Everyone worries.
You might worry about money before a large bill, about work before an important meeting or about someone you love when they are unwell.
That kind of worry is part of ordinary life.
Generalised anxiety disorder, usually shortened to GAD, is different.
With GAD, worry becomes persistent, difficult to control and spread across many areas of life. It can continue even when there is no immediate crisis to solve.
People may find themselves repeatedly worrying about:
- work;
- money;
- health;
- family members;
- relationships;
- appointments;
- future problems;
- small everyday decisions.
The worry can feel almost continuous.
It may also produce physical symptoms such as muscle tension, poor sleep, fatigue, stomach problems, palpitations or dizziness.
The NHS says GAD may be diagnosed when anxiety affects daily life, is hard to control, involves worrying about a wide range of things and has been present much of the time for at least six months.
This guide explains how GAD differs from normal worry, what symptoms can look like, why reassurance often fails to settle it and how treatment such as CBT and medication can help.
What Is Generalised Anxiety Disorder?
GAD is a mental health condition characterised by excessive and persistent anxiety.
The important word is generalised.
The anxiety is not limited to one narrowly defined situation.
Someone may worry about their job in the morning, their health at lunchtime, money in the afternoon and whether a family member is safe at night.
When one concern settles, another can take its place.
The NHS describes the main feature as frequent anxiety about many different things, where the worry is difficult to control and interferes with everyday life.
That can make GAD feel less dramatic than a panic attack but more exhausting over time.
People sometimes describe it as:
“My brain is always looking for the next thing that could go wrong.”
How Is GAD Different From Normal Worry?
Normal worry usually has an identifiable reason and tends to reduce when the situation changes.
For example:
You worry about a job interview, attend the interview and then the worry starts to settle.
With GAD, the process is often different.
| Everyday worry | Generalised anxiety disorder |
|---|---|
| Usually linked to a specific problem | Often spreads across many different areas |
| Generally proportionate to the situation | May feel much larger than the actual risk |
| Usually settles when the problem is resolved | Often moves on to another concern |
| You can usually redirect your attention | Worry may feel extremely difficult to control |
| Does not usually dominate daily life | Can affect sleep, concentration, work and relationships |
| Often short-lived | Typically persists for months |
It is also possible to have periods of intense ordinary worry without having GAD.
Bereavement, redundancy, relationship breakdown, serious illness or financial problems can understandably produce sustained anxiety.
The question is not simply:
“Am I worrying a lot?”
It is more useful to ask:
“Is my anxiety persistent, difficult to control, disproportionate and interfering with my life?”
What Does GAD Feel Like?
GAD affects both thoughts and the body.
Mental symptoms can include:
- constant worrying;
- difficulty stopping anxious thoughts;
- expecting something to go wrong;
- repeatedly analysing possible problems;
- difficulty concentrating;
- irritability;
- difficulty making decisions;
- needing reassurance from other people.
Physical symptoms can include:
- muscle tension;
- headaches;
- tiredness;
- poor sleep;
- restlessness;
- stomach discomfort;
- palpitations;
- dizziness;
- feeling on edge.
The NHS specifically lists sleep problems, restlessness, irritability, difficulty concentrating, fatigue, tension, stomach problems, palpitations and dizziness among common symptoms.
Some people do not initially recognise these symptoms as anxiety.
They may first seek help because of:
- indigestion;
- headaches;
- poor sleep;
- chest awareness;
- muscle pain;
- ongoing exhaustion.
It is still important for new physical symptoms to be assessed appropriately rather than automatically assuming anxiety is the cause.
Why Does GAD Keep Going Even When Nothing Is Wrong?
Anxiety is designed to protect us from danger.
When the brain believes something may be threatening, it increases alertness and prepares the body to respond.
That system is extremely useful when danger is real.
With GAD, the threat system can become overactive.
The brain begins repeatedly asking questions such as:
- What if something goes wrong?
- What if I have forgotten something?
- What if this symptom is serious?
- What if I cannot cope?
- What if something happens to my family?
The problem is that many of these questions cannot be answered with complete certainty.
Trying harder to obtain certainty can therefore generate even more thinking.
A person may start:
- rechecking things;
- asking others for reassurance;
- searching online repeatedly;
- mentally reviewing conversations;
- avoiding situations that feel uncertain.
These behaviours can reduce anxiety temporarily.
But they may also teach the brain that uncertainty really is dangerous, which helps keep the cycle going.
GAD vs Health Anxiety, Panic and Social Anxiety
Anxiety disorders overlap, but the focus of the fear differs.
