Generalized Anxiety Disorder 223
more pervasive, pronounced, and distressing; have longer du ration; and frequently occur
without precipitants. The greater the range of life circumstances about which a person
worries (e.g., finances, children’s safety, job performance), the more likely his or her symp-
toms are to meet criteria for generalized anxi ety disorder. Third, everyday worries are much
less likely to be accompanied by physical symp toms (e.g., restlessness or feeling keyed up
or on edge). Individuals with generalized anxiety disorder report subjective distress due
to constant worry and related impairment in social, occupational, or other important areas
of functioning.
The anxiety and worry are accompanied by at  least three of the following additional
symptoms: restlessness or feeling keyed up or  on edge, being easily fatigued, difficulty
concentrating or mind going bl ank, irritability, muscle tens ion, and disturbed sleep, al-
though only one additional symptom is required in children. 
Associated Features Supporting Diagnosis
Associated with muscle tension, there may be  trembling, twitching, feeling shaky, and
muscle aches or soreness. Many individuals wi th generalized anxiety disorder also expe-
rience somatic symptoms (e.g., sweating, naus ea, diarrhea) and an exaggerated startle re-
sponse. Symptoms of autonomic hyperarousal  (e.g., accelerated heart rate, shortness of
breath, dizziness) are less prominent in genera lized anxiety disorder than in other anxiety
disorders, such as panic disorder. Other conditions that may be associated with stress (e.g.,
irritable bowel syndrome, headaches) frequently accompany generalized anxiety disorder. 
Prevalence
The 12-month prevalence of generalized anxiet y disorder is 0.9% among adolescents and