Midlife Onset of Generalized Anxiety Disorder

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While most individuals with generalized anxiety disorder (GAD) report a lifelong feeling of worry, sudden midlife onset of GAD is unusual.

Generalized anxiety disorder is defined as at least six months of excessive, uncontrollable anxiety and worry, accompanied by several physical symptoms including muscle tension, twitching, low energy, difficult concentration, sleeplessness, and irritability. Individuals with GAD expect the worst to happen, leading to a constant state of alert attention as they wait for their fears to come true. There may be stress-related physical discomfort, such as headaches or irritable bowel syndrome. In GAD, the excessive worries concern the daily living of life, including work, love, money, health, and family. For a diagnosis of GAD, the level of worry must greatly exceed the likelihood of the feared events actually happening. However, individuals experiencing GAD generally do not realize that their worry is out of proportion. They may admit that their worry is overwhelming and uncontrollable, but they may not be aware that what they fear is unlikely to actually occur.

Ongoing or Unusual?

Most individuals who experience the vague, pervasive worry and dread of GAD have lived with this feeling their entire lives, to some degree, and they are unable to point to a specific cause to their worry. They often have other mental health issues such as depression, panic disorder, social phobias and specific phobias, and they often present with substance abuse in conjunction with GAD. They may come from families that experienced upheavals, and there is some indication of a genetic predisposition to nervousness. For those individuals, their anxiety levels will fluctuate depending on the life stressors they encounter. Treatment may have limited results in changing lifelong patterns of worry and nervousness.

However, at times, individuals who have a history of successfully managing life stress may find themselves with the unusual feelings of pervasive anxiety. This may be due to a known stressful event, the total stress load, or because previously existent support systems are not accessible. For example, an individual may use exercise to manage stress, but if an injury prohibits exercise, the favored stress-coping mechanism is not available. Unless another stress reducing strategy is put into place, the individual may experience GAD-like symptoms for the first time.

The midlife years can carry considerable stress, as one may have concurrent responsibilities to work, children, and aging parents, in addition to one’s own heath. There may be worries about funding retirement, seeking employment, or paying a mortgage. Adult children may boomerang back home, bringing additional stress into the household. However, the level of stress is not the deciding factor in GAD; it is how one handles stress that makes the difference.

Individuals with GAD share the same over arousal and hypervigilance as individuals with PTSD. They may have a frequent startle response or be jumpy. The tendency to expect the worst is termed anticipatory anxiety and causes individuals to be highly alert to any perceived threat. GAD is noted in people who do not work outside the home, include homemakers, retired persons, and the disabled.

GAD or Adjustment Disorder?

It’s important to distinguish midlife onset GAD from what’s called an adjustment disorder. An adjustment disorder describes a greatly distressed response, in excess of what would be anticipated, to one or more known stressful events or circumstances. A qualified mental health professional taking a detailed history can make the distinction between these two syndromes. The basic differences include the length of time for which the individual feels distressed, and if the distress is generalized across all areas of life or focused in one area, like work or health. As the name implies, GAD features a broad, free floating, generalized sense of anxiety across many areas of life.

Adjustment to midlife, when there are more years already lived than there are years yet to live, can bring depression, fear of death, and existential dread. Individuals can become consumed with trying to regain the lost years or in fending off death at all costs. Although midlife may bring vague, pervasive fear and worry, midlife crisis is much different than the fear experienced in GAD, and is not generally a mental health issue.


One of the most outstanding features of all anxiety is the sense of uncontrollability. When individuals feel without power to predict, control, or obtain their desired goals, a feeling of helplessness often sets in, and concern about the helplessness follows. It can be difficult to admit that we all have much less control over our lives than we’d like to have, while at the same time taking responsibility for the things we do control. The line dividing the two may be gray. Individuals experiencing GAD may need help coming to terms with level of control they actually have over stressful events, along with realistically calculating the odds that their fears will come true.

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