When to worry about worrying

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There is no shortage of things to worry about --- from personal concerns about job security or health, to fears related to larger issues such as political conflicts or natural disasters. Temporary anxiety can be a healthy response to uncertainty and danger, but constant worry and nervousness may be a sign of generalized anxiety disorder.

Do I have generalized anxiety disorder?

You'll need your doctor's help to know for sure, but while other types of anxiety disorders arise from particular situations, generalized anxiety disorder is characterized by debilitating worry and agitation about nothing in particular, or anything at all.

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Everyone worries or gets scared sometimes. But if you feel extremely worried or afraid much of the time, or if you repeatedly feel panicky, you may have an anxiety disorder. Anxiety disorders are among the most common mental illnesses, affecting roughly 40 million American adults each year. This report discusses the latest and most effective treatment approaches, including cognitive behavioral therapies, psychotherapy, and medications. A special section delves into alternative treatments for anxiety, such as relaxation techniques, mindfulness meditation, and biofeedback.

People with generalized anxiety disorder tend to worry about everyday matters. They can't shake the feeling that something bad will happen and they will not be prepared. They may worry to excess about missing an appointment, losing a job, or having an accident. Some people even worry about worrying too much.

Physical symptoms are common too, and can include a racing heart, dry mouth, upset stomach, muscle tension, sweating, trembling, and irritability. These bodily expressions of anxiety can have a negative effect on physical health. For example, people with generalized anxiety disorder are at greater risk for heart attack and other cardiovascular problems.

Taming anxiety

If you have generalized anxiety disorder, therapy — particularly cognitive behavioral therapy (CBT) — can help. CBT helps people recognize when they are misinterpreting events, exaggerating difficulties, or making unnecessarily pessimistic assumptions, and offers new ways to respond to anxiety-provoking situations.

For some people, medications can be an important part of treatment. Commonly prescribed drugs include antidepressants, such as selective serotonin reuptake inhibitors (like Prozac or Zoloft), or dual serotonin and norepinephrine reuptake inhibitors (like Effexor or Cymbalta). These drugs take longer to work than the traditional anti-anxiety drugs, but also may provide greater symptom relief over time.

Symptoms of generalized anxiety disorder

Persistent, excessive worry about several different things for at least six months
Fatigue, difficulty sleeping, or restlessness
Trouble concentrating
Irritability
Muscle tension
Feeling tense or "on edge"

Only your doctor can determine whether you meet the criteria for generalized anxiety disorder. If you think you might have this condition, don't hesitate to talk to your primary care doctor. There are many different treatments that can ease the very real discomfort of this condition.

For more on diagnosing and treating anxiety and phobias, buy Coping with Anxiety and Stress Disorders, a Special Health Report from Harvard Medical School.

Trying to be perfect can cause anxiety

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No one is "perfect." Yet many people struggle to be, which can trigger a cascade of anxieties.

Perfectionism may be a strong suit or a stumbling block, depending on how it's channeled, as clinical psychologist Jeff Szymanski explains. Dr. Szymanski is an associate instructor of psychology at Harvard Medical School and executive director of the International OCD Foundation.

"The core of all perfectionism is the intention to do something well," says Dr. Szymanski. "If you can keep your eye on intention and desired outcome, adjusting your strategy when needed, you're fine.... But when you can't tolerate making a mistake, when your strategy is to make no mistakes, that's when perfectionism starts veering off in the wrong direction." In its most severe form, perfectionism can leave you unable to complete any task for fear of making a mistake.

To help you prioritize the projects and activities that mean the most to you and keep your personal strategy in line, Dr. Szymanski has shared the following exercise:

What do you find valuable in life? What would you want 50 years of your life to represent? If that seems overwhelming, think about where you want to put your energies for the next five years.

Think about your current goals and projects, and assign them priorities. Use the letters "ABCF" to help you decide where you want to excel (A), be above average (B), or be average (C), and what you can let go of (F). For example:

A (100% effort): This is reserved for what's most important to you. For example, if your career is most valuable, your goals might be to impress the boss, make sure clients are happy, put out good products at work.
B (above average, maybe 80% effort): Perhaps you like playing golf or tennis or want to learn a new language. You enjoy these activities, but have no plans to go pro.
C (average effort): Perhaps having a clean home is important, too. But how often does your home need to be cleaned? People aren't coming to see it every day. Could you just clean up on the weekends? Or focus on a few rooms that get the most traffic?
F (no effort): Time-consumers that don't advance your values or bring you pleasure — for example, lining up all your hangers or folding all your clothes in a specific way. Do you have any tasks that, upon reflection, don't really matter — you've just done them one way for so long that you're on autopilot? These deserve to be pruned.

To learn more about anxiety, including the difference between what's normal and should be considered serious, as well as ways to treat anxiety, buy Coping with Anxiety and Stress Disorders, a Special Health Report from Harvard Medical School.