What is a Severe Anxiety Disorder


Please note that health information can only support discussions with psychotherapists or doctors, but never replace them.

What is Generalized Anxiety Disorder?

People with generalized anxiety disorder have one constant feelings of anxiety and tension in relation to everyday events and problems. The worries relate to various areas that other people are also worried about, e.g. that they or their relatives might become seriously ill or have an accident. In people with generalized anxiety disorder, however, such worries are much more pronounced than in other people, so that everyday life can be severely affected. It is normal to be worried in certain situations: someone who works for a company that is doing badly may worry about their job. However, people with generalized anxiety disorder worry excessively even when there is no particular danger. They also have little or no control over their worries.

A diagnosis of "generalized anxiety disorder" applies when there is concern and tension about everyday events at least 6 months is present and various physical and mental symptoms exist, for example:

  • Palpitations
  • Sweats
  • Tingling in the stomach
  • dizziness
  • Afraid of going crazy or dying
  • Feeling hot or cold
  • Muscle tension
  • Difficulty concentrating
  • irritability
  • Difficulty falling asleep

Those affected often try to avoid triggers for the fears (e.g. reports of accidents) or try, for example, to assure their relatives that they are fine and nothing will happen. Since relatives often experience the worries as stressful, conflicts can arise.

How common are generalized anxiety disorders?

About 5 in 100 people will develop generalized anxiety disorder at some point in their lives. Women are affected about twice as often as men. While other anxiety disorders usually develop in adolescence or early adulthood, this is rare in generalized anxiety disorders. Generalized anxiety disorders often appear for the first time between the ages of 35 and 45.

Are there different shapes or courses?

Most people with generalized anxiety disorder also experience other mental illnesses. Mood disorders (e.g. depression), other anxiety disorders, and somatoform disorders are most common in parallel.

If there are other illnesses in addition to the generalized anxiety disorder, the disorder more often has a chronic course. If the condition is left untreated, there is a high risk that it will persist for a long time, although the severity often fluctuates: while many patients experience times when they are symptom-free, about half of the people step complaints again later. For many of those affected, it also takes several years to seek help.

How does a generalized anxiety disorder develop?

There are several causes and explanations as to how and why an anxiety disorder can develop:

Influences one inherited (genetic influences) can play a role in the development of fears.

People with generalized anxiety disorder may have more activity in certain areas of the brain than other people. Presumed to be in people with anxiety disorders Messenger substances in the brainthat provide relaxation are less present or may have a worse effect.

Some people who develop an anxiety disorder had it as children no secure bond e.g. to their parents or other close caregivers. They have sometimes experienced the behavior of their close caregivers as unpredictable.

For people with generalized anxiety disorder it is often more difficult to bear than for other people that one does not have "absolute security" (example: on the road, at work). You are very reactive sensitive to stimulithat pose a danger could. Ambiguous stimuli (i.e. events that can be harmless or threatening) are more likely to be seen as threatening. Sufferers believe that they cannot change or control things, which in turn creates fear.

Many people affected assume that worry can protect themselves from disappointment or avert an accident. Behind this positive assumptions about worries The idea is: if you are ever afraid that something might happen, as a precaution, you will not be disappointed if it really should happen.

How do you find out if you have Generalized Anxiety Disorder?

If the symptoms and signs described here are correct, generalized anxiety disorder could be the cause. Then it is very advisable to seek medical or psychotherapeutic help. An anxiety disorder rarely goes away "on its own".

In a conversation, doctors or psychotherapists will ask about the individual complaints, general health, family history and physical illnesses and check whether a generalized anxiety disorder is present. Questionnaires help the therapist to assess the severity of the illness and to clarify whether other psychological problems may be the cause. A physical exam can clarify whether the symptoms - especially the physical ailments - have physical causes.

How are generalized anxiety disorders treated?

Treatment for generalized anxiety disorder includes psychotherapy or medication - especially so-called selective serotonin reuptake inhibitors (SSRI), selective serotonin norepinephrine reuptake inhibitors (SNRI) or the active ingredient pregabalin. The aim of both treatments is to reduce anxiety to a tolerable level.

