Have you ever had a time when you could not stop worrying about what’s going to happen at your work? Or at your school? Or about what your neighbors are going to say to you next?
Well, you are not alone.
This is something that people experience regularly, called anxiety.
Anxiety is an emotional experience in which we feel worried. It can also present as tension or fear about things or events that are about to happen. Therefore, anxiety is usually future-based, where individuals experience a worrying emotional state while waiting for a potential incident.
Generally, anxiety disorders are a group of mental disorders that differentiate themselves from other conditions with two key features: anxiety and fear (1). This article will focus on explaining what Generalized Anxiety Disorder (GAD) is, who is likely to get GAD, what the symptoms are, and what treatment options are available.
What is Generalized Anxiety Disorder (GAD)
Generalized Anxiety Disorder (GAD) is a type of an anxiety disorder that is marked by a disproportionate amount of worry and symptoms of physiological arousal such as insomnia, restlessness, and muscle tension (2). This worry could be due to multiple things such as financial issues, family matters, health concerns, and the future. It is considered extreme, hard to control, and accompanied by many non-specific psychological and physical indications. It is the most common type of mental disorder that people get diagnosed with in the United States (3).
Individuals get a diagnosis of GAD different points in their life; however, the median onset age is 30 (4). Research studies have shown that women are more likely to be diagnosed with GAD than men. The lifetime prevalence of GAD in the United States (U.S) is around 5.1 percent to 11.9 percent (5). Whereas, studies in Europe (6) found a lifetime prevalence of about 4.3 percent to 5.9 percent, which is substantially lower than the U.S.
Generalized Anxiety Disorder (GAD) Signs and Symptoms
Generalized anxiety disorder is diagnosed by licensed clinical Psychologists and Psychiatrists using the Diagnostic and Statistical Manual (DSM-5). This is a handbook of psychological and mental disorders, which contains descriptions, symptoms, and other criteria for diagnosis (7). According to the DSM-5, an individual with GAD will have excessive anxiety and worry for at least six months (8). The individual will also have the following symptoms:
- Feeling restlessness or always on the edge
- Getting easily fatigued
- Find it difficult to concentrate on things such as work or school
- Getting irritable easily on small things
- Muscle tension in the body, such as aches or stiffness
- Sleep disturbances, such as insomnia or unsatisfying sleep
These individuals have worry to such an extreme extent which impairs their social functioning. For example, individuals diagnosed with GAD will have trouble keeping up with their job or relationships. It is also essential to make sure that this anxiety and worry is not due to other substances, such as alcohol or drugs. Other medical conditions such as hyperthyroidism should be ruled out as well.
Diagnosis and Evaluation of Generalized Anxiety Disorder (GAD)
Diagnosing someone with GAD can be challenging as anxiety can present in different ways for different people. Researchers have also found that Asian Chinese people who experience anxiety report a lot of somatic symptoms. For example, Chinese people with an anxiety disorder believe that it is due to organ dysfunction, especially to a weak kidney or a weak heart (9). Similarly, a weak heart is a joint presentation of Generalized anxiety disorder in Vietnamese culture. Hence, it is vital to keep in mind the cultural factors during diagnosis, and this can also make the diagnosis procedure challenging.
Initial intake session starts off by tackling behavioral and somatic symptoms, which are causing impairment in daily life. It is then important to evaluate the following:
- Psychosocial stress: this is the level and type of stress experienced as a result of our social interaction with others around us.
- Psychosocial difficulties: these are impairments, activity limitation and participation restriction due to GAD.
- Developmental issues: these involve developmental delays, motor skills, problem solving, communication and adaptive behavior.
To have a diagnosis of generalized anxiety disorder, individuals need to be experiencing excessive worry for the last six months. The intensity, duration and frequency of such worry would have to be out of proportion. Adults with generalized anxiety disorder often worry about every day, routine life circumstances, such as possible job responsibilities, health and finances. Children with generalized anxiety disorder tend to worry excessively about their competence or the quality of their performance. During the disorder, the focus of worry may shift from one concern to another.
Individuals will also show muscle tension, trembling, twitching, shakiness and muscle aches. These symptoms might be more in individuals from non-white ethnic backgrounds such as African Americans and Asians. Other somatic symptoms might also be present such as nausea, headaches, accelerated heart rate and dizziness.
It is prevalent for individuals to meet criteria for other mental health conditions too. This means someone who gets a diagnosis of GAD is likely to have symptoms that can also fit into another diagnosis. According to the DSM-5, people with GAD can have the following differential diagnosis:
- Anxiety disorder due to another medical condition
- Substance/medication-induced anxiety disorder
- Social anxiety disorder
- Obsessive-compulsive disorder
- Posttraumatic stress disorder and adjustment disorders
- Depressive, bipolar, and psychotic disorders
Research has shown that people with GAD can have a comorbid condition such as separation anxiety disorder, panic disorder, eating disorder and major depressive disorder (10). Your physician will be able to differentiate between each condition to provide you with the right treatment.
Generalized Anxiety Disorder (GAD) Treatment
There are three types of treatments for people with GAD: psychotherapy, medication and self-care. The goal of all these three treatments is to assist people with GAD to improve their quality of life psychologically and physically. They also focus on improving their relationships, school, work and social engagement that previously seemed frozen by their excessive worry. We will not look at each treatment in detail:
- Psychotherapy: According to American Psychological Association (11), Cognitive Behavioral Therapy (CBT) is recommended for the treatment of GAD. The basic idea essential to CBT is that changing negative thoughts and feelings can alleviate problem associated with GAD. Methods used in cognitive therapy focus on changing the negative thinking patterns and beliefs which revolve around the worrying process; this approach is called cognitive restructuring. Whereas, the behavioural methods focus on teaching relaxation training, having a specific ‘worry time’, but also planning for enjoyable activities. This allows exposure to events and circumstances that are being avoided due to anxiety.
- Medication: Medications are only prescribed by a physician or a psychiatrist. Hence, each person gets medication according to their requirement. Recommended medications according to research are the selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors (12).
- Self-help: There are many resources for people who are not yet ready to take professional help. These include exercising, yoga, Pilates, meditation and access to support groups.
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2. Hoge, E.A., Ivkovic, A., & Fricchione, G.L. (2012). Generalized anxiety disorder: diagnosis and treatment. BMJ, 345, 1-6.
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10. Borkovec, T. D., Newman, M. G., Pincus, A. L., & Lytle, R. (2002). A component analysis of cognitive– behavioral therapy for generalized anxiety disorder and the role of interpersonal problems. Journal of Consulting and Clinical Psychology, 70, 288–298.
11. Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in clinical neuroscience, 19(2), 93–107.
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