Generalized anxiety disorder is a condition in which one tends to feel anxious and worry excessively about various events or activities in life such as performance at school or even going for shopping. In addition a person lives with this apprehension for almost most things and most days in life, for more than six months. The worry generally spirals out of control due to “what if” scenarios and thinking of worst possible outcomes in future. It is difficult for an individual to control the worrisome thoughts. Worry and anxiety manifest in symptoms such as1,2:
- Being easily fatigued
- Low concentration
- Irritability Muscle tension
- Sleep disturbance.
Excessive anxiety can interfere significantly with social and work performance amongst other areas of functioning. An important feature is that the anxiety and worry experienced is out of proportