Management of Generalized Anxiety Disorder Causing Physical Symptoms in Women

Assessment and Screening

The American College of Physicians recommends that women with generalized anxiety disorder (GAD) causing physical symptoms should be assessed using validated instruments such as the Generalized Anxiety Disorder-7 (GAD-7) scale, which categorizes GAD severity as mild (0-9), moderate (10-14), and moderate to severe/severe (15-21) 2, 4, 5
GAD is characterized by excessive, uncontrollable worry and is highly prevalent in women, with a lifetime prevalence of approximately 40%, twice that of men 3

For women with mild GAD symptoms (GAD-7 score 0-9), education and active monitoring, self-help resources based on cognitive behavioral therapy principles, and structured physical activity/exercise are recommended 2, 5
For women with moderate GAD symptoms (GAD-7 score 10-14), referral to educational and support services and consideration of low-intensity psychological interventions are recommended 5
For women with moderate to severe/severe GAD symptoms (GAD-7 score 15-21), high-intensity interventions including cognitive behavioral therapy, behavioral activation, structured physical activity/exercise, acceptance and commitment therapy, and pharmacotherapy are recommended 4, 5

Cognitive Behavioral Therapy (CBT) is the psychological treatment with the strongest evidence of efficacy for anxiety disorders, and should be delivered by licensed mental health professionals using treatment manuals that include cognitive change techniques, behavioral activation, biobehavioral strategies, education, and relaxation strategies 2, 3, 4, 5
CBT has shown improved symptoms and decreased relapse rates compared to waitlist controls, usual care, or psychological placebos 1
Group psychosocial interventions led by licensed mental health professionals can address stress reduction, positive coping strategies, enhancing social support, and managing physical symptoms 4

The American College of Physicians recommends that first-line pharmacological therapies for GAD in women are selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), which have demonstrated statistically significant improvement in anxiety based on clinician evaluations in placebo-controlled trials 1
Common side effects of SSRIs and SNRIs include diarrhea, dizziness, dry mouth, fatigue, headache, nausea, sexual dysfunction, sweating, tremor, and weight gain 1

Regular follow-up is essential as patients with anxiety may not follow through on referrals or treatment recommendations, and monthly assessment is recommended until symptoms have subsided to evaluate compliance with psychological/psychosocial referrals, assess medication adherence and side effects, and monitor symptom relief 4, 5, 6

Anxiety disorders can increase in both frequency and effects during pregnancy and the postpartum period, and while pregnant and postpartum women were not included in many clinical trials of anxiety medications, SSRIs and SNRIs are widely used in these patient groups 1, 7
Consider culturally sensitive assessments and treatments, particularly for women from diverse backgrounds 5

Anxiety disorders frequently co-occur with depressive disorders, and consider screening for both anxiety and depression simultaneously due to their frequent co-occurrence 1, 6
Only about 20% of people with anxiety disorders seek care for these conditions, highlighting the importance of proactive screening 6
Cautiousness and avoidance are cardinal features of anxiety, which may lead to poor follow-through with treatment recommendations 5