sure that they are OK; re-reading e-mails repeatedly to make sure that there are no spelling mistakes)
• Information seeking or list making (e.g. having to read every book on a subject before making a decision; being unwilling to do simple tasks such as grocery shopping without a list; making elaborate “to do” lists)
• Refusal to delegate to others (e.g. not allowing anyone else in the house to complete small chores in order to make sure that it is “done right”)
• Avoidance/procrastination. This can include avoiding friendships or new opportunities, and procrastinating as long as possible before completing a task (in an attempt to have as little time as possible to worry about the task once it is finished)
• Having others make decisions for you. Because of the uncertainty of making decisions, some people with GAD will hand off the responsibility for decision making to others
• Distraction/keeping busy. Many people with GAD will try to “keep moving” all day long in order to keep their minds busy and to avoid worrying. If you are always distracting yourself with other worries, you won’t “have time” to think about all the uncertain things that are coming up in your life. The problem with this strategy is that it is tiring, and the worries and thoughts about uncertainty come back as soon as you try to relax (for example, when going to sleep at night)

My Anxiety Plan (MAPs)

MAP is designed to provide adults struggling with anxiety with practical strategies and tools to manage anxiety. To find out more, visit our My Anxiety Plan website.