Dr. Arnold Shapiro is a board-certified psychiatrist with offices in Cincinnati, Ohio and Fort Wright, Kentucky, who has treated anxiety disorders in children, teens and adults for 35+ years. He evaluates generalized anxiety disorder (GAD) by looking at the whole picture, including other conditions that overlap with it, and then builds a treatment plan with you that can include psychotherapy, medication management, or both.
What generalized anxiety disorder is
Everyone worries. Worry about a deadline, a medical test or a teenager who is late coming home is part of being human, and it often fades once the situation passes. Generalized anxiety disorder is different. The worry is broad, it moves from one topic to the next, and it keeps going even when nothing in particular is wrong.
In the language of the DSM-5-TR, the diagnostic manual psychiatrists use, GAD involves excessive anxiety and worry about a number of everyday things, present more days than not for at least six months, that the person finds hard to control. The worry comes with physical and mental symptoms and it gets in the way of work, school, relationships or sleep.
That last part matters. Plenty of people describe themselves as “worriers” and do fine. The question is whether the worry is costing you something, and whether you have tried to turn it off and found you can’t.
How GAD shows up in adults, teens and children
GAD is not only a feeling. It is often a body-and-mind pattern that people live with for years before they put a name to it. Many adults say they have “always been this way,” which is one reason it goes unrecognized.
In children and teenagers the worry often looks different. A child may not say “I’m anxious.” Instead you may see frequent stomachaches or headaches, a need for constant reassurance, perfectionism about schoolwork, trouble falling asleep, or reluctance to go to school. Young people with GAD often worry about their performance, about making mistakes, and about things happening to people they love. The DSM-5-TR requires only one of the associated symptoms (restlessness, tiring easily, trouble concentrating, irritability, muscle tension or sleep problems) in children, compared with three in adults.
Common signs of GAD
- Worry that is hard to control and jumps from one topic to another
- Feeling restless, keyed up or on edge
- Being tired easily, even after a night in bed
- Trouble concentrating, or a mind that goes blank
- Irritability that seems out of proportion
- Muscle tension, especially in the neck, shoulders and jaw
- Trouble falling asleep, staying asleep, or waking unrefreshed
- In children: stomachaches, headaches, reassurance-seeking and school reluctance
What else it can be, and what often comes with it
Several things can look like GAD, and several often travel with it. A good evaluation does not assume. Thyroid problems, certain medications, caffeine and other stimulants, alcohol or other substance use, and sleep disorders can all produce a wired, worried feeling, so a medical contribution is worth ruling out with your primary care doctor when it is relevant.
On the psychiatric side, GAD frequently overlaps with depression, and the two can be hard to separate from the outside. It can also sit alongside panic disorder, social anxiety, OCD or ADHD. Inattention and restlessness from ADHD can look like anxiety, and chronic anxiety can look like ADHD. Treating the wrong thing, or only one of two things, is a common reason treatment does not seem to work.
How Dr. Shapiro evaluates GAD
The practice uses a thorough, team-based evaluation. For adults that includes a full hour with the practice’s therapist and a full hour with Dr. Shapiro. For children and teens it includes time with the parents, time with the young person, and a family meeting with Dr. Shapiro. You can read the step-by-step description on the evaluation page.
A careful history
When the worry began, what it attaches to, what makes it better or worse, and how it has changed over time. Family history and past treatment count too.
Looking for everything, not just anxiety
Depression, ADHD, OCD and other conditions can overlap with GAD or mimic it. The evaluation screens for them so the plan fits the whole picture.
Rating scales and outside input
Standard questionnaires can give a structured baseline. For children, input from parents and teachers is gathered when appropriate.
A plan you help choose
Dr. Shapiro explains your diagnosis and the options in plain language, including the pros and cons of each, and you decide together what makes sense.
Treatment options for GAD
GAD is treatable, and there is more than one reasonable path. The two main approaches are psychotherapy and medication, and many people use both.
Psychotherapy, especially cognitive behavioral therapy (CBT), teaches you to notice the patterns of thinking that keep worry going and to respond to them differently. It builds skills you keep after treatment ends. Relaxation and stress-management skills can help alongside it. Dr. Shapiro works together with therapists, and the practice’s own therapist and Dr. Shapiro share one record so nothing is lost between visits.
Medication can reduce the constant background anxiety. The SSRI and SNRI classes of antidepressants are generally the first-line choices for GAD; escitalopram and venlafaxine are examples of well-established options. Buspirone is another medication used for chronic anxiety. Benzodiazepines can calm anxiety quickly, but because of the risk of dependence they are generally kept to short-term use rather than treated as a long-term solution. In children and teens, SSRIs have the strongest evidence; buspirone and benzodiazepines are not routine choices for young people. Antidepressants carry a warning that a small number of children, teens and young adults may have increased suicidal thoughts, especially in the first weeks or after a dose change, so close follow-up early in treatment is important.
No single option is right for everyone. Dr. Shapiro will go over the choices, side effects and what to expect, and he will adjust the plan if something is not working or if you are uncomfortable with it.
When to seek help
Consider an evaluation if worry is taking up much of your day, if it is affecting your sleep, concentration, work or relationships, or if your child’s worries are keeping them from school, friends or activities they used to enjoy. You do not need to wait until things are unbearable. Earlier help is usually simpler help.
If you have thoughts of harming yourself, call or text 988 at any time. If you have chest pain or symptoms that could be a heart attack, call 911 rather than assuming it is anxiety.
Common questions
How do I know if I have GAD or just a worrying personality?
The difference is mainly in how much the worry costs you. If it has been present most days for six months or more, feels hard to control, and comes with symptoms like poor sleep, tension, fatigue or trouble concentrating, an evaluation is worth having. A free self-check on this site can help you decide, though it cannot make a diagnosis.
Can GAD be treated without medication?
Yes. Cognitive behavioral therapy is a well-established treatment for GAD, and skills like relaxation training and stress management can help. Some people do well with therapy alone, some with medication alone, and many with a combination. Dr. Shapiro will lay out the options and will not push you toward one you are not comfortable with.
Do you treat children and teenagers with anxiety?
Yes. Dr. Shapiro treats children, teens and adults. In young people, anxiety often shows up as stomachaches, school avoidance or constant reassurance-seeking rather than as spoken worry, so the evaluation includes the parents and, when appropriate, teachers as well as the child.
Will I need to be on medication for life?
Not necessarily. Some people take medication for a period and then stop with their doctor’s guidance, while others do better staying on it longer. That decision is made together over time, based on how you are doing, not decided in advance on the first visit.
What if I have tried treatment before and it did not help enough?
That is common, and it is a reason to look again rather than give up. An undiagnosed overlapping condition, a medication choice that was not the right fit, or therapy that was not a good fit can each explain it. The treatment-resistant GAD page on this site explains how Dr. Shapiro approaches that situation.