Generalised anxiety disorder (GAD) is a mental health condition that causes excessive and disproportionate anxiety and worry about multiple areas of life that negatively impacts the person’s everyday activity.
Panic disorder involves recurrent panic attacks. The panic attacks are unexpected (they appear randomly, often without a trigger) and result in worry about further attacks and maladaptive behaviour changes relating to the attacks (e.g., avoiding activities).
Secondary causes of anxiety include:
- Substance use (e.g., caffeine, stimulants, bronchodilators and cocaine)
- Substance withdrawal (e.g., alcohol or benzodiazepine withdrawal)
- Hyperthyroidism
- Cushing’s syndrome
Presentation
Emotional and cognitive symptoms of GAD include:
- Excessive worrying
- Unable to control the worrying
- Irritability
- Restlessness
- Difficulty relaxing
- Easily tired
- Difficulty concentrating
Behavioural symptoms include:
- Avoiding social situations (e.g., school)
- Reassurance seeking
Physical symptoms (generally relating to overactivity of the sympathetic nervous system) include:
- Muscle tension
- Palpitations (e.g., a feeling of their heart racing)
- Sweating
- Tremor
- Chest pain and shortness of breath
- Gastrointestinal symptoms (e.g., abdominal pain and diarrhoea)
- Headaches
- Sleep disturbance
Criteria
A diagnosis of generalised anxiety disorder requires:
- Excessive and uncontrollable anxiety and worry
- Present more days than not
- Lasting at least 6 months
- Affecting multiple domains (e.g., school, home and social interactions)
- Associated physical or cognitive symptoms (e.g., restlessness, fatigue, irritability, tension and sleep disturbance)
Management
Risk assessment for self-harm and suicidal thoughts is required. Parental involvement and education is important.
Mild anxiety is managed with watchful waiting and advice about self-help strategies (e.g., meditation), diet, exercise and avoiding alcohol, caffeine and drugs.
Moderate to severe anxiety is referred to CAMHS to initiate:
- Psychological interventions (e.g., cognitive behavioural therapy)
- Medication if not responding to psychological therapy (e.g., fluoxetine or sertraline)
Last updated February 2026
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