What is generalized anxiety disorder (GAD)?

Worrying is a normal part of life. It helps you make decisions and prepare for important situations. In many cases, worry is temporary and remains connected to specific problems that can be addressed. However, when worry becomes persistent, excessive, and difficult to control, it may be a sign of generalized anxiety disorder.

For individuals with generalized anxiety disorder (GAD), however, worry becomes persistent, excessive, and difficult to control. Instead of helping to solve problems, it turns into an ongoing mental process that creates tension and often leads to expecting negative outcomes, even when there is little objective reason to do so. You can read more about related conditions on our page about anxiety disorders.

People with GAD often experience their mind as constantly active, moving from one concern to another. This continuous stream of thoughts can make it difficult to relax, concentrate, or feel in control. Over time, this pattern is commonly associated with fatigue, irritability, sleep problems, and physical tension. If you want a more detailed overview, you can explore the symptoms of generalized anxiety disorder.

Because these worries often focus on everyday topics such as work, health, or relationships, GAD is not always immediately recognized. Many individuals describe themselves as “overthinkers” or assume they are simply dealing with stress, without realizing that their symptoms reflect a recurring psychological pattern that maintains anxiety over time.

In the United States, approximately 4–5% of people will experience GAD at some point in their lives. In the Netherlands, this is estimated at around 2–3%. However, GAD is likely underdiagnosed, as symptoms are often attributed to other conditions or not identified as a distinct disorder.

This page explains what generalized anxiety disorder is, how it develops, what symptoms to look for, and what can help reduce excessive worry. If you are already considering support, you can also read more about online treatment for anxiety.

 

 

How does generalized anxiety disorder develop?

Generalized anxiety disorder (GAD) usually develops gradually. What starts as increased worrying about everyday situations can slowly turn into a persistent pattern where the mind continuously searches for potential problems or risks. You can read more about underlying factors on our page about causes of generalized anxiety disorder.

For many people with GAD, worrying creates a temporary sense of control. By thinking through different scenarios, they try to anticipate and prevent negative outcomes. In the short term, this can reduce uncertainty and anxiety.

However, this strategy has a downside. When situations are uncertain or cannot be fully controlled, the mind continues generating new “what if” scenarios. Instead of resolving the problem, worry expands, moving from one concern to another. This process is closely related to intolerance of uncertainty, which is explained further below.

This creates a self-reinforcing cycle:

• Uncertainty triggers anxiety
• Worry is used to reduce that anxiety
• Worry provides short-term relief
• The brain learns that worrying “helps”
• Worry increases in frequency and intensity

Because worrying temporarily reduces discomfort, it becomes a habitual coping strategy, even though it maintains anxiety in the long run. Understanding this cycle is an important step in treatment, as many interventions focus on breaking this pattern. You can read more about this on the treatment for generalized anxiety disorder page.

Intolerance of uncertainty

A key factor in GAD is intolerance of uncertainty, a concept developed by Dugas and colleagues. People with high intolerance of uncertainty tend to experience ambiguous or unpredictable situations as stressful and difficult to manage.

A key factor in GAD is intolerance of uncertainty, a concept developed by Dugas and colleagues. People with high intolerance of uncertainty tend to experience ambiguous or unpredictable situations as stressful and difficult to manage.

Instead of accepting that not everything can be known or controlled, they try to reduce uncertainty by thinking through all possible outcomes. This often leads to more worry rather than less, because most real-life situations cannot be resolved through thinking alone.

In this way, worrying functions as a safety behavior: it reduces anxiety in the short term, but increases sensitivity to uncertainty over time.

Generalized anxiety disorder symptoms

Generalized anxiety disorder (GAD) is characterized by excessive and persistent worry that is difficult to control and occurs across multiple areas of life, such as work, health, or relationships.

Because many symptoms overlap with other conditions, such as depression or social anxiety, GAD is not always immediately recognized. A proper diagnosis requires a careful evaluation of both the pattern and duration of symptoms.

According to the DSM-5-TR, the following symptoms are commonly associated with generalized anxiety disorder:

• Excessive anxiety and worry about multiple topics, occurring more days than not
• Difficulty controlling the worry
• Restlessness or feeling “on edge”
• Being easily fatigued
• Difficulty concentrating or mind going blank
• Irritability
• Muscle tension
• Sleep disturbances (difficulty falling or staying asleep, restless sleep)

In addition to these core symptoms, many people with GAD also experience:

• Persistent “what if” thinking and anticipating negative outcomes
• Indecisiveness or fear of making the wrong decision
• Intolerance of uncertainty and difficulty coping with unpredictability
• Physical symptoms such as headaches, gastrointestinal discomfort, sweating, or trembling
• Meta-worry (worrying about worrying itself)

If you recognize several of these symptoms and they persist over time or interfere with your daily functioning, it may be helpful to seek professional support.

 

Which symptoms do you recognize?

We are interested in the GAD symptoms you experience yourself:

 

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Frequently asked questions about generalized anxiety disorder

Literature:

• Ladouceur, R., Gosselin, P., & Dugas, M. J., 2000. Experimental manipulation of intolerance of uncertainty: a study of a theoretical model of worry.Behaviour Research and Therapy , 38, 933-941.
• Bijl, R. V., van Zessen, G,m & Ravelli, A., 1997. Psychiatric morbidity among adults in The Netherlands: the NEMESIS-Study. II. Prevalence of psychiatric disorders. Netherlands Mental Health Survey and Incidence Study. Nederlands Tijdschrift Geneeskunde, 141, 2453-2460.
• Grant B. F., et al., 2005. Prevalence, correlates, co-morbidity, and comparative disability of DSM-IV generalized anxiety disorder in the USA: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychological Medicine, 35, 1747-1759.