These disorders are quite persistent, and only rarely disappear on their own.  Instead they usually persist throughout life unless treated.  Although they can be caused by a medical condition, prescribed medicines or chemicals such as caffeine, they are more often caused by a combination of factors, including a genetic predisposition, individuals makeup and life events.  Interestingly, people with anxiety disorders often show up at their doctor's often not only complaining about the unpleasant feeling of anxiety; rather, 90 percent of them complain about physical symptoms caused when the body tries to cope with the effects of anxiety.  These symptoms might include:

Generalized Anxiety Disorder

"Well, wouldn't you be worried if you chest pain every day and nobody could find a cause?" Jim asked his doctor.  They were in the doctor's examining room, and Jim, a 43-year-old automobile mechanic, was putting his shirt back on.  He had just finished another examination--normal again--and had gone over the consultation that his family doctor had recently arranged with a cardiologist.  "There must be something wrong--it couldn't possibly be normal."
    Over the last year or so, Jim had always experienced almost daily, recurring episodes of chest tightness--a squeezing pain in his back going around to the front and up into his neck--but no one could find an explanation.  Jim was concerned about the pain, and the possibility that he might not be able to continue working or provide for his young family.  The fact that no one could find an explanation for the symptoms, in spite of multiple consultations and testing, was of even more concern to Jim.  He knew there was "something wrong"--if only the doctors could find it.  He was unable to concentrate on even the simplest jobs at work.  The fear that some terrible medical condition was causing his symptoms was never far from his mind.  The whole process was so exhausting that sometimes he didn't even have the energy to go to work.  Although he was always tired, he usually had trouble getting to sleep, tossing and turning every night.  The second he woke up from his troubled sleep every morning he began thinking about the possibility of disability and early death from heart disease or cancer.  His days were consumed by worry, and he was very irritable and unable to participate in his family's life.  The other night, when his daughter had asked him to help him with her math homework, he had been unable to solve the problem, and slammed the book shut in frustration.  Immediately he regretted it and apologized--but it was obvious that he was unable to keep his emotions in check.  This worried him even more, because he took his responsibilities as a father very seriously.
    But now, sitting on the examining table in the doctor's office, he broke down in frustration and anger "I'm falling apart--why can't you find out why?"

People such as Jim seem to have symptoms of chronic tension and anxiety most of the time, focused on simple and everyday concerns such as healthy, family, finances, and interpersonal relationships.  Since the 1980's, psychiatrists have recognized that this pattern of excessive and uncontrolled worry is common, and can be very debilitating.  Generalized anxiety disorder (GAD) has, as its cardinal symptom, excessive or chronic worrying about everyday concerns.  Naturally, we all are concerned about our relationships, the growth and development of our family, and our management of money.  But in GAD the worry is different both in quality and in quantity.  Although it is often related to the simple everyday events and concerns of life, it is excessive, frequent, uncontrollable and damaging.  Apprehension about the future is pervasive, often present from the moment that you get up in the morning until the moment that you try to get to sleep at night.  You worry about everything.  The distress about the possibilities of danger or some other negative consequences is uncontrollable--you cannot put the problem out of your mind, get on with other business or think about another topic.  The worry seems to come back again and again, intruding into thought processes and impairing performance by stealing concentration and focus.  Often several problems are the focus of worry, and there are is a perception that the cumulative hassles of life are just too many.
    To be diagnosed with GAD, such excessive anxiety and uncontrollable worry must be present for more than six months.  In addition, person with generalized anxiety disorder have physical symptoms associated with their chronic worry.  Common patterns include:

Because GAD includes both the phenomenon of excessive worry and combination of physical symptoms, people with this syndrome often go to their doctor's office not because because of the symptoms of excessive worry and anxiety but with physical symptoms alone.  Although quite distressing and disabling, the excessive worrying is often tolerated by people who believe this is simply "the way I am."  Only 50 percent of individuals with the disorder ever seek treatment, and usually only after they experience symptoms for up to ten years.  Of those who do go to their doctor, only about 50 percent are correctly diagnosed.  Symptoms --such as insomnia, muscle pain (for example, chest pain, neck pain, chronic back pain,), abdominal pain with diarrhea, dizziness, shakiness, restlessness, recurring headaches, shortness of breath, sweating, and palpitations--are often what bring the sufferer to the doctor, and multiple investigations soon follow.  The individual does not connect the symptoms of anxiety and worry with the unresolved physical problems.  Usually no specific physical abnormalities are found, and, unless the underlying chronic anxiety is diagnosed, these people are treated symptomatically for their physical complaints.  The mental anguish is (the distress of chronic worry) is not the focus; it's the physical symptoms (caused by the anxiety)  that are more prominent.  In one study, 80 percent of patients with GAD sought help for their physical complaints and only 20 percent preseated with a psychological problem.  Because the physical complaints are a direct result of the chronic anxiety, usually no specific cause for the physical symptom can be found, in spite of multiple investigations and consultations.  Sometimes these people are erroneously diagnosed as having chronic fatigue syndrome, chronic ligamentous, disc degenerative back pain, fibromyalgia, migraines, irritable bowel syndrome or any number of other physical ailments.