GAD
The worry usually covers many different areas of life.
Health anxiety
The anxiety centres mainly on having or developing a serious medical condition.
People may repeatedly check their body, search symptoms or seek medical reassurance.
See our guide to health anxiety, reassurance seeking and treatment.
Panic disorder
The main problem is recurrent panic attacks and fear of having further attacks.
A panic attack causes a sudden surge of intense fear with symptoms such as rapid heartbeat, breathlessness, trembling and dizziness.
Our guide to panic attacks and what to do explains the difference further.
Social anxiety disorder
The fear is focused largely on social situations and being judged, embarrassed or criticised.
See our guide to social anxiety disorder.
A person can have more than one anxiety disorder at the same time.
GAD also commonly occurs alongside depression.
How Is GAD Diagnosed?
There is no blood test or brain scan that diagnoses generalised anxiety disorder.
A GP or mental health professional usually asks about:
- what you worry about;
- how often anxiety occurs;
- how long it has been happening;
- whether you can control the worry;
- sleep;
- concentration;
- physical symptoms;
- how anxiety affects work and relationships.
The NHS says GAD may be diagnosed if:
- you frequently worry about many different things;
- anxiety affects daily life;
- the worry is difficult to control;
- you have felt anxious much of the time for at least six months.
Clinicians may also consider whether another condition better explains the symptoms.
For example, anxiety can sometimes be worsened by:
- thyroid disease;
- some medicines;
- stimulants;
- high caffeine intake;
- alcohol withdrawal;
- drug use;
- sleep disorders.
Other mental health conditions such as OCD, PTSD and depression may also need to be considered.
What Treatment Helps GAD?
GAD is treatable.
NICE uses a stepped-care approach, starting with the least intensive treatment likely to help and increasing support where symptoms are more severe or persistent.
Education and active monitoring
For relatively mild symptoms, understanding anxiety and monitoring how it develops may sometimes be enough initially.
CBT-based self-help
NICE recommends low-intensity options such as:
- structured self-help;
- guided self-help;
- psychoeducational groups.
Guided self-help is generally based on CBT principles and supported by a trained practitioner.
Cognitive behavioural therapy
CBT is one of the main psychological treatments for GAD.
It does not simply teach people to “think positively”.
It looks at how thoughts, attention, behaviour and avoidance help maintain anxiety.
Therapy may address:
- catastrophic predictions;
- intolerance of uncertainty;
- reassurance seeking;
- avoidance;
- unhelpful beliefs about worry;
- problem-solving habits.
NICE recommends CBT or applied relaxation as high-intensity psychological options for GAD. A standard CBT course is often around 12 to 15 weekly sessions.
If you are considering private treatment, our guide to private CBT costs in the UK explains typical fees.
Which Medicines Are Used for GAD?
Medication can be considered when symptoms are significantly affecting life or when psychological treatment has not been enough.
The main medicines are usually antidepressants.
This does not mean the clinician thinks you are depressed.
Certain antidepressants are also effective treatments for anxiety.
NICE recommends an SSRI as the main first medication option and suggests considering sertraline first on cost-effectiveness grounds.
Other SSRIs or an SNRI may be considered if the first medicine is ineffective or causes troublesome side effects.
Pregabalin can sometimes be considered when antidepressants are unsuitable.
Antidepressants do not work instantly.
Some people temporarily experience:
- increased anxiety;
- agitation;
- sleep disturbance;
- nausea;
- other early side effects.
NICE advises discussing these possible effects before treatment and reviewing effectiveness and side effects regularly.
Our guides to sertraline and fluoxetine explain what the first weeks of antidepressant treatment can feel like.
Why Are Benzodiazepines Usually Avoided?
Medicines such as diazepam can reduce anxiety quickly.
That makes them tempting when somebody feels extremely anxious.
But they can cause:
- sedation;
- tolerance;
- dependence;
- withdrawal symptoms;
- difficulty concentrating.
NICE therefore says benzodiazepines should generally not be used for routine treatment of GAD except as a short-term measure during a crisis.
The goal of long-term treatment is to improve the anxiety disorder itself rather than repeatedly suppress symptoms for a few hours.
What Can You Do Yourself?
Self-help does not mean simply being told to relax.
Several practical habits can reduce the background level of anxiety and make formal treatment easier.
Reduce excessive caffeine
Caffeine can increase:
- palpitations;
- restlessness;
- trembling;
- difficulty sleeping.
These sensations can then feed anxiety.
