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Generalized Anxiety Disorder (GAD)


Have you ever been in a situation where you are worried you’ll be late for an important meeting when you’re stuck in a traffic congestion? How about that worry prior to exams? Or when you have to give a speech to a huge audience?

Sounds perfectly normal, right? However, if your worries and fears are so intense and consistent up to a point if affects your normal daily function and ability to relax, you may have Generalized Anxiety Disorder (GAD).

In Malaysia, a national survey back in 2011, the National Health Morbidity Survey IV (NMHS IV), which was conducted among adults aged 16 years old and above reported that the prevalence of GAD was 1.7%. Females of the younger age group (16-24 years old) and the Indian ethnic group had higher prevalence of GAD. The prevalence was also higher among singles, widows/widowers, divorcee and those with tertiary education level.

Getting To Know GAD

Generalized Anxiety Disorder is a common anxiety disorder where one has an excessive anxiety and worry for more days than not, for at least 6 months, according to the 5th Diagnostic and Statistical Manual of mental disorders (DSM-V)

People with GAD have difficulties to shake off their concerns even over simple matters; a “worry tap”. Adults for example may often worry about every day routine life issues such as job responsibilities, finances, possible misfortunes to the children or other family members, or minor matters such as being late to work or unsettled house chores. While in children, they tend to worry regarding their competency or quality of their performance in school.

GAD symptoms can vary. They may include;

  • Persistent worry or obsession about small or large concerns that’s out of proportion to the impact of the event
  • Difficulty to let go of worry
  • Inability to relax, restlessness, and feeling keyed up or on edge
  • Difficulty to concentrate, feeling that mind ‘goes blank”
  • Distress about making decision for fear of making the wrong decision
  • Carrying every option in a situation all the way out to the possible negative conclusion

Physical signs and symptoms may include:

  • Feeling tired without obvious reasons
  • Fatigue
  • Irritability
  • Sleep disturbances
  • Being easily startled
  • Headaches
  • Tremors/ trembling
  • Nausea, diarrhoea or irritable bowel syndrome
  • Sweatings
  • Muscle tension/ ache

The level of anxiety can range from mild where the individual is still able to do their daily tasks and socialize normally. In severe cases, the individual is unable to turn off the anxious thoughts. The thoughts will run through one’s head endlessly, repetitively. When the anxiety reach this intensity, one may not be able to function normally in terms of social, occupational or other important areas of functioning.

Non-pathological Anxiety



– able to put off worry when more important matter arises

Difficult to control the worry

– causing difficulty to do routine daily tasks and activities

Shorter in duration

– occur with significant cause

Longer in duration

– may occur without any specific cause

Not usually accompanied by physical symptoms

Commonly associated with physcial symptoms

What Causes GAD

There are often a combination of factors involved in the development of GAD

  • Biological factors – Studies have shown that GAD is associated with some changes in brain functioning.
  • Family history – People with GAD often has a history of mental health problems in the family. However, this doesn’t mean that a person will automatically develop anxiety if a parent or close relative has had a mental health condition.
  • Stressful life events – People may be more at risk if they experience a major life change that causes stress; such as loss/breakdown of a close relationship, financial difficulties, physical/ sexual or emotional abuse, also traumatic experiences in childhood.
  • Psychological factors – Some personality traits may put a person at a greater risk for GAD, such as perfectionistic tendencies and/or easily sensitive.

Seek help early

If you detect the signs and symptoms of the above meeting the criteria for GAD either in yourself or someone around you, a visit to the nearest doctor may enlighten you with the condition you are in. If necessary, a referral to a psychiatrist would be given.


  1. Medication – The first line treatment is usually anti-depressants especially if the individual is also depressed. Anti-depressants affect the activity of serotonin, a chemical messenger involved in brain’s anxiety response. Selective-serotonin-reuptake-inhibitor (SSRI) such as sertraline (Zoloft) and Fluoxetine (Prozac) are commonly used. In the early phase of treatment, anti-depressants are often used in conjunction with benzodiazepines for a fast-acting relief as the effect of anti-depressants may take some time to be effective.
  2. Psychotherapy – This involves conversing with a trained mental health professional such as psychiatrist, psychologist or counselor to help deal with your anxiety. One common therapy used is Cognitive-Behaviour Therapy.
  3. Relaxation Techniques – methods such as deep breathing exercises, meditation, distraction are beneficial to help you calm down. Referral to Occupational therapist may be necessary to aid in the relaxation techniques.
  4. Healty lifestyle – Keeping physicaly active is very useful as exercise is a powerful stress reducer. Healthy food, such as vegetables, whole grains and fish are linked to reduced anxiety. Make sure you get enough sleep to feel well rested. Limit your caffeine intake and stay away from smoking, alcohol and drugs – all these can cause or worsen anxiety.

In A Nutshell

With good compliance to treatment coupled with good support from family and friends, you can overcome GAD and may once again be able to perform your normal daily tasks as well as socializing with your worry under control.

Last Reviewed : 02 July 2018
Writer :  Dr. Aida Harlina Bt. Abd Razak
Accreditor :  Dr. Firdaus Bt.  Datuk Abdul Ghani