Who Gets GAD?

Like so many of his generation, Robert had been looking forward to his retirement for years.  He had risen through the ranks of employment at the factory where he worked, taking great pride in the fact that he had been the supervisor of the evening shift the last twelve years.  He had been, as the president said at the retirement dinner, someone the company could count on, someone able to handle any problem that might arise.
    But since retirement, Robert found that his days were not filled with pleasure and enjoyment.  Instead he seemed to spend much of his time concentrating on the problems of his life and his family.  It wasn't that he found himself in the midst of a crisis, but he had three grown daughters with families, and his wife had developed arthritis.  It just seemed to him that there were things to worry about every day, from the time he got up until the time he went to bed.  He was irritable all the time.  He had headaches and complained that he couldn't concentrate.  Whatever he tried to do--even if it was something simple, like gardening or reading the newspaper in the morning--he found that his mind kept going over things that might happen.  He couldn't seem to put the thoughts out of his head.  The same thing happened when he tried to go to sleep at night or even sometimes while he watched television.  He felt fatigued and overwhelmed.  He was particularly concerned about the possibility that one of his family might be injured while traveling in a car.  The possibility of anyone in his extended family taking a long drive would have him worried for days, imagining the anguish and pain of a possible accident.  He knew this was not reasonable, but he couldn't help himself.  On a couple of occasions one of his daughters had driven on a holiday for several days without Robert's knowledge.  When he learned of the the trip, he immediately felt guilty--because he hadn't known about it, and thus hadn't worried about it--as if the mere fact of his worrying about an accident would have prevented one.

His family doctor diagnosed Robert's symptoms as GAD, and initiated treatment with counseling and medicine.  Within a few weeks, Robert was able to understand the pattern of his abnormal worrying and begin to enjoy his retirement.

GAD is very common; it affects 5 percent of the population during their lifetime and is twice as common in women at is in men.  Although it often begins at a young age (in one study the median age onset was twenty-one years), and can be seen in children, it becomes more frequent as we age.  In one study, the prevalence (the number of diagnosed cases in the population) was only 2.3 percent of persons aged 18 to 24, but rose to 4.4 percent of persons aged 35 to 44, suggesting that older people worry more and for longer periods than do younger people.  GAD is common in seniors--in one study the prevalence was 20 percent, making it one of the commonest anxiety problems of older life.  There is a genetic predisposition to the disease.  First-degree relatives (parents, children, siblings) are five times more likely to share the diagnosis as the general population.  Studies of twins confirm a strong inherited tendency.  In identical twins (where the genetics are the same), if one twin is diagnosed with GAD, the chance that the second twin will develop it is 50 percent.  however, in nonidentical twins (where genetics are only partially the same), if one twin develops GAD, the chance that the other twin will develop it is only 15 percent.  This implies a strong genetic predisposition.  GAD has been found to be more common in those who have been previously married (divorced, widowed, long-term relationshiped) than in those who are currently married, and in those who work at home (including homemakers) rather than those whose employment is elsewhere.  Race and income levels were not associated with risk, nor were education, religion or geographic location.
In some people the disorder begins after a life crisis such as the death of a spouse, financial difficulties or the breakup of a relationship.  Such events seem to be more common as we age as initiating features for the disorder--being more notable in those whose GAD started later in life.  The full-blown syndrome is rare before age twenty-five, and some investigators feel that there are two patterns: GAD with an earlier age of onset associated with childhood history of fears, anxiety, chronic social difficulties and a disturbed home environment; and a second pattern of late-onset GAD, often precipitated by a stressful life event.

Why Worry?

