By: Khomotso Fredah Matlala
What is Generalized Anxiety Disorder?
Generalized Anxiety Disorder (GAD) is a prevalent psychiatric comorbidity in people with epilepsy. Research studies consistently highlight a significant co-occurrence between epilepsy and anxiety disorders, including GAD with approximately 18% of individuals diagnosed with epilepsy developing GAD.
Generalized Anxiety Disorder is a mental health condition that is characterized by persistent and excessive worry or anxiety about a variety of everyday things that can significantly impact daily functioning (American Psychological Association, 2022). Unlike normal worry, which is typically occasional and situational, individuals with GAD experience constant anxiety that is difficult to control (National Institute of Mental Health, 2022). Individuals with GAD experience frequent anxiety lasting for months if not years. The disorder develops gradually, usually beginning showing during adulthood however it can also occur in childhood. It is more common in women than it is in men (National Institute of Mental Health, 2022).
Symptoms of GAD
People with GAD may:
- Worry excessively about everyday things.
- Have difficulties controlling their worries or feelings of nervousness.
- Feel restless and have trouble relaxing.
- Having difficulties concentrating or experiencing mind going blank
- Get startled easily
- Have trouble falling asleep or staying asleep
- Be easily fatigued
- Have muscle tension
- Become irritable.
Causes of Generalized Anxiety Disorder.
To understand the causes of GAD, an integrated approach can be considered. The biopsychosocial model proposes that there are multiple and interrelated causes of pathological anxiety. The model suggests that there is no single cause of GAD, instead it emerges from the interaction of biological, psychological and social factors.
Research has shown that GAD tends to run in families which suggest that there is a genetic predisposition. For instance, studies indicate that there is a shared genetic factor between GAD and neuroticism (Gottschalk & Domschke, 2017). Neuroticism is characterized by a tendency to experience negative emotions such as worry, fear and emotional instability (Pawlak et al., 2024). Individuals with high levels of neuroticism are more prone to perceive everyday situations as threatening or stressful, thereby increasing their vulnerability to developing GAD (Pawlak et al., 2024). This heightened emotional reactivity often leads them to worry about potential problems before they even occur.
In addition to biological and psychological factors, social influences also play a critical role in the development of GAD. For instance, adverse childhood experiences such as neglect, abuse or parental overcontrol have been associated with an increased risk for anxiety disorders (Alipour et al., 2025). Furthermore, chronic social and environmental stressors such as financial strain, lack of social support, exposure to trauma and chronic illnesses can exacerbate an individual’s vulnerability to anxiety (Alipour et al., 2025). These environmental pressures often interact with existing biological or psychological predispositions, increasing the risk of developing GAD.
Treatment for GAD
Effective treatment for GAD may include a combination of psychotherapy, pharmacotherapy and lifestyle changes. Cognitive Behavioural Therapy (CBT) has been recognized as the first-line psychological treatment for GAD (Papola et al., 2024). It involves identifying and modifying maladaptive thought patterns and behaviours contributing to anxiety. CBT has been considered as the first treatment for adults with GAD, due to its effectiveness and long-term benefits (Papola et al., 2024).
Other treatment options include medications such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) (Bandelow et al., 2017). SSRIs work by increasing serotonin levels in the brain which help alleviate anxiety symptoms while SNRIs increase both serotonin and norepinephrine levels contributing to mood stabilization (Bandelow et al., 2017). It is important to note that pharmacological treatments are usually employed as the second line treatment particularly when psychotherapy alone is insufficient or inaccessible (Bandelow et al., 2017).
Generalized Anxiety Disorder and Epilepsy
Individuals with epilepsy are at a significantly higher risk of developing anxiety disorders including GAD. Approximately 30-50% of people with epilepsy are experiencing some form of anxiety, with GAD being the most reported anxiety disorder (Seid et al., 2022; Sehlo et al., 2022). Studies have linked reduced quality of life, greater risk of suicide, poor response to anti-epileptic drugs, increased seizure activity and severity of the disease with anxiety comorbidity in persons with epilepsy (Sehlo et al., 2022). Seid et al., identified secondary educational status, medication-related side effect, substance use history, seizure-related physical trauma, stress symptoms and a mental illness belief as factors that contributed significantly to the development of GAD in patients with epilepsy. For instance, approximately 40,0% of persons with epilepsy were found to have anxiety in a cross-sectional study in Canada (Seid et al., 2022).
