Generalized
anxiety disorder (GAD)
is a relatively common anxiety problem, affecting 3 - 4% of the
population, Generalized anxiety disorder is much more than the
normal anxiety people experience day to day. It's chronic and
exaggerated worry and tension, even though nothing seems to provoke
it. Having this disorder means always anticipating disaster, often
worrying excessively about health, money, family, or work. Sometimes,
though, the source of the worry is hard to pinpoint. Simply the
thought of getting through the day provokes anxiety. The diagnostic
criteria for GAD is as follows:
For more than half the days in at least 6 months, the patient
experiences excessive anxiety and worry about several events or
activities.
The person has trouble controlling these feelings.
Associated with this anxiety and worry, the patient has 3 or more
of the following symptoms, some of which are present for over
half the days in the past 6 months:
Feels restless,
edgy, keyed up.
Tires easily.
Trouble concentrating.
Irritability.
Increased muscle tension.
Trouble sleeping (initial insomnia or restless, unrefreshing
sleep).
The symptoms cause clinically important distress or impair work,
social or personal functioning.
The disorder is not directly caused by a general medical condition
or by substance use, including medications and drugs of abuse.
It does not occur only during a Mood
Disorder, Psychotic Disorder,
Posttraumatic Stress Disorder or Pervasive
Developmental Disorder.
Associated
Features:
Depressed
Mood
Somatic
or Sexual Dysfunction
Anxious or Fearful or Dependent
Personality
Differential
Diagnosis:
Some disorders have similar or even the same symptoms. The clinician,
therefore, in his diagnostic attempt, has to differentiate against
the following disorders which he needs to rule out to establish
a precise diagnosis.
Anxiety
Disorder Due to a General Medical Condition;
Substance-Induced
Anxiety Disorder;
Panic Disorder;
Social Phobia;
Obsessive-Compulsive
Disorder;
Anorexia Nervosa;
Hypochondriasis;
Somatization Disorder;
Separation Anxiety
Disorder;
Obsessional thoughts;
Posttraumatic Stress
Disorder;
Adjustment Disorder;
Mood Disorders;
Psychotic Disorders;
Nonpathological Anxiety.
Cause:
GAD may be
caused by both biological and psychological factors. The presence
of GAD has previously been linked to abnormalities in a number
of different brain chemicals, particularly those known to be associated
with fear and emotional responses. Moreover, the symptoms of GAD
appear to worsen during periods of stress. Although some studies
have reported that GAD runs in families, others have not found
this connection. GAD usually does not cause people to avoid situations,
it’s the thinking, dwelling, ruminating, and
inability to shut the mind off that so incapacitates the person.
At other times, thoughts seem almost non-existent because the
anxious feelings are so dominant. Feelings of worry, dread, lack
of energy, and a loss of interest in life are common. Many times
there is no cause for these feelings and the person realizes these
feelings are irrational. Nevertheless, the feelings are very real.
Normal life
stresses appear to aggravate generalized anxiety. The person who
typically performs well at work and receives a sense of accomplishment
from it, all of a sudden finds that work has become drudgery.
If work is perceived as a negative environment, and the person
no longer feels fulfilled, then considerable worry takes place
over these situations. As a result, the anticipatory anxiety about
going to work can become quite strong.
Treatment:
GAD can be
treated with drug therapy, counseling, or both. Many persons have
demonstrated improvement with counseling techniques such as behavioral
and cognitive-behavioral therapy. GAD has also been shown to respond
best to cognitive-behavioral therapy, an active therapy that involves
more than just talking to a therapist. In CBT, the person gradually
learns to see situations and problems in a different perspective
and learns the methods and techniques to use to alleviate and
reduce anxiety. Sometimes medication is a helpful adjunct to therapy,
but for many people it is not necessary. Research indicates that
generalized anxiety is fully treatable and can be successfully
overcome over the course of about three to four months if the
person is motivated and works toward recovery.
Counseling
and Psychotherapy [ See
Therapy Section ]:
Psychotherapy:
Most patients with mild symptoms can be treated with supportive
counseling and education without need for medication. Other
therapies: Relaxation training and cognitive therapy have been
found to be of benefit. General measures: Regular exercise
and avoidance of caffeine and alcohol.
Pharmacotherapy
[ See
Psychopharmacology Section ] :
There are
several medications that have been used successfully to relieve
the symptoms of anxiety, including benzodiazepines and azapirones.
Some antidepressants are also currently under investigation for
the treatment of GAD.
Tricyclic
Antidepressants (TCAs). Imipramine
Antihistamines. Hydroxyzine (Atarax, Vistaril)
Benzodiazepines.Alprazolam (Xanax) Lorazepam (Ativan)
Buspirone. Selective Serotonin Reuptake Inhibitors (SSRIs).
(Prozac, Paxil, Luvox, Zoloft).
Beta-blockers. Propranolol (Inderal).
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Anxiety
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