So-called benzodiazepines (drugs that calm you down quickly) can help in the short term, but they should only be prescribed in absolute exceptional cases, as they - unlike other drugs - can make you addicted.

Through psychotherapy, those affected can learn to deal with their worries and to reduce the accompanying physical and psychological complaints (e.g. through relaxation techniques) so that they are no longer so stressful. The method that has been best studied and proven to be effective in the long term is cognitive behavioral therapy.

If a patient would prefer to be treated with a psychodynamic psychotherapy procedure or if the behavioral therapy has not worked, these procedures can also be used. However, they have so far been less well studied for generalized anxiety disorder than behavior therapy.

What can friends or family members do?

Close caregivers (e.g. relatives, partners) are usually also affected, as those affected often include them in their worries, for example want to assure themselves that nothing bad has happened or will happen and, for example, often call their caregivers.

It is helpful to have family members knowledgeable about generalized anxiety disorder. If possible, you should avoid repeatedly reassuring the person concerned, as this often helps in the short term, but maintains the worries in the long term.

For well-being, it is important that relatives do not restrict themselves too much. For example, they shouldn't forego activities that they enjoy because they would worry. If the anxiety disorder of the partner, family member or friend becomes too stressful, relatives can also get help from self-help groups, advice centers, doctors and psychotherapists.

Helpful information and links:

Becker, E.S. & Margraf, J. (2017). With all the worries ...: Help for people with generalized anxiety disorder (GAS) and their relatives. 2nd Edition. Weinheim: Beltz.

Hoyer, J., Beesdo-Baum, K., Becker, E.S. (2016). Generalized Anxiety Disorder Guide. Information for those affected and their relatives. 2nd Edition. Göttingen: Hogrefe.

Action Alliance for Mental Health

Bandelow, B .; Wiltink, J .; Alpers, G. W .; Benecke, C .; Deckert, J .; Eckhardt-Henn, A .; Ehrig, C., Engel, E .; Falkai, P .; Geiser, F .; Gerlach, A.L .; Harfst, T .; House.; Joraschky, P .; Kellner, M .; Köllner, V .; Kopp, I .; Langs, G .; Lichte, T .; Liebeck, H .; Matzat, J .; Reitt, M ​​.; Rüddel, H.P .; Rudolf, S .; Schick, G .; Schweiger, U .; Simon, R .; Springer, A .; Staats, H., Ströhle, A .; Ströhm, W .; Waldherr, B .; Watzke, B .; Wedekind, D .; Zottl, C .; Zwanzger, P .; Bag M.E. (2014). German S3 guideline treatment of anxiety disorders. http://www.awmf.org/leitlinien/detail/ll/051-028.html

Becker, E.S. & Margraf, J. (2017). With all the worries ...: Self-help with generalized anxiety disorder. 2nd Edition. Weinheim: Beltz.

National Institute for Health and Care Excellence (NICE) (2011). Generalized anxiety disorder and panic disorder (with or without agoraphobia) in adults. London: NICE. Available at https://www.nice.org.uk/guidance/cg113 [Access: 05.09.2017]

Volz, H. P., Stieglitz, R.-D. (2009). Generalized anxiety disorder - clinical picture, comorbidities, psycho- and pharmacotherapy. Stuttgart: Schattauer.

Wittchen, H.U. & Hoyer, J. (2001). Generalized anxiety disorder: nature and course. Journal of Clinical Psychiatry, 62 (suppl. 11), 15-19.

Written by:

Dr. Sarah Liebherz (psychological psychotherapist), PD Dr. Jörg Dirmaier (psychological psychotherapist), Prof. Dr. Dr. Martin Härter (doctor and psychological psychotherapist)

Participating experts:

Prof. Dr. med. Michael Kellner (specialist in psychiatry), head of the "Fear / Compulsion" department at the UKE

Date of creation: 04/08/2013
Date of the last content revision: May 7th, 2021
Date of the next content revision: May 7th, 2022