Exercise regularly
The NHS recommends regular exercise as one way of reducing anxiety and stress and improving sleep.
Protect sleep
Poor sleep makes the nervous system more reactive and can make ordinary uncertainty feel much harder to tolerate.
Notice reassurance seeking
Ask yourself whether repeatedly asking:
“Are you sure everything is okay?”
actually solves the problem or only reduces anxiety for a few minutes.
Separate problems from hypothetical worries
A useful distinction is:
Can I do something about this problem right now?
If the answer is yes, practical problem-solving may help.
If the worry is entirely hypothetical — “What if something bad happens one day?” — more thinking may not produce a solution.
When Should You Ask for Help?
Consider speaking to a GP or mental health professional if worry:
- has persisted for months;
- feels difficult to control;
- affects sleep;
- interferes with work or studying;
- damages relationships;
- causes significant physical symptoms;
- leads you to avoid ordinary activities;
- causes repeated reassurance seeking.
In England, many adults can self-refer to NHS Talking Therapies without seeing a GP first.
Our guide to self-referral to mental health services in the UK explains how this works.
If you prefer private therapy, our guide to private therapy costs in the UK covers typical fees and options.
People with complex or treatment-resistant anxiety may need assessment by a psychiatrist or specialist mental health service.
Frequently Asked Questions
Is worrying every day a sign of GAD?
Not necessarily. The important factors are how difficult the worry is to control, how broadly it spreads across life, whether it affects daily functioning and how long it has persisted.
How long does anxiety need to last to be GAD?
The NHS describes GAD as involving anxiety much of the time for at least six months alongside difficulty controlling the worry and impact on everyday life.
Can GAD make you feel physically ill?
Yes. Anxiety can cause muscle tension, tiredness, stomach symptoms, palpitations, dizziness, headaches and poor sleep.
Can GAD cause chest pain?
Anxiety can contribute to chest tightness or discomfort, but new or unexplained chest pain should not automatically be assumed to be anxiety. Seek appropriate medical assessment, particularly if the pain is severe or associated with breathlessness, sweating or exertion.
Can GAD cause constant tiredness?
Yes. Persistent hyper-alertness and poor sleep can be exhausting. Fatigue can also have many physical causes, so persistent unexplained tiredness may need medical assessment.
Is GAD the same as overthinking?
No. Overthinking is a common everyday description rather than a medical diagnosis. In GAD, excessive worrying forms part of a broader persistent anxiety disorder that affects functioning.
Is GAD the same as health anxiety?
No. Health anxiety is mainly focused on illness and bodily symptoms. GAD typically involves worry about several areas of life, although someone can have both.
Can you have GAD and panic attacks?
Yes. Some people with GAD also experience panic attacks, but recurrent panic attacks are not required for a GAD diagnosis.
Does GAD cause depression?
GAD and depression commonly occur together. Persistent anxiety can also affect sleep, motivation and quality of life, which can contribute to low mood.
What is the best treatment for GAD?
There is no single best treatment for everyone. NICE recommends CBT-based approaches, applied relaxation and medication depending on severity, previous treatment and personal preference.
Does CBT work for GAD?
Yes. CBT is one of the main evidence-based treatments recommended by NICE for generalised anxiety disorder.
Which antidepressant is used for GAD?
SSRIs are commonly used. NICE suggests considering sertraline first, although the best option depends on individual circumstances and side effects.
Do antidepressants make anxiety worse at first?
They can temporarily increase anxiety, agitation or sleep problems when first started. This usually settles, but significant or concerning symptoms should be discussed with the prescriber.
Is diazepam used for GAD?
It is generally not recommended for long-term GAD treatment because of tolerance and dependence risks. NICE advises benzodiazepines only as short-term treatment during crises.
Can GAD go away without treatment?
Sometimes symptoms improve naturally, particularly when stressors change. Persistent GAD can also continue for a long time, so treatment is worth considering when it is significantly affecting everyday life.
Can exercise cure GAD?
Exercise can reduce anxiety and improve sleep and wellbeing, but severe or persistent GAD may still require psychological therapy, medication or both.
When is anxiety an emergency?
Seek urgent mental health help if anxiety is accompanied by immediate risk of self-harm, suicidal thoughts, severe loss of functioning or a mental health crisis. In an immediate life-threatening emergency, call 999 or attend A&E.
This article provides general information rather than a diagnosis. Persistent anxiety can overlap with physical illness and other mental health conditions, so seek professional assessment if symptoms are significant, new, worsening or difficult to manage.
