Anxiety and Fear-Related Disorders: Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is an emotional disorder characterized by excessive and difficult-to-control worry about daily events and activities such as work/school, finances, minor matters, community affairs, and health/safety. Despite initial concerns surrounding its diagnostic validity, a vast literature now exists on the nature, course, assessment, and treatment of GAD. This chapter reviews the current state of the science of GAD. GAD is one of the most common forms of psychopathology, resulting in significant human and economic burden across the world. It is partly heritable, and a selective number of serotonergic and catecholaminergic genetic markers have been identified in recent years, albeit with small individual effects. Neuroimaging and neurophysiological studies of GAD also have identified abnormalities in structure, functional connectivity (e.g., between the amygdala and dorsolateral prefrontal cortex), and event-related potentials (e.g., error-related negativity). In addition, several psychological (e.g., intolerance of uncertainty) and environmental (e.g., stress, childhood adversity) factors have been linked to GAD onset, expression, and course. Research on the psychopathology of GAD underscores the complex neurobiological–psychological profile of the condition. Nevertheless, significant progress has been made in the development of reliable assessment tools and effective treatments. Several self-report questionnaires and semistructured clinical interviews can be used to assess GAD. In addition, meta-analytic evidence suggests that serotonergic pharmacological agents and cognitive–behavioral therapy are first-line treatments. As understanding of GAD continues to improve, efforts are needed to develop personalized treatment recommendations based on intervention(s) predicted to achieve optimal benefit.