Conclusion
Generalized Anxiety Disorder (GAD) is a complex and chronic mental health condition marked by excessive, uncontrollable worry that significantly impairs daily functioning. Rooted in a multifactorial aetiology, GAD arises from the interaction of genetic predispositions, personality traits like neuroticism, and psychosocial stressors such as trauma or chronic adversity. While highly treatable, GAD remains underdiagnosed, especially when it presents alongside other medical conditions such as epilepsy.
The comorbidity between epilepsy and GAD is particularly concerning, as it not only exacerbates the clinical course of epilepsy but also severely impacts patients’ quality of life, treatment response, and psychosocial well-being. Studies show that up to half of individuals with epilepsy may experience anxiety, with GAD being one of the most prevalent presentations. This emphasizes the need for integrative, multidisciplinary approaches in both the diagnosis and management of epilepsy to ensure that co-occurring psychiatric conditions like GAD are not overlooked.
Given the significant implications of GAD for individuals with epilepsy, early identification and evidence-based interventions such as Cognitive Behavioural Therapy and pharmacological support are critical. A greater awareness of the interplay between neurological and psychiatric disorders can lead to more holistic care, reduce stigma, and ultimately improve health outcomes for individuals navigating the dual challenges of anxiety and epilepsy.
Resources:
Alipour, F., Rafiey, H., Sarmadi, S., Moradi, S., Ahmadi, S., & Khankeh, H. (2025). Exploring generalized anxiety disorder symptoms: Key insights from a population-based study in Iran. BMC Psychiatry, 25, 262. https://doi.org/10.1186/s12888-025-06707-5
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.; DSM-5-TR). American Psychiatric Publishing. https://doi.org/10.1176/appi.books.9780890425787
Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in Clinical Neuroscience, 19(2), 93–107. https://doi.org/10.31887/DCNS.2017.19.2/bbandelow
Gottschalk, M. G., & Domschke, K. (2017). Genetics of generalized anxiety disorder and related traits. Dialogues in Clinical Neuroscience, 19(2), 159–168. https://doi.org/10.31887/DCNS.2017.19.2/kdomschke
National Institute of Mental Health. (2022). Generalized anxiety disorder (GAD). U.S. Department of Health and Human Services. https://www.nimh.nih.gov/health/publications/generalized-anxiety-disorder-gad
Pawlak, M., Schmidtler, H., & Kopala-Sibley, D. C. (2024). Neuroticism and extraversion as predictors of first-lifetime onsets of depression, anxiety, and suicidality in high-risk adolescents. Development and Psychopathology, 36(2), 497–509. https://doi.org/10.1017/S0954579424000130
Papola, D., Miguel, C., Mazzaglia, M., Franco, P., Tedeschi, F., Romero, S. A., Patel, A. R., Ostuzzi, G., Gastaldon, C., Karyotaki, E., Harrer, M., Purgato, M., Sijbrandij, M., Patel, V., Furukawa, T. A., Cuijpers, P., & Barbui, C. (2024). Psychotherapies for generalized anxiety disorder in adults: A systematic review and network meta-analysis of randomized clinical trials. JAMA Psychiatry, 81(3), 250–259. https://doi.org/10.1001/jamapsychiatry.2023.4567
Seid, M. A., Mersha, A. G., Gebremariam, E. T., & Tesfaye, M. (2022). Prevalence and associated factors of anxiety among people with epilepsy in Mekelle, Ethiopia: A cross-sectional study. BMC Psychiatry, 22, 123. https://doi.org/10.1186/s12888-022-03745-4
Sehlo, M. G., Youssef, U. M., Mohamed, M. Y., Alghamdi, M. M., & Mehdar, A. M. (2022). Psychiatric comorbidities and their impact on the quality of life in people with epilepsy during the COVID-19 pandemic in Egypt. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery, 58(1), 1–9. https://doi.org/10.1186/s41983-022-00513-6
