Generalized Anxiety Disorder — How to Recognize GAD and What to Do

What is Generalized Anxiety Disorder (GAD)?

Anxiety is a normal and useful emotion — it prepares us to face threats. But when worry becomes excessive, uncontrollable and persistent, even when there is no real danger, it is called Generalized Anxiety Disorder (GAD).

In France, GAD is estimated to affect 4 to 5% of the general population, with a prevalence twice as high among women. It is one of the most common anxiety disorders, yet it often goes undiagnosed because its symptoms resemble ordinary stress or tiredness.

The 6 Symptoms of GAD According to the DSM-5

To diagnose GAD, the DSM-5 (the reference diagnostic manual) requires excessive worry that is hard to control across several topics, together with at least 3 of the following 6 symptoms (for at least 6 months):

Restlessness or feeling on edge — a constant sense of being keyed up
Fatigue — exhaustion even without any particular physical effort
Difficulty concentrating — the mind "drifts off", memory blanks
Irritability — out-of-proportion reactions to minor situations
Muscle tension — stiff neck, clenched jaw, headaches
Sleep disturbance — trouble falling asleep, waking in the night, unrefreshing sleep

Note: for children, one symptom is enough.

The "Worry Train": Why Worries Chain Together

One hallmark of GAD is what psychologists call the "worry train" (worry chain): one worry calls up another, which calls up a third... and so on. This happens because of specific cognitive mechanisms:

Intolerance of uncertainty: people with GAD perceive uncertainty as inherently dangerous
Metacognitive beliefs: "worrying protects me" or "if I don't anticipate it, something terrible will happen"
Emotional avoidance: verbal worrying can paradoxically reduce emotional arousal in the short term, which reinforces the behaviour

The GAD-7 Test: a Validated Screening Tool

The GAD-7 (Generalized Anxiety Disorder 7-item scale) is a 7-question questionnaire developed by Spitzer et al. (2006) and validated in many international studies. In France it is recommended today by the HAS (Haute Autorité de Santé, the national health authority) for screening in general practice.

Score interpretation:

0–4: Minimal anxiety
5–9: Mild anxiety
10–14: Moderate anxiety — consultation recommended
15–21: Severe anxiety — urgent consultation advised

Important: a high score is not a diagnosis. Only a health professional (GP, psychiatrist, psychologist) can diagnose GAD.

Anxiety and Everyday Life in France

The French sociocultural context shapes how anxiety is experienced and expressed:

The culture of "you mustn't complain" often pushes people to hide anxiety symptoms
Work pressure (long hours, job insecurity) is a documented risk factor
The stigma around mental health remains an obstacle to seeking help — in France, fewer than 50% of people with GAD see a professional

Validated Treatment Strategies

1. Cognitive Behavioural Therapy (CBT)

CBT is the first-line psychological treatment for GAD. It aims to change catastrophic thoughts and avoidance behaviours. Its effectiveness is documented in many meta-analyses (Cuijpers et al., 2014).

Specific techniques:

Cognitive restructuring — identifying and questioning negative automatic thoughts
Gradual exposure — facing anxiety-provoking situations step by step
Problem solving — telling "productive" worries (ones you can act on) apart from "unproductive" ones

2. Mindfulness

Mindfulness-based therapy (MBCT/MBSR) has shown significant effectiveness in reducing GAD, notably through the technique of "cognitive defusion": observing your thoughts without identifying with them.

3. Medication

SSRIs (antidepressants such as sertraline or escitalopram) and SNRIs are first-line treatments for severe GAD. The decision to take medication must be made with a doctor.

4. Lifestyle

Regular physical activity (30 min/day) — lowers cortisol and raises endorphins
Limiting caffeine and alcohol — both make anxiety worse
A consistent sleep routine
Breathing techniques (cardiac coherence: breathe in for 5 seconds, out for 5 seconds)

When Should You See Someone?

See a health professional if:

your worries interfere with your work or your relationships
you avoid situations because of anxiety
you have recurring intrusive thoughts
you use alcohol or other substances to manage anxiety

In France, you can contact your GP, a CMP (Centre Médico-Psychologique, a public mental-health centre) or a psychologist in private practice.

Check Your Anxiety Level

Our online GAD-7 test is the screening tool recommended by the HAS, available for free. It does not replace a medical consultation, but it can help you assess your symptoms and prepare a conversation with your doctor.

Related tests: GAD-7 Anxiety Test · Burnout Test (OLBI) · Well-being Test