At the heart of GAD is the concept of excessive worry.  We all worry; we all focus on negative possibilities for the future and "fuss" about these--the possible impact on our lives and the negative consequences.  In GAD, however, the nature and particulars of worry are different, and it is these differences that fuel the chronic symptoms.
    The Canadian Oxford Dictionary defines worry as "to give way to anxiety or unease; to allow one's mind to dwell on difficulty or troubles."  The word itself comes from the Old English wyrgan, meaning to strangle.  A "worry wart" is one who habitually worries unduly.  Worrying is an attempt to solve a mental problem that has not yet arisen.  To worry about something is not always a bad thing.  Normal worrying allows one to consider the possibilities that might occur in the future (particularly negative events) and to prepare for these eventualities.  It allows a preview, a "look ahead," to evaluate a possible negative outcome, and to begin the process of deciding what you can or cannot do should such a situation arise.  Normal worrying is thus very much an advantage: should a negative consequence actually come about, you will be at least partially prepared.  Worrying for most of us is thus the beginning of the process of problem solving.  Beginning with the question "what if...?" you allow your mind to both imagine a negative outcome and to explore the options.  This kind of worry is helpful and normal.  It gives you a sense of control.
    The abnormal worry of GAD begins the same way with the question "what if...?" but the process of worry seems to be disrupted soon after this.  In normal worrying, one the negative consequences are examined and possible reactions and adaptations considered, you are able to move on to other topics and functions.  The problem, the worry, has been addressed.  It might not be solved but it is manageable.  In GAD this is not possible.  Rather than functioning normally, the worrying process never seems to lead to a reasonable course of action, leaving the individual with a chronic unresolved and frustrated problem.  The worry does not solve anything; it fails to provide any possibility of an acceptable solution.  This is why the worry returns again and again, intruding into other mental processes and causing excessive distress.
    Not only is the quality or nature of their worrying different, the quality or nature of their worrying different, individuals with GAD also seem to have much more to worry about.  They have a sensitivity to the relatively mild difficulties of everyday life, believing that "If anything can go wrong it will."  They find fuel for worry in almost every encounter and situation.  A single problem is not the focus of worry, but many concerns (that are ultimately unresolved) and possibilities fill the day.  Such things as children's progress in school, the return on financial investments, the possibility of motor vehicle accidents, being perceived by friends as inadequate or any one of a million possibilities occupy their mind, draining both energy and peace.  They have a tendency to view ambiguous or neutral situations as negative, imagining the worst disasters and threats in what others see as innocuous situations.  They fear more, worrying that every minor problems will become a full-blown disaster--a phenomenon known as catastrophic thinking.  Older sufferers of GAD t end to worry more about health concerns; younger sufferers, although they do worry about their physical well-being, are more likely to worry about their social status and evaluation by others, their job competence and their interpersonal relationships.  Interestingly, around the world in different cultures and places, the concerns seem to be quite similar.
    Sometimes individuals with GAD, aware that they are "worry warts," even begin to worry about their excessive worrying--a problem that has been called "meta worrying."  The worry itself has become a cause for more worrying.  In addition, worrying sometimes takes on a magical quality, with the process (and intensity) of worrying by itself having the power to alter events and protect against a negative outcome.  It is not uncommon for individuals with GAD to believe that a negative outcome is more likely if they don't consider it and worry sufficiently about it.  For example, mother might believe that the chances of her children being hit by a car on the way to school are much less if she worries about this possibility--that her suffering (through the anguish of her considering the awful event) will somehow protect them.
    GAD is usually a chronic condition, with symptoms persisting over a lifetime, often with significant life events causing a worsening of symptoms.  Occasionally, in about 20 percent of cases, the disorder will go away on its own.

The Burden of Generalized Anxiety Disorder

Other psychological problems are frequently associated with GAD.  In one study, fully 90 percent of GAD patients had another psychological diagnosis; depression was seen in 62 percent of cases, alcoholism in 38 percent (often an attempt to deal with chronic anxiety), social phobia in 35 percent and panic disorder in 25 percent.  These other psychological problems often compound the diagnosis and management of the disorder, and increase the burden of the problem.
    At first glance, it might seem that simply worrying too much might not drastically interfere with life.  However, most people with GAD have pervasive and disabling psychological symptoms.  Consistently, across many studies, sufferers complain that their lives are much altered by the process of worry and consequent anxiety.  In addition, the disruption of their physical well-being (by such things as chronic pain, insomnia and fatigue) severely affects their lives.  Because they are unable to focus or concentrate, such simple pleasures as reading, crossword puzzles, even watching a movie or television can be difficult, if not impossible.  There is a lack of flexibility and ease in interpersonal relationships; they cannot "let themselves go"; interactions with family are difficult and often unfulfilling.  Physical symptoms, so much a part of the syndrome, are present most of the time and detract from their quality of life--not only because of the symptom itself (often chronic pain) but also because of the multiple investigations and consultations that these difficulties usually incur, and the medications (such as painkillers or muscle relaxants) that are often prescribed to deal with these symptoms.  Education and employment opportunities are limited, as are possibilities for the enjoyment of life.  In addition, as in panic disorder, sufferers of GAD often actively try to avoid those situations in which their worry is escalated.  Sometimes this avoidance behavior is quite severe.  For example, they might refuse to ride in an automobile, fearing an accident.  Similarly, they might avoid any social gatherings out of fear that something might go wrong at the function or even that their might be a possible spread of infection with so many people present.  They sun attendance at plays and movies (the images or ideas portrayed might expand the possibilities for worry) and, in general, life experiences and enjoyment are severely truncated.  Many have developed so-called "safe behaviors"--actions that they believe will decrease the chance of a problem developing--that are sometimes complicated and demanding.

