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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

August 2018

Recognizing Generalized Anxiety Disorder in the Primary Care Setting


While generalized anxiety disorder (GAD) is a common disorder, it often goes unrecognized and untreated. Diagnosis can be challenging because many other serious health problems exhibit similar symptoms. Symptoms of GAD come on without the recognizable triggers we associate with phobias and obsessive-compulsive disorders, or the dramatic onset we see in panic disorders. 

Occurrence and Symptoms
GAD is a chronic condition characterized by persistent worry and excessive apprehension about everyday activities such as work or school performance, occurring more days than not and lasting six months or more. The Anxiety and Depression Association of America (www.adaa.org/understanding-anxiety) reports that GAD affects 6.8 million adults in the U.S. (about 3.1% of the population), with women twice as likely to be affected.

People with GAD often anticipate disaster, expecting the worst even if there isn’t a good reason for concern, and they find it difficult to control their worry. In GAD more than in other anxiety disorders, anxious thoughts are accompanied by physical symptoms such as muscle tension, restlessness, fatigue and insomnia, which are also persistent. GAD patients often complain of “free floating anxiety” and describe themselves as “worriers.” Anxiety disorders, like GAD, can interfere with performing daily activities and with personal relationships.

Because of the high degree of somatic complaints, a physical exam is especially important in patients with symptoms of GAD, to rule out other health conditions or medication side effects. A referral to a behavioral health specialist can be helpful for diagnosing and treating GAD.

Treatment Options

Treatment typically involves psychotherapy, medication, or both. Relaxation techniques and self-help or support groups can also help patients manage their anxiety.

  • Psychotherapy—Cognitive-behavioral therapy (CBT) can be helpful. With CBT, patients gradually learn to view situations and problems from a different perspective, learning techniques to reduce anxiety.
  • Medication—Common drug treatment includes buspirone (Buspar) used alone or with antidepressants known as selective serotonin reuptake inhibitors (SSRIs). Careful and well-monitored use of benzodiazepines is another treatment of choice.
  • Relaxation and mindfulness programs—Meditation and yoga teach patients to achieve control over their distressing thoughts and sensations. They are extremely effective techniques for managing anxiety symptoms.
  • Self-help and support groups—Self-help and support groups allow patients to share their experiences, receive compassion and understanding from others with similar challenges, and discuss strategies for managing GAD.

Harvard Pilgrim’s member website offers helpful information for patients, including information on Mind the Moment, a mindfulness meditation program that may help patients manage stress.

To refer a patient for behavioral health or substance abuse services, call Optum/UBH at 888-777-4742.

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