Description

• A condition characterized by persistent, excessive, and difficult-to-control worry associated with significant symptoms of motor tension, autonomic hyperactivity, and/or disturbances of sleep or concentration
• System(s) affected: nervous (increased sympathetic tone and catecholamine release); secondary effects on other symptoms such as cardiac (tachycardia), pulmonary (dyspnea), and GI (nausea, irregular bowels)

Epidemiology

• 12-month prevalence rate: 1.8%
• Lifetime prevalence rate in United States 5.1–11.9%
• Elderly prevalence as high as 7–10%
• Onset can occur any time in life but is typically during adulthood; median age of onset in the United States is 31 years.
• Predominant sex: female > male (2:1)
• Generally recurrent and chronic in nature; gradual in onset; fluctuates in severity; complete remission less likely (1)

Etiology and Pathophysiology

• May be mediated by abnormalities of neurotransmitter systems (i.e., serotonin, norepinephrine, and γ-aminobutyric acid [GABA])
• Associated with altered regional brain function (increased activity in the amygdala and prefrontal cortex)

• Strongly linked to depression in heritability studies
• A variant of the serotonin transporter gene (5HT1A) or other genes may contribute to both conditions.

Risk Factors

• Adverse life events
• Family history
• Chronic physical illness
• Lack of social support
• Poverty
• Comorbid psychiatric disorders (2)

General Prevention

• Physical activity and cardiorespiratory fitness are associated with decreased generalized anxiety and depression.
• Cognitive-behavioral therapy (CBT) and parental intervention in children with early anxiety may protect against the development of GAD (2).

Commonly Associated Conditions

• Major depressive disorder (>60%), dysthymia, bipolar disorder, schizophrenia
• Alcohol/drug abuse
• Cigarette smoking in adolescence
• Panic disorder, agoraphobia, simple phobia, social anxiety disorder, anorexia nervosa, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), ADHD
• Somatoform and pain disorders