Laila entered the office with heavy steps, walking slowly and casting confused looks around, and after greeting me she asked: Where should I sit, please?
I pointed to the sofa in front of me and she sat down, rubbing her fingers and moving her right leg involuntarily.
Then she began to tell me: “Doctor, I feel very tired. I have been worried and stressed for several months now. I cannot relax, whether at home or at work. I am constantly afraid that some disaster will happen, that something bad will happen to my children, that I will lose my father, or that my husband will be unable to pay for school.
My neck muscles hurt, I have headaches, and I can’t remember the last time I had a deep sleep. I feel like I’m about to collapse. Help me, please! Then I burst into tears.
The number of people suffering from anxiety disorders is more than 300 million people, and women appear to be more susceptible to the disease, while symptoms begin to appear concentrated in the age group between 25 and 44 years, with the disease being able to be diagnosed even in children and adolescents.
Laila suffers from what is called: Generalized Anxiety Disorder, which is a chronic psychological condition characterized by excessive and continuous anxiety and tension regarding daily events and activities such as work, family, and health.
The affected person complains of psychological and physical symptoms that hinder his normal life.
A report issued by the World Health Organization in 2025 noted that the prevalence of generalized anxiety disorder in the world is about 1.8% during the year and about 3.7% over the course of a lifetime.
The number of people suffering from anxiety disorders is more than 300 million people, and women appear to be more susceptible to the disease, while symptoms begin to occur mainly in the age group between 25 and 44 years, with the disease being able to be diagnosed even in children and adolescents.
What are the diagnostic characteristics of this disorder?
The basic feature of generalized anxiety disorder is excessive anxiety and fears (apprehensive anticipation) about many events or activities.
The intensity, duration, or frequency of the fears is disproportionate to the real possibility of the event occurring or to its potential impact, and the affected person finds it difficult to control his fears.
These psychological symptoms are accompanied by other physical symptoms such as chronic fatigue, increased heart palpitations, excessive sweating, muscle pain, stomach and intestinal disorders, or sleep disturbances.
Adults often worry about the daily circumstances of life (professional responsibilities, financial problems, the health of family members, misfortunes that may befall their children), while children and adolescents with this disorder worry excessively about their abilities or how well they will perform in school.
Some may object, saying: I am not convinced that what you are describing is a medical condition. Isn’t it normal for us to worry about our children, our work, or our health? Isn’t that our responsibility?
Good question.
How then do we differentiate between what is normal and what is pathological?
There are several characteristics that distinguish generalized anxiety disorder from normal anxiety.
The basic feature of generalized anxiety disorder is excessive anxiety and fears (apprehensive anticipation) about many events or activities. These psychological symptoms are accompanied by other physical symptoms such as chronic fatigue, excessive heart palpitations, excessive sweating, muscle pain, stomach and intestinal disorders, or sleep disturbances.
Firstly, In normal anxiety related to daily life, we notice that the fears appear to be more manageable, with no noticeable impact on psychological, social, or occupational functioning.
secondly, Normal everyday fears are not accompanied by very severe physical symptoms, persistent sleep disturbances, or a feeling of loss of control or collapse.
Thirdly, The duration of fears is limited and is often linked to a clear motivating factor.
So what are the factors that determine the risk of developing this disorder and the predictive factors for its outcome?
There are three types of factors:
1- Genetic and physiological factorsOne-third of the risk of developing generalized anxiety disorder is attributable to genetic factors that overlap with factors associated with the risk of neuroticism.
It is also common with other anxiety disorders and mood disorders, especially major depressive disorder.
2- Mood factors (Temperamental risk factors): Behavioral inhibition, neuroticism, and risk avoidance have been linked to generalized anxiety disorder.
3- Surrounding environmental factors: Difficult childhood experiences, or excessive parental protection, are among the most important environmental factors associated with this disorder. However, no environmental factor has been identified as a specific, necessary or sufficient factor for diagnosis.
So how do we differentiate between generalized anxiety disorder and other disorders that include anxiety among their symptoms?
1- Anxiety disorder caused by another medical condition: It is diagnosed if it is determined, based on the medical history, clinical examination, and complementary tests, that anxiety and fears are a direct physiological result of another specific medical condition (such as pheochromocytoma, or hyperthyroidism).
2- Substance/drug-induced anxiety disorder: When anxiety is causally linked directly to a substance of abuse or drug.
3- Social anxiety disorder: Here the person suffers from anticipatory anxiety centered around future social situations in which he must perform a certain performance or be the subject of evaluation by others (such as speaking in front of the department for students, or presenting presentations and research for students, or speaking in a meeting in front of colleagues and the manager at work… etc.).
People with generalized anxiety disorder feel constant anxiety, whether they are being evaluated by others or not.
