Generalised anxiety: worry about family

Seven forty in the evening, load-shedding in Malibagh, and the rain has started. Rina, 48, homemaker and maths tutor to half the building, has called her daughter eleven times. Mou, nineteen, was meant to be home from coaching at seven fifteen. By call four, Rina has imagined an accident. By call eight, a kidnapping. By call ten, she is standing at the gate in her house slippers.

Call eleven connects. “Ammu, I’m in a CNG at Bijoy Sarani. It’s not a war zone, it’s traffic. Please stop calling, the driver thinks you’re my boss.” Rina laughs, with her heart still pounding, and goes inside to reheat the dal for the third time.

It is not only Mou. It is her husband’s blood pressure, her son’s motorbike, her mother’s knees in Barishal, the gas cylinder, the exam results of students who are not hers. She has had headaches for a year, her shoulders ache, and she lies awake planning for disasters that never come. Her husband says she was born a worrier. She has started to wonder if it has to be this way.

An illustration drawn from common experience. The person is invented; the pattern is not.

Understanding generalised anxiety

Everyone worries about family. Generalised anxiety disorder (GAD) is different: worry that is excessive, hard to control and present most days for months, spreading from one subject to the next. It comes with physical symptoms such as restlessness, muscle tension, headaches, tiredness, poor concentration and disturbed sleep. People with GAD often know the worry is out of proportion, and still cannot switch it off. It frequently comes with depression or other anxiety disorders, and physical causes such as an overactive thyroid should be checked.

How common is generalised anxiety?

In World Health Organization surveys of 147,261 adults in 26 countries, 3.7% had GAD at some point in their lives and 1.8% in the past year; rates were lower in low-income countries. Most people with GAD (81.9%) also had another disorder during their lives, most often a mood disorder such as depression, and only about half had sought treatment. In Bangladesh, an analysis of the 2019 national mental health survey found that about 90% of adults with a mental disorder had not sought care.

Signs and symptoms of generalised anxiety

• Worry most days, about many things, for six months or more
• Needing constant reassurance, such as repeated calls
• Headaches, muscle tension or stomach upsets
• Trouble falling asleep because the mind will not stop
• Avoiding things, or planning endlessly, to prevent imagined disasters

Treatment for generalised anxiety

A psychiatrist checks for physical causes, for depression, and for medicines or caffeine that worsen anxiety. Psychological therapy has strong evidence. A meta-analysis of 79 randomised trials with 11,002 people with GAD found a medium to large effect for evidence-based psychotherapies such as cognitive behavioural therapy (CBT), and a small effect for medication; the authors caution that the two cannot be compared directly. CBT helps people notice the habit of imagining the worst, tolerate uncertainty, and cut down on checking and reassurance. Medication is an option for some people and is discussed carefully.

What getting better can look like

Rina’s evenings might hold one agreed text from Mou when she leaves coaching, and no calls in between, a walk in the evening instead of standing at the gate, a night of unbroken sleep, and the dal heated only once.

Common questions about generalised anxiety

What is the difference between normal worry and generalised anxiety disorder?

Normal worry is tied to a real problem and passes when it is solved. In generalised anxiety disorder, worry is excessive, hard to control, moves from one topic to another and is present most days for months, often with tension, poor sleep and tiredness. If worry is affecting your health or daily life, it is worth an assessment.

What is the best treatment for generalised anxiety disorder?

Psychological therapy, especially cognitive behavioural therapy, has good evidence from many trials for GAD. Medication can also help some people. A doctor can help you choose based on your symptoms and preferences.

When to see a psychiatrist

If worry has taken over your days, your sleep or your body, please seek help. You do not need to wait until something goes wrong.

Care here is personal: built around your history, your health and what you want to change, and reviewed with you as it goes.

If you or someone else is in immediate danger, call 999 or go to the nearest hospital emergency department.

Sources

• Ruscio et al., JAMA Psychiatry, 2017 (PMID 28297020)
• Carl et al., Cognitive Behaviour Therapy, 2020 (PMID 30760112)
• Huque et al., BMC Psychiatry, 2025 (PMID 40781659)