Constant Worry That Won’t Switch Off: Understanding GAD in Men
Anxiety is one of the most common mental health struggles men deal with, even if it doesn’t always look the way people expect. When it’s left unchecked, it doesn’t just sit silently in the background, it often feeds into other issues like depression, and in some cases increases the risk of suicide.
In fact, anxiety is often the first mental health difficulty many young men experience. And if it’s not recognised or dealt with early, as many men will know, it doesn’t just disappear, it tends to evolve. Over time, it can sit alongside, or contribute to, other difficulties like depression, bipolar disorder, and even psychosis.
What I see time and time again in my therapy room is that anxiety is the starting point, not the end point. But because it’s missed or misunderstood in men, it’s often only picked up once things have already escalated.
My observation has been that men’s anxiety is still widely overlooked. On paper, statistics often show that men have lower rates of anxiety than women. In the therapy room, that doesn’t quite hold up. What those numbers miss is how anxiety actually shows up in men, for example through irritability, shutdown, overworking, avoidance, or feeling constantly on edge rather than openly “anxious.” So it’s not that men aren’t experiencing anxiety. It’s that it’s being missed, misread, or masked in ways that don’t fit the usual narrative.
There’s also growing evidence that anxiety in men can present in a slightly different way. What some researchers are starting to describe is a more “male-type” pattern of anxiety, one that leans heavily into the body. So instead of a client saying, “I feel anxious,” it might come out as constant headaches, chest tightness, panic attacks, or unexplained physical pain. It often has a chronic, on-and-off pattern, with this underlying sense of being out of control that never quite settles.
The problem is, that doesn’t always line up neatly with how anxiety is officially defined. If you look at the criteria for Generalised Anxiety Disorder in the DSM-5, the focus is more on things like restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep problems. So there’s a bit of a gap here. The clinical definition captures part of the picture, but not always how anxiety actually shows up in men day to day. And when there’s a gap like that, things get missed.
If you look at the numbers, it can seem like anxiety is more of a women’s issue. In Australia, around 16% of women are diagnosed with an anxiety disorder within a 12-month period, compared to about 11% of men. You see a similar pattern in other Western countries, the United States, Canada, even here in the UK, where rates in young adults can be as high as 30% for women compared to around 15% for men.
When men describe anxiety, they don’t usually call it anxiety. They talk about their mind not switching off. About always thinking ahead. About feeling like they’re carrying something all the time, even when nothing obvious is wrong. It’s not always intense. It’s not always visible. But it’s constant. And more often than not, what they’re describing fits with what we’d call generalised anxiety.
What it actually looks like
With Generalised Anxiety Disorder, the worry isn’t tied to one specific thing. It moves. One day it’s money. Then it’s work. Then it’s your relationship. Then your health. Then something small that suddenly feels bigger than it should. Even when one thing gets resolved, the mind finds something else to latch onto.
I’ll often hear something like, “I know I shouldn’t be worrying about this, but I can’t stop.” That’s usually the point where frustration starts to creep in. Because it’s not just the worry, it’s the sense of being stuck in it.
The constant background noise
What stands out with GAD is the ongoing nature of it. It’s there when you wake up.
It’s there when things are quiet. It’s there even when things are going relatively well. Some men describe it as a kind of mental noise that never fully drops. Others describe it more physically, a tightness, a sense of pressure, difficulty relaxing even when there’s time to rest.
Sleep is often affected. Either struggling to fall asleep because the mind keeps going, or waking up already tense. Over time, it wears people down. Not in a dramatic way. More gradually.
Why it’s hard to recognise
Because it’s been there for so long, a lot of men assume it’s just how they are.
“I’ve always been like this.”
“I just think a lot.”
“I like to stay on top of things.”
And to an extent, that can be true. Many men with this pattern are responsible, switched on, aware of what’s going on around them. The difficulty is that the line between being thoughtful and being constantly on edge gets blurred. And because they’re still functioning, as in they are still working and still managing responsibilities, it doesn’t always get picked up as something that needs attention.
What’s underneath it
When we start to unpack it in therapy, the worry itself is only part of the picture. Often, there’s a strong sense of responsibility. A need to get things right.
A pressure to stay in control. For some, that comes from earlier experiences, environments where things felt unpredictable, or where they had to grow up quickly.
