Generalized Anxiety Disorder (GAD)

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Anxiety is a fact of life, but generalized anxiety disorder (GAD) describes a debilitating, constant, and uncontrollable worry for six months or more. The worry is out of proportion or exaggerated and usually cannot be pinpointed to any actual threat. If there is a known threat or danger, then the worry far exceeds the likelihood of the actual danger. GAD is a serious condition that leaves people feeling frightened and overwhelmed. GAD also notably features extreme pessimism and marked fear of potential calamity. A disaster always seems just around the corner, and nothing will work out right.

With GAD, the excessive worries often feel life-encompassing, touching on areas such as work and career, academic performance, relationships, finances, and family heath. The most common symptoms of GAD include the incapacity to relax, tension, fear, jumpiness, unsteadiness, and uncontrollable worry.

Physical Symptoms

Individuals with GAD may experience physical symptoms such as perspiration, nausea or bowel dysfunction. Muscle tension and soreness along with dry mouth frequently occur. Less commonly, they may feel shortness of breath and rapid heart rate. Because these physical symptoms overlap with other anxiety disorders such as panic attacks and PTSD, it’s important to seek a diagnosis from a qualified mental health professional.

Insomnia and Fatigue

Insomnia can describe difficulty falling asleep, awakening during the night, or waking early without being able to fall back asleep. With or without insomnia, individuals with GAD often report feeling tired and easily worn-out.

Psychological Distress

The mental distress includes feeling on edge, restless, or keyed up. It can be difficult to focus and concentrate, which often creates more worry. There is a fear of losing control and a fear of rejection. The inability to control the worry may reinforce the fear of losing control. Some individuals feel ill-tempered and easily annoyed. These symptoms can have a significant impact on life and normal functioning.

Anticipatory Anxiety

Individuals with GAD experience hypervigilance and a constant, high state of arousal. They expect their worst fears to come true with each new day. It’s important to note that they cannot control this worry or overcome it, no matter how hard they try. They usually have highly distorted or inaccurate thoughts about the likelihood of their fears coming true, or the impact that any negative event will have in their life. These distorted thoughts are fuel to the fear and worry that consumes individuals with GAD.

Prevalence

  • Generalized anxiety disorder affects about 5 percent of Americans over the course of their lifetimes and is seen more often in women than in men.
  • Approximately half of all individuals first experience GAD in childhood or the early teen years. GAD is seen in younger persons with a long history of anxiety, combined with a past physical illness or a history of substance abuse.
  • Anxiety disorders don’t usually begin in later life, although they sometimes appear after an unexpected traumatic event.
  • Approximately 80 to 90 percent of those with GAD have or concurrently experience an additional condition such as major or low-grade depression, social phobia, specific phobia, or panic disorder.

Treatment

Without treatment, individuals will experience increased anxiety in times of stress. Individuals with GAD will sometimes seek treatment for their physical symptoms only, especially if they feel ashamed of their psychological distress. Because anxiety is so pervasive, many treatment options have been developed including: cognitive therapy, behavior therapy, affective therapy, cognitive behavior therapy, anxiety management training, acceptance and commitment therapy, and medication.

Medication Treatment

Medications such as Xanax (alprazolam) may be prescribed for short-term use, but are generally not suggested for long-term treatment. Because depression occurs frequently along with GAD, antidepressant medications are sometimes helpful. Effexor (venlafaxine) was the first antidepressant to get approval for use in treating GAD; however, research has shown that individuals show much better long-term results through psychotherapy rather than medication.

Psychotherapy for GAD

Psychotherapeutic techniques can be roughly divided into therapy that seeks to manage the individual’s thoughts about anxiety versus managing behaviors that can reduce anxiety. Some approaches, such as cognitive behavioral therapy (CBT), combine both.

A cognitive therapist will seek to correct distorted thoughts while also uncovering the client’s unspoken beliefs, which may be unrealistic or otherwise contribute to anxiety. The client will learn to recognize and reconstruct thoughts that bring on anxiety and fear. A behavioral therapist will emphasize stress management. The client will learn various relaxation techniques such as guided imagery, correct breathing and biofeedback, among others.

Many treatment modalities require participation in a structured group of eight to 20 sessions that are specifically designed to treat GAD. Groups may be more helpful than individual therapy, as they strictly focus on GAD. Furthermore, a group format introduces individuals to others who struggle with the same conditions.

Prospects

GAD does not usually go away completely, even with treatment. However, psychotherapeutic treatment can reduce the crushing anxiety and fear that often incapacitates individuals with GAD, making it manageable in day-to-day living.

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