Generalized Anxiety Disorder

Generalized Anxiety Disorder

Also called: General Anxiety Disorder, GAD, Persistent Anxiety

Summary

Generalized anxiety disorder (GAD) is a condition in which people worry excessively, even when there are no signs of extraordinary trouble in their lives. Patients may experience anxiety surrounding issues of health, family, money, work and more. It is not unusual for patients with GAD to report that they cannot remember the last time they felt relaxed.

Patients with GAD may experience symptoms such as insomnia, irritability, restlessness, muscle tension and difficulty concentrating. For the diagnosis of GAD to be made, this excessive and unfounded worry must also interfere with their ability to engage in their usual activities. The condition is also often associated with other mental disorders, such as depression or substance abuse problems.

About 6.8 million Americans experience GAD each year, according to the National Institute of Mental Health(NIMH). This makes it among the most common anxiety disorders. Although GAD can begin during childhood or adolescence, the median age of onset is 31 years. The condition affects women twice as often as men. GAD can be difficult to diagnose because it is not characterized by dramatic symptoms, such as panic attacks (sudden, brief episodes of fear and anxiety), that are associated with other anxiety disorders. However, once it is diagnosed by a physician, it is usually successfully treated with a combination of medications and psychotherapy.

About generalized anxiety disorder

Generalized anxiety disorder (GAD) is a condition in which a person worries excessively about all types of life issues, including health, family, money and work. Patients with this disorder may find themselves unable to relax, even when there are no signs of abnormal trouble in their lives.

Each year, about 6.8 million Americans over the age of 18 years experience GAD, according to the National Institute of Mental Health(NIMH). This makes it among the most common anxiety disorders. GAD tends to develop more gradually than many other anxiety disorders. Although GAD can begin during childhood or adolescence, the median age of onset is 31 years. The disorder affects women twice as often as men.

Evidence of GAD may differ slightly depending on a patient’s age. Children with the disorder may worry about their performance in school or during sporting events, and may be perfectionists, conformists and unsure of themselves. Meanwhile, adults may worry excessively and continually about finances, their children’s health, job responsibilities or minor things such as household chores.

Patients with GAD may report a feeling of unease that has been present most of their lives. It is not unusual for patients to report that they cannot remember the last time they felt relaxed.

Experts remain unsure of what exactly causes generalized anxiety disorder (GAD). Factors that are believed to contribute include heredity and stress. 

Signs and symptoms of GAD

Patients who have generalized anxiety disorder (GAD) expect the worst to occur in most or all aspects of their lives. As a result, they are generally tense and worry even when there are no signs of impending trouble. When a person feels anxious, the body releases hormones that prepare it to react to a threat. This is known as the “fight or flight” response.

Many patients with GAD experience insomnia, and may have physical symptoms such as:

  • Irritability
  • Restlessness
  • Fatigue
  • Trembling
  • Muscle tension
  • Chest Pains
  • Headaches
  • Difficulty concentrating
  • Stomach ache
  • Dysphagia (difficulty swallowing)
  • Diarrhea
  • Sweating or hot flashes

Patients with GAD often experience other mental disorders, such as depression or substance abuse problems. However, patients with GAD are less likely to experience symptoms of autonomic hyperarousal (such as accelerated heart rate, shortness of breath or dizziness) than patients with other anxiety disorders. In addition, several other physical symptoms typically associated with stress also are associated with GAD. These include irritable bowel syndrome (disorder of the lower intestinal tract) and bruxism (grinding of the teeth).

Diagnosis of GAD

Patients who find themselves unable to control their anxiety should consult a physician, especially if excessive worry interferes with their ability to engage in their usual activities. Before generalized anxiety disorder (GAD) can be diagnosed, a physician will perform a complete physical examination and compile a thorough medical history. The physician will also attempt to rule out other medical conditions that could be causing symptoms, such as excessive thyroid production (which can be measured through a blood test), and the presence of substances in the blood or urine (e.g., recreational drugs, prescription medication). 

In addition, other mental disorders must be ruled out before a diagnosis of GAD can be made. If a non-psychiatric physician suspects that GAD is present, the patient will be referred to a psychiatrist, psychologist or other mental health professional.

GAD can be difficult to diagnose because it is not characterized by dramatic symptoms, such as panic attacks (sudden, brief episodes of fear and anxiety), that are associated with other anxiety disorders. GAD is diagnosed when patients experience at least six months of chronic, exaggerated worry or tension about a number of different events or activities. The worry must be disproportionate to what would be expected given the circumstances. During this six-month time period, anxiety must be present on more days than it is not. In addition, patients are likely to have levels of worry that are much more severe than the normal levels of anxiety experienced by most people.

Patients with GAD also typically exhibit at least three of the following six symptoms (children may exhibit only one):

  • Restlessness, or a feeling of being on edge
  • Becomes fatigued easily
  • Difficulty concentrating
  • Irritability
  • Muscle tension
  • Sleep disturbances

Treatment and prevention of GAD

Although generalized anxiety disorder (GAD) cannot be prevented, patients have several effective treatment options. In most cases, a combination of individual and/or group psychotherapy and anti-anxiety or antidepressant medications approved by the U.S. Food and Drug Administration (FDA) for the treatment of GAD is the best treatment.

It is important to note that use of both antidepressants and anti-anxiety medications should be closely monitored by a physician. They may take time to become effective and the effectiveness varies by patient. A physician may have to modify the dose of a medication several times, or even change medications, before identifying the optimal one for the patient’s symptoms, while minimizing any side effects.

Patients should not stop using antidepressant or anti-anxiety medications unless under close supervision of a physician, because this may cause withdrawal symptoms. In addition, use of antidepressants may increase the risk of suicidal thinking and behavior in children and adolescents, according to the FDA. However, the benefits of such medications generally outweigh the risks. 

Patients with GAD often benefit from cognitive behavior therapy, in which they learn new skills that help them react differently to situations that typically trigger anxiety. Patients also learn more about negative thought patterns that increase anxiety and ways to redirect such thinking. In addition, patients may be gradually exposed to situations that are frightening and in which they can test new coping skills. This is known as exposure therapy.

Taking time to engage in leisure and recreational activities can also help restore balance to patients’ lives, leaving them less vulnerable to stress and panic. Adhering to a healthful diet and getting plenty of rest and avoiding certain substances – such as caffeine – can reduce the likelihood of symptom flare-ups in patients with GAD. Finally, ongoing participation in support groups can also help patients relieve their anxiety. These are sessions in which people with anxiety disorders share their own experiences and offer encouragement and understanding to one another. Understanding and supportive family and friends can further help alleviate anxieties in patients with GAD.

Questions for your doctor regarding GAD

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to generalized anxiety disorder (GAD):

  1. How can we tell if I have GAD or another type of anxiety disorder?
  2. Is it possible that I have more than one type of anxiety disorder? Or another emotional disorder in combination with GAD?
  3. What tests do you recommend to rule out other causes of my GAD?
  4. What are my treatment options? How effective are treatments?
  5. Are there medications that may help me to control my GAD? What are their risks and benefits?
  6. What medication do you recommend for me? Why?
  7. Are there any over-the-counter medications or supplements I should avoid?
  8. What types of therapy might benefit me? Can you recommend a therapist and/or support group?
  9. Might members of my family also benefit from counseling?
  10. Can any of my lifestyle habits exacerbate my GAD?
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