Diagnosis

As with other anxiety disorders, there is no blood test or laboratory work than can prove the diagnosis; rather the syndrome is identified by the symptoms already outlined.  It is important to note than excessive anxiety and worry can be produced by many medical problems (such as hyperthyroidism) or by many medicines (such as stimulant medicine or caffeine).  The following screening questions may be helpful in deciding if GAD exists.

Treatment

Cognitive Behavior Therapy

Studies have shown that cognitive behavioral therapy is a very effective treatment for GAD.  Therapy usually begins with education about the nature of the disorder, the concept of the abnormal worry or understanding of how this kind of chronic worry impact on daily life.  The way an individual thinks, or approaches a potential problem, is crucial to treating GAD.  Early identification of the cues of abnormal worrying is important, as is the understanding of the abnormal automatic thoughts (negative) that occur and inflame the worry.  This educational aspect is usually supplemented by teaching some form of relaxation therapy to achieve control over the worry and chronic muscular tension that it causes.
    An important part of therapy focuses on examining the individual's understanding of the thoughts and beliefs that accompany worry, because these responses are considered to be crucial in solving the problem.  For example, in order to put the possibilities into their correct perspective, you are asked to consider "What would be the worst thing that could happen, and how likely would that be?"  Examining the underlying assumptions (such as "The world is a very dangerous or unpredictable place") that are often premises for abnormal for worry is fundamental progress.  These beliefs or assumptions, often acquired from life experiences, color your interpretation of situations.  In addition, controlled exposure to situations that might produce excessive worry is gradually and progressively introduced, along with the teaching of new techniques to handle these situations.  This allows you to rehearse the skills that would be important to minimizing the effects of the situations in producing worry.  Attention to proper sleep habits (to achieve restorative sleep), the avoidance of stimulants (such as caffeine), regular exercise and attention to substance abuse (such as alcohol) are also emphasized.

Pharmacotherapy

There are a number of drugs that can be used to treat GAD.

Social Anxiety Disorder (Social Phobia)

As usual, everyone at the gathering was having a good time--except David.  It was the end of the school year, and David and his classmates were celebrating at a pool party.  Some were swimming, others were laughing and talking beside the pool.  David wasn't very good at parties--he always felt uncomfortable, couldn't seem to relax--and he was very poor at making small talk.  He'd already had a couple beers to relax and even now he sat on the edge of the pool by himself, not joining in, feeling uncomfortable and shy.  He just didn't want all of his friends (especially the girls) seeing how boring and unattractive he was.  He was sure they would all think he was a "jerk."
    Alice, one of the girls in his class, noticed David sitting by the pool and came over to talk to him.
    "Why don't you join us David?" she asked.
    David could feel himself blush.  He was sure Alice would see it too.  He felt hot all over, very uncomfortable, and he began to sweat.  He knew he had to answer her but couldn't look directly at her.  He smiled and said, "Oh, I'm okay here," stammering just a little on the "okay."  Alice smiled, and David felt horribly embarrassed, knowing for certain she was laughing at his embarrassment, his shyness.  "She must think I'm a complete idiot," he thought.  His heart began to pound, he tried to smile back but he couldn't.  All he could think was getting out of there, away from the crowd, away from the awful embarrassment of this humiliating experience.
    "Well, gotta go now," he blurted out, even though the party had barely begun.  Then he quickly left Alice and the party, walking home alone in the warm summer night, cursing his shyness.  In his heart, David knew the others were right--he was hopelessly inadequate, hopelessly shy, hopelessly embarrassed.
    "They're right," he thought "I am a jerk."