For others, it’s linked to expectations they’ve taken on over time. Providing, performing, holding things together. The worry then becomes a way of trying to stay ahead of problems. A way of preventing things from going wrong. It makes sense, but it comes at a cost.
How men tend to deal with it
Most don’t stop and sit with it. They push through. Stay busy. Keep their mind occupied. Or they try to outthink it, going over scenarios, trying to prepare for every outcome. Short term, that can feel like it’s helping. Long term, it keeps the cycle going. Because the mind learns: if I keep worrying, I stay in control.
When it starts to take its toll
Over time, this constant state of alertness has an impact. Concentration can dip.
Patience gets shorter. Relationships can feel strained, especially if irritability starts to show. There’s often a sense of never quite being at ease. Even during moments that are meant to be enjoyable, part of the mind is somewhere else. That’s usually when men start to question it. Not necessarily because of the worry itself, but because of what it’s starting to affect.
The work in therapy
When someone comes in with this, the aim isn’t to get rid of worry completely. Worry, in itself, isn’t the problem. It’s the relationship to it. We start by understanding how it operates for that person. What triggers it. What keeps it going. What it’s trying to achieve.
Then gradually, we look at doing things differently. That might mean:
- noticing when the mind starts to run
- not automatically following every thought
- reducing the need to control every outcome
- building tolerance for uncertainty
That last part is often key. Because a lot of the anxiety sits in the discomfort of not knowing.
Men with this pattern are often described as overthinkers. But in the room, it usually looks more like someone who has spent a long time trying to stay one step ahead of everything. Trying to make sure nothing falls apart. Trying to hold things together. The difficulty is, when that becomes constant, there’s no off switch. And what starts as a way of coping ends up becoming something that quietly takes over. The work isn’t about forcing the mind to be quiet. It’s about helping it realise it doesn’t have to work that hard all the time.
When anxiety turns inwards
One of the parts that doesn’t get spoken about enough is where this can lead if it goes on for too long. With Generalised Anxiety Disorder, it’s not just the intensity of the worry that causes problems. It’s the duration. Living in a constant state of mental tension, day after day, month after month, starts to wear something down internally. Not all at once, but gradually.
At first, it shows up as tiredness. Irritability. Feeling stretched. Then over time, something shifts. The worry stops feeling productive. It stops feeling like it’s helping. Instead, it starts to feel like a trap. Like no matter how much you think, prepare, or stay on top of things, the mind doesn’t give you any relief.
That’s often where hopelessness begins to creep in. And this is where the link to suicide risk becomes important to understand. It’s not usually that a man goes from anxiety straight to suicidal thinking overnight. What tends to happen is more subtle than that. The constant pressure, the lack of rest, the sense of never being able to switch off, can slowly turn into a feeling of “I can’t keep doing this.” Not because he wants to die. But because he doesn’t know how to keep living like this. For some men, that thought stays in the background. For others, especially when anxiety is combined with depression, sleep deprivation, or alcohol use, it can become more serious.
There’s also something else that comes up in the room. A lot of men experiencing this level of anxiety don’t talk about it openly. They keep functioning. They keep working. They keep showing up. From the outside, nothing looks obviously wrong. But internally, they’re exhausted. And that gap between how things look on the outside and how they feel on the inside can make it even harder to reach out.
By the time some men do speak about it, they’re not just anxious anymore. They’re burnt out. Flat. Disconnected. And in some cases, starting to question what the point of it all is. That’s why anxiety in men needs to be taken seriously early on. Not just because of how it feels in the moment, but because of where it can lead if it’s left to run unchecked.
A point that often gets missed
When people think about suicide risk in men, the focus is usually on depression. But anxiety plays a role more often than people realise. Constant worry can create a sense of mental entrapment. Always being “on” can lead to emotional exhaustion. Trying to stay in control all the time can make any loss of control feel overwhelming. So when things do go wrong, a relationship breakdown, financial stress, loss, it doesn’t land on a calm system. It lands on one that’s already stretched to its limit. And that’s where risk increases.
Bringing it into the work
In therapy, this means we don’t just treat anxiety as something separate or minor. We pay attention to how long it’s been there, how intense it is, and what it’s starting to do to the person’s sense of hope, energy, and meaning. Sometimes the most important shift isn’t reducing the worry straight away. It’s helping the person feel like they’re not stuck in it forever. Because once that sense of permanence starts to loosen, even slightly, the pressure tends to reduce with it.
