An Overview of
Generalized Anxiety Disorder
All parents worry about their children, young adults may worry about their personal life and jobs, and retirees may worry about their financial security. Worry is a normal human characteristic, and many of us continue to worry even when we don’t need to. But when normal worries turn into disruptive and distressing anxiety which significantly impairs your life, it can be debilitating and should be treated. This reading material will focus on the medical condition called generalized anxiety disorder, also called GAD, not on the normal mood of sadness or worry.
Generalized Anxiety Disorder, or GAD is a recognized medical condition that can affect anyone, anytime in life. GAD is an anxiety disorder, distinct from other types of anxiety disorder such as panic disorder or a particular phobia. GAD is not just worry, or even very serious worried concern. It is worry and anxiety that is clearly excessive. When you experience GAD, you are worried to an extent that is inappropriate, and even you may know the anxiety is not normal.
While GAD is defined based on the presence of excessive anxiety, it can be difficult to diagnose. The diagnosis is based on the following symptoms, as defined by the DSM-IV:
- You may experience excessive anxiety and worry (also known as apprehensive expectation), occurring more days than not for at least six months about a number of events or activities.
- You may feel that it is difficult to control the worry, even when you try.
- The anxiety and worry is associated with three or more of the following symptoms, with at least some symptoms present for more days than not for the past six months. (In children, only one symptom needs to be present):
- restlessness or feeling keyed up or on edge;
- being easily fatigued;
- having difficulty concentrating or mind going blank;
- muscle tension;
- sleep disturbance
You may also experience headaches and other pains, frequent urination, light-headedness, difficulty in swallowing, or excessive sweating.
Exactly what causes GAD is not well understood. There are a few known factors that seem to predispose people to GAD which include:
- Significant life events: trauma of various kinds, including major life events (death of a loved one, experiencing a civilian disaster, being bullied), are known risk factors.
- Genetic factors: GAD is somewhat more common in people whose biological family members have GAD. This is true of other anxiety disorders.
- Contrast Avoidance Model of Worry: This is a recent theory which proposes that those suffering from GAD are more sensitive to unexpected negative events, which cause a sudden change in outlook. For these individuals, worrying serves to maintain a negative state as a coping mechanism to avoid the effects of future negative events. This may be one cause of GAD.
- Brain Chemistry and Function: It is clear that there are some changes in the brain that relate to GAD but the specifics are unknown. The brain systems that control fear and worry are similar to – and overlap with – systems involved in mood. Perhaps for this reason, medications that can help people with depression can often help patients with GAD. In addition, anti-anxiety medications can help control symptoms.
According to the Centers for Disease Control and Prevention, anxiety disorders (including GAD and other anxiety disorders) are the most common mental disorders in the general population. At any given time, 15 percent of the population is suffering from some type of anxiety disorder. GAD specifically affects about 5% of adults
Importance of Treatment
GAD can be significantly disabling, and is different from the normal worry and anxiety that all people experience at various times in life. Left untreated, the condition can make other conditions (such as depression or other medical conditions) much worse. Anxiety disorders (including GAD) exert a substantial burden on yourself and those around you.
Treatment and Drugs
Various treatments are available for GAD. Medications and counseling (psychotherapy) can be effective in many patients. Mild cases are sometimes managed well with counseling alone. Many cases call for a combination of medication and psychotherapy.
Some fairly new methods in psychotherapy are being used successfully to treat GAD. One is called Cognitive-Behavioral Therapy, or CBT. In CBT, the patient learns to alter thinking patterns that create fear, and to alter behavioral patterns in response to fear triggers.
As mentioned above, two different types of medications are used to treat GAD: anti-anxiety drugs and antidepressants.
- Buspirone: A newer anti-anxiety medication that is not a benzodiazepine. It works in a very different way, by stimulating the receptors for a different brain chemical called serotonin.
- Antidepressants: These often work by increasing the levels of serotonin; for example, selective serotonin reuptake inhibitors (SSRIs) can be very effective in depression. A similar drug, venlafaxine (also known as Effexor), is often helpful in GAD.
- Benzodiazepines: The most widely-used anti-anxiety medications. Examples are diazepam (Valium) and alprazolam (Xanax). These medications work to affect the receptors for a brain chemical called GABA. These medications when used chronically can be addictive and abrupt stop can trigger drug withdrawal state. Therefore, they should be used with extreme caution due to the risk of addiction.
GAD can occur at any age, but is less common in older people. GAD is significantly more common in people who have experienced trauma, and in those who have experienced bullying or numerous difficult life events. GAD very frequently occurs in combination with other mental disorders. Women are about twice as likely to suffer from GAD as men.
Tests and Diagnosis
There is currently no test to diagnose GAD. However, routine lab tests are performed to exclude diseases that present like GAD.
There’s no sure way to prevent GAD. However, taking steps to control stress, maintaining a good support system, and keeping chronic medical illness in control can help manage anxiety. In addition, treatment at the earliest sign of a problem can help prevent GAD from worsening.
- National Institute of Mental Health. Anxiety disorders. ww.nimh.nih.gov/health/publications/anxiety-disorders/index.shtml – Accessed March 2013.
- Centers for Disease Control and Prevention. Burden of Mental Illness. http://www.cdc.gov/mentalhealth/basics/burden.htm – Accessed March 2013.
- Addiction Part I. Benzodiazepines-Side Effects, Abuse Risk and Alternatives – American Family Physician. http://www.aafp.org/afp/2000/0401/p2121.html – Accessed July 2013.
- National Institute of Mental Health. Generalized Anxiety Disorder (GAD): When Worry Gets Out of Control – http://www.nimh.nih.gov/health/publications/generalized-anxiety-disorder-gad/generalized-anxiety-disorder-gad-when-worry-gets-out-of-control.shtmlAccessed March 2013.
- Gale, C. and Davidson, O. (2007) Generalized anxiety disorder. British Medical Journal 334: 579–581. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1828319/
- Newman, M.G. and Llera, S.J. (2011) A novel theory of experiential avoidance in generalized anxiety disorder: A review and synthesis of research supporting a contrast avoidance model of worry. Clinical Psychology Review 31:371–382.