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(Chronic Free-Floating Anxiety; Generalized Anxiety Disorder)

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Anxiety is a normal state of dread, tension, and unease. It is considered a normal response to stress or uncertain situations. Prolonged or intense periods of anxiety may suggest an anxiety disorder. A disorder may also be indicated if:

  • Anxiety occurs without an external threat (“free-floating” anxiety)
  • Anxiety impairs daily functioning

The most common types of anxiety disorders are:

Anxiety is often complicated by the presence of alcohol or drug abuse and depression .


Anxiety may result from many factors including:

  • Appropriate response under stressful circumstances
  • Drugs that affect the nervous system, such as:
    • Caffeine
    • Alcohol
    • Cocaine
    • Nicotine
    • Amphetamines (eg, “crystal meth”)
    • Some herbal medications
  • Biological factors:
    • Brain chemistry imbalances (eg, serotonin and norepinephrine)
    • Personality traits
  • Faulty perceptions and irrational beliefs (eg, phobias)
  • Unresolved emotional conflicts

Risk Factors

A risk factor increases your chance of getting a disease or condition. Risk factors for anxiety include:

  • Sex: female
  • Family member with anxiety disorders
  • Stressful life events
  • Ineffective coping strategies
  • History of physical or psychological trauma


Psychological symptoms may include:

  • Worry or dread
  • Obsessive or intrusive thoughts
  • Sense of imminent danger or catastrophe
  • Fear or panic
  • Restlessness
  • Irritability
  • Impatience
  • Ambivalence
  • Trouble concentrating

Physical symptoms may include:

  • Rapid or irregular heartbeat
  • Sweating, especially the palms
  • Dry mouth
  • Flushing or blushing
  • Muscle tension
  • Shortness of breath
  • Lightheadedness or faintness
  • Difficulty sleeping
  • Shaking
  • Choking sensation
  • Frequent urination
  • Nausea or vomiting
  • Diarrhea
  • Constipation
  • Feeling of "butterflies" in the stomach
  • Sexual difficulties
  • Tingling sensations
  • Nail biting or other habitual behavior

Symptoms of Anxiety

Physical reaction anxiety

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Your doctor will ask about your symptoms and medical history. A psychiatric evaluation will be done. Your doctor may also perform a physical exam and diagnostic tests. Usually the results of these tests are normal. You may be referred to a psychotherapist for further evaluation.


Effective treatment usually involves a combination of interventions, including:

Lifestyle Changes

Relaxation Techniques

  • Deep breathing
  • Meditation
  • Deep muscle relaxation
  • Massage
  • Engaging in pleasurable activities

Social Support


This therapy addresses thoughts, feelings, and behaviors that play a role in anxiety. It helps you work through traumas and conflicts.

Cognitive-behavioral therapy can help you identify negative thought patterns and behaviors. Over time, you can learn to retrain your thinking. This will help you choose better options in response to stress and anxiety.


For severe anxiety or anxiety disorder, medications may include:

  • Benzodiazepines
  • Buspirone
  • Tricyclic antidepressants
  • Selective serotonin reuptake inhibitors (SSRIs)

    Please Note: On March 22, 2004, the Food and Drug Administration (FDA) issued a Public Health Advisory that cautions physicians, patients, families, and caregivers of patients with depression to closely monitor both adults and children receiving certain antidepressant medications. The FDA is concerned about the possibility of worsening depression and/or the emergence of suicidal thoughts, especially among children and adolescents at the beginning of treatment, or when there is an increase or decrease in the dose. The medications of concern—mostly SSRIs (Selective Serotonin Re-uptake Inhibitors)—are: Prozac ( fluoxetine ), Zoloft ( sertraline ), Paxil ( paroxetine ), Luvox ( fluvoxamine ), Celexa ( citalopram ), Lexapro ( escitalopram ), Wellbutrin ( bupropion ), Effexor ( venlafaxine ), Serzone ( nefazodone ), and Remeron ( mirtazapine ). Of these, only Prozac (fluoxetine) is approved for use in children and adolescents for the treatment of major depressive disorder. Prozac (fluoxetine), Zoloft (sertraline), and Luvox (fluvoxamine) are approved for use in children and adolescents for the treatment of obsessive compulsive disorder. For more information, please visit .


To help prevent anxiety, consider taking the following steps:

  • Avoid situations, occupations, and people that cause you stress
  • If unavoidable, confront and overcome situations that provoke anxiety
  • Find a relaxation technique that works for you and use it regularly
  • Develop and maintain a strong social support system
  • Express your emotions when they happen
  • Challenge irrational beliefs and counterproductive thoughts
  • Correct misperceptions. Ask others for their views
  • Work with a psychotherapist or marriage and family counselor
  • Avoid using nicotine or other drugs, and drink alcohol in moderation


Anxiety Disorders Association of America

The Canadian Network for Mood and Anxiety Treatments


Canadian Psychiatric Association

Canadian Psychological Association


Generalized Anxiety Disorder. National Institute of Mental Health website. Available at: . Accessed June 18, 2008.

Nietzel MT, Wakefield JC. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders . 4th ed. Text Revision. Washington, DC: American Psychiatric Association; 2000.

Tierney LM, McPhee SJ, Papadakis MA. Current Medical Diagnosis and Treatment . 45th ed. New YorK, NY: McGraw-Hill;2006.

Last reviewed February 2008 by Rosalyn Carson-DeWitt, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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