What you’re trying to do here is actually strong—but it needs tightening so it doesn’t read like three different models stitched together. The key is to anchor it in NHS/DSM structure (so it’s credible), then show how your pluralistic approach deepens the work, especially with men.
How we would actually work with this (Male Minds Counselling – Reading)
If a man walks into the room with this kind of anxiety, we’re not starting from theory. We’re starting from what it looks like in his life. But it helps to understand the clinical backbone we’re working from.
According to the NHS, Generalised Anxiety Disorder is defined by persistent, hard-to-control worry that affects daily life, often alongside sleep problems, irritability, fatigue, and difficulty concentrating (nhs.uk). Similarly, the DSM-5 describes GAD as excessive anxiety present most days for at least six months, with symptoms like restlessness, muscle tension, poor concentration, and sleep disturbance (PsychDB). That gives us a structure. But structure alone doesn’t explain the man sitting in front of you.
Step 1: Making sense of it (not just labelling it)
The first part of the work isn’t “treatment.” It’s understanding. A lot of men come in saying: “I don’t think it’s anxiety, I just can’t switch off.” So we map it out in a way that makes sense to them. This is where CBT is useful, but not in a rigid, textbook way. We might look at:
- What triggers the worry (work, money, relationships)
- What the mind does next (overthinking, worst-case scenarios)
- What behaviours follow (avoidance, overworking, shutting down)
In NHS-style CBT, this is about identifying the cycle of thoughts, feelings, and behaviours. But with men, you often have to translate it: “Your mind is trying to stay one step ahead of everything, but it’s got stuck in overdrive.” That lands better than diagrams alone.
Step 2: Breaking the cycle (CBT work)
Once it’s mapped, we start to interrupt it. This lines up with NHS guidance, where CBT is a first-line treatment for GAD (nhs.uk). Practically, that might look like:
- Learning to notice worry rather than automatically follow it
- Challenging the assumption that worry = control
- Gradually reducing avoidance
- Building tolerance for uncertainty
But here’s the key difference in how I work: I’m not just asking, “Is this thought rational?” I’m also asking, “Why does your mind need this thought in the first place?” That’s where we move beyond standard CBT.
Step 3: What’s underneath it (psychodynamic layer)
With a lot of men, the anxiety isn’t random. It’s connected to something deeper:
- Growing up in unpredictable environments
- Feeling responsible too early
- Learning that mistakes aren’t safe
- Pressure to perform or hold things together
So the worry starts to make sense. It’s not just anxiety. It’s a strategy. “If I think ahead, nothing can catch me off guard.” Psychodynamic work helps us understand where that pattern came from and why it’s still running. Because if you don’t address that, you can teach coping skills all day, but the system underneath doesn’t change.
Step 4: The relationship to self (humanistic work)
This is the part that often gets missed, especially with men. Underneath the anxiety, there’s usually:
- Harsh self-criticism
- Pressure to get things right
- Little room to feel unsure or overwhelmed
So alongside CBT and insight, we’re also working on:
- Developing self-awareness without judgment
- Creating space to actually feel, not just manage
- Building a different relationship with vulnerability
This is where the humanistic side comes in. Not in a soft or abstract way, but in a grounded one. Because if a man only ever relates to himself through pressure and performance, the anxiety has nowhere to go.
Step 5: Bringing it together (pluralistic approach)
At Male Minds Counselling, the work isn’t one model, it’s responsive. Some sessions are more CBT: “Let’s slow this thinking down and look at what’s happening.” Some are more psychodynamic: “Where did you learn you had to be this switched on all the time?” Some are more humanistic: “What happens if you don’t hold it together for a moment?” The approach shifts depending on the man in front of me. Because no single model fully captures what’s going on.
Why this is important for men specifically
If you only use a diagnostic lens, you risk missing how this actually shows up in men. The DSM-5 might say:
- restlessness
- fatigue
- irritability
But in the room, it often looks like:
- snapping at people
- working constantly
- feeling on edge but calling it “stress”
- not stopping until burnout hits
And if you only treat the symptoms, without understanding the meaning behind them, it tends to come back.
The aim of the work
The goal isn’t to eliminate worry completely. It’s to help the man:
- step out of constant mental overdrive
- feel less trapped in his own thinking
- build tolerance for uncertainty
- and ultimately realise he doesn’t have to carry everything at once
Because for a lot of men with GAD, that’s what it comes down to: carrying too much, for too long, without a way to put it down.
Cassim