Most of us feel slightly uncomfortable in a crowd, when meeting strangers, when asked to say a few words at a meeting, or in social gatherings and occasions.  This mild sense of unease is quite normal, focusing our energies and mental acumen and helping us prepare for the encounters or interactions.  For some (like David), the anxiety is not helpful and can be so intense and severe that the sufferer is unable to function.  This condition is known as social anxiety disorder.
    In this common disorder, intense anxiety and fear is triggered by social situations in which an individual thinks she or he might be humiliated or embarrassed when evaluated by others.  Any situation in which you are exposed to scrutiny can trigger the reaction.  Common situations that cause social anxiety include:

    In other words, any situation in which behavior or performance could be evaluated by others.
    Social anxiety can be generalized (that is, it is related to most or all social interactions) or it can be one or only a few social situations (such as public speaking--so called performance anxiety).  Exposure to or anticipation of the situation produces symptoms such as sweating, stammering, trembling, inability to concentrate, acute loss of self-esteem and a feeling that one will lose control.
    Interestingly, blushing is frequently seen in this disorder--the only one in which blushing is prominent.  Some theorize that blushing is a readily visible physical sign of embarrassment or submission, an important physical cue to others that a person is not dominant in a social situation.
    All of these symptoms reinforce the fear of appearing foolish, stupid, incompetent, uninteresting, or inept in public, and thus reinforce the disorder.  There is another difference between normal anxiety and in encounters with others and social anxiety.  Most of us are uneasy when asked to speak in public, especially if we are unprepared.  However, our discomfort is fairly easily overcome and we are able to complete the task--the acute, initial anxiety abates as we speak.  In social anxiety disorder, however, thoughts of humiliation are paramount and, as we speak, the anxiety increases and concerns about appearing inadequate or incompetent.  Our performance weakens as we realize how foolish we must look, and eventually, we are unable to continue.

Who Gets Social Anxiety Disorder?

Social anxiety disorder, with a lifetime prevalence of 13.3 percent, is the most common anxiety disorder (and third commonest psychiatric disorder after substance abuse and depression).  Usually it begins in adolescence, around the time that young people are expanding their social contacts and learning more complex processes of social interaction involving those outside the family; members of the opposite sex, teachers, friends, and co-workers.
    Although the disability can be severe, most sufferers fed that there are simply "shy" and adapt to their "shyness."  Their discomfort in social situations is so extreme that it quickly leads to avoidance of those situations that cause the discomfort.  This avoidance leads to progressive isolation and demoralization, the belief that they are somehow inadequate, just as they suspected.  Consequently, they limit their contact with friends and family, avoiding social interactions, presentations and other situations where they perceive themselves as being inept.  If they cannot avoid these occasions completely, they try to limit  their exposure within encounters.  Dating and interaction with the opposite sex is often severely restricted or completely avoided, and further schooling, occupational training or community work are undertaken only after the likelihood of being exposed to such situations is assessed.  This can have profound effects on their future, as young people decide to avoid school and job opportunities because of their perceived inadequacy, or due to the possibility of distressing interactions with others.  In one study, nearly half of those with social anxiety disorder were unable to complete high school, and most adjusted their education and occupational training to minimize social contact.

Co-Morbidity

The word co-morbidity refers to the association of one abnormality with another.  In social anxiety disorder co-morbid psychological problems are common.  For example, 40 to 50 percent of sufferers have major depression, increasing the psychological burden.  The marked distress experienced by individuals with social anxiety disorder may explain some of the co-morbidity, and the isolation and avoidance often mean that an individual's support network, such as family and friends, is quite limited.  The younger the sufferer at the onset of the disorder, the higher the co-morbidity.  Alcoholism and drug abuse are also commonly seen, as these agents are used to decrease the "nervousness" and anxiety symptoms.  Many individuals are unaware that they have an anxiety problem, simply accepting their "shyness" as part of their personality.  Many people participating in substance abuse programs have underlying unrecognized social anxiety disorder as a cause for their substance abuse.  Sometimes, the distress becomes unbearable; both suicidal thoughts and attempts are increased in social anxiety disorder.

Treatment

Social anxiety disorder, though often very disabling, is usually effectively treated with a combination of psychological therapy and medicines.  Generalized anxiety disorder (in which symptoms of excess anxiety are precipitated by many different social encounters) is often complicated by the sufferers' belief that what they suffer is not treatable--that it is "just me," normal shyness, or poor self-esteem.  Treatment usually includes:

All of this is from the book Anxiety Disorders (EVERYTHING YOU NEED TO KNOW) by J. Paul Caldwell