Treatment of generalized anxiety disorder depends mainly on combining psychotherapy, especially cognitive behavioral therapy, and improving lifestyle with resorting to drug therapy when needed.
4- Obsessive-compulsive disorder: There are several characteristics that distinguish excessive fears from obsessive thoughts, as the latter are considered inappropriate thoughts, impulses, or intrusive and unwanted mental images that are inconsistent with the person’s beliefs (aggressive, sexual, religious thoughts, etc.).
5- Post-traumatic stress disorder (PTSD) and adjustment disorders: In adjustment disorders, anxiety emerges in response to a stressful event within 3 months following the onset of the event and does not persist for more than 6 months after the end of the event or its consequences.
6- Depressive, bipolar and psychotic disorders: If excessive anxiety occurs only during the course of these disorders.
How do we treat this disorder?
Treatment of generalized anxiety disorder depends mainly on combining psychotherapy, especially cognitive behavioral therapy, and improving lifestyle with resorting to drug treatment when needed.
Psychotherapy (first line of treatment):
1- Cognitive behavioral therapy (CBT): It is the reference psychotherapy for generalized anxiety disorder, and it helps to identify negative and irrational thoughts and modify them with alternative thoughts with the aim of changing the way of dealing with psychological stress and increasing the ability to tolerate uncertainty.
This treatment depends on rationed psychological sessions, which are based on certain stages:
- The first stage is education, and it depends on informing the patient about the nature of general anxiety and differentiating between normal anxiety and pathological anxiety. The goal is to understand how anxiety works in the mind and body to reduce fear of it.
- Cognitive restructuring: It depends on identifying negative and exaggerated automatic thoughts (such as catastrophic thinking) and discussing them logically. The goal is to replace worrying thoughts with more realistic and balanced thoughts.
- Dealing with problems: Training the patient to distinguish between two types of problems: real, current problems and then developing a plan to solve them immediately, and hypothetical future problems in which the mind is trained to accept uncertainty (Intolerance of Uncertainty).
- Cognitive exposure to fears: This is done by confronting the catastrophic scenarios that the patient fears in his imagination, instead of escaping from them, in order to break the cycle of fear.
- Relaxation and stress management techniques: It depends on teaching the patient deep breathing techniques and progressive muscle relaxation to reduce physical tension.
- Modifying behaviors: Preventing the patient from repeating reassuring behaviors (such as constantly searching the Internet, and visiting many doctors in all organic specialties, even if the tests prove to be safe) and reducing avoidance, in order to increase self-confidence and the ability to tolerate doubt.
Reducing avoidance means enhancing the ability to confront problems or things that make us feel afraid and stressed instead of avoiding them, as affected people usually seek to avoid things that make them feel stressed, and this continuous avoidance has the opposite effect as it makes the brain more afraid, even though the problem may be simple in reality.
2- Mindfulness: Mindfulness-based meditation programs help you focus on the present moment and reduce rumination and repetitive thoughts.
It is essential that these medications are not taken or their doses adjusted or stopped suddenly except under the supervision of a specialized psychiatrist to avoid side effects or withdrawal symptoms.
3- Changing lifestyle: Maintain regular sleep schedules along with a regular diet. It is also recommended to reduce stimulants and other substances (such as coffee, tobacco, and alcohol) because they exacerbate anxiety. It is necessary to pay attention to physical activity, as exercise helps regulate physical and psychological tension and alleviate symptoms of anxiety.
Drug treatment
1- Antidepressants: They are the first and primary option for long-term treatment, as they work to improve mood and relieve persistent anxiety by rebalancing neurotransmitters in the brain.
These include serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors.
2- Fast-acting anti-anxiety agents (Anxiolytics): They are given only for short periods at the beginning of treatment to calm acute symptoms, due to the risk of causing habit or addiction if used in the long term.
3- Anticonvulsants: They are used in some cases as an effective and quick option to relieve the symptoms of generalized anxiety.
4- Beta-blockers: They do not treat anxiety itself, but are prescribed to control physical symptoms such as heart palpitations, tremors, and excessive sweating in stressful situations.
It is essential that these medications are not taken or their doses adjusted or stopped suddenly except under the supervision of a specialized psychiatrist to avoid side effects or withdrawal symptoms.
We currently live in a world charged with constant tension, political conflicts, and successive economic crises, which puts the human nervous system in a constant state of alert and contributes to the spread of anxiety disorders.
Attention to mental health remains essential because it improves the quality of our daily lives and supports our abilities to make the right decisions, especially because it protects against many organic diseases, including heart disease, chronic pain and constant fatigue.
The opinions expressed in the article do not necessarily reflect the editorial position of Al Jazeera Network.