Generalised anxiety (constant worry)

What it is

Everyone worries. Generalised anxiety disorder (GAD) is worry that has slipped its leash: persistent, excessive concern about many ordinary things at once (money, health, family, work, safety) on more days than not, for six months or longer, and very difficult to switch off.

The worry is out of proportion to the actual situation, jumps from topic to topic, and keeps running even when things are going well. People with GAD often describe it as living with a mind that treats every day like an emergency. It is a recognised medical condition, not a nervous personality and not a lack of faith or gratitude.

What it can feel like

A constant background hum of dread. Trouble concentrating because the mind keeps returning to what could go wrong. Muscles that never quite relax: tight shoulders, clenched jaw, headaches. Sleep that takes hours to arrive or breaks at 3 a.m. with the mind already racing. Irritability, tiredness, and a stomach that churns.

Because the body carries so much of it, many people first visit a clinic for the physical symptoms: headaches, palpitations, chest tightness, stomach problems. When tests come back normal, both patient and clinician can feel stuck. Unexplained physical symptoms plus relentless worry is a pattern worth naming, because naming it opens the door to treatment that works.

How common is it

Around 3-4% of adults experience GAD in any given year, and roughly one person in twenty will experience it at some point in life. It is one of the most common conditions seen in primary care worldwide, yet one of the least recognised, partly because worry feels normal and partly because the physical symptoms point attention elsewhere.

What causes it

As with most mental health conditions, several factors combine: family history, a temperament tuned toward threat, chronic stress, financial insecurity, caregiving burdens, and earlier adversity. Brain circuits involved in detecting danger appear to run hot in GAD, which is why treatments that retrain the threat response work so well. There is no single cause and no one to blame, including yourself.

How it is diagnosed

A clinician makes the diagnosis through a careful conversation: what you worry about, how controllable it feels, how long it has lasted (six months is the marker), and how it affects sleep, energy, concentration and daily life. Medical look-alikes get ruled out, especially thyroid problems, heart rhythm issues, anaemia and the effects of caffeine, khat or medications. Screening tools like the GAD-7 are useful pointers, but a questionnaire is never a diagnosis on its own.

How it is treated

Cognitive behavioural therapy (CBT) is the best-evidenced psychological treatment for GAD. It teaches practical skills: spotting and testing anxious predictions, tolerating uncertainty, solving real problems instead of rehearsing imaginary ones, and releasing the physical tension that worry builds. Applied relaxation and mindfulness-based approaches also help many people.

Where medication is needed, SSRIs and SNRIs are the recommended first choices, with effects building over several weeks. Benzodiazepines (common in many pharmacies in our region) calm anxiety quickly but cause dependence within weeks and are not a long-term treatment; prescribing guidelines worldwide limit them to short, supervised use. Regular exercise, cutting back caffeine and khat, and protecting sleep all measurably lower the baseline of anxiety.

Anxiety in the African context

Anxiety disorders are common across African countries, but most cases never reach care; WHO's mhGAP programme exists precisely to equip nurses and clinical officers in ordinary clinics to recognise and treat them. Community-delivered talking therapies have strong African evidence: Zimbabwe's Friendship Bench, run by trained lay health workers, significantly reduced symptoms of common mental disorders, anxiety included. Support from family and faith communities is a real asset; it works best alongside treatment, not instead of it.