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

May 2013

Recognizing General Anxiety Disorder in the Primary Care Setting 


While generalized anxiety disorder (GAD) is a common disorder, it often goes undiagnosed and untreated. Proper diagnosis and treatment can be challenging because many other serious health problems exhibit similar symptoms and GAD lacks the dramatic, more easily recognizable symptoms, such as fears of being in public or panic attacks, that are characteristic of other, more specific anxiety disorders.

Occurrence and Symptoms

GAD is a chronic condition characterized by pervasive 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 reports that GAD affects 6.8 million adults in the U.S. (about 3.1% of the population), with women are twice as likely to be affected.

People with GAD often anticipate disaster, have self doubt, are shy and self-deprecating, and realize that they worry more than they should. Anxiety disorders, like GAD, can interfere with performing daily activities and with personal relationships. According to the National Institute of Mental Health other symptoms include: fatigue, being easily startled, difficulty swallowing, trembling or twitching, restlessness, irritability, having trouble falling or staying asleep, and difficulty concentrating.

Once a physical exam has ruled out other health conditions, a referral to a behavioral health specialist is often 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 techniques—By promoting relaxation, techniques such as meditation and yoga can effectively reduce 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 articles on health topics such as GAD, and listings of health classes, including mind/body programs and meditation courses that may help relieve anxiety symptoms.

How United Behavioral Health can help your patients—For complex clinical situations, United Behavioral Health (UBH) is available to provide consultative assistance. Practitioners can call the UBH Physicians Consultation Service at (800) 292-2922. To refer a patient for behavioral health services and to facilitate the coordination of care, call UBH at (888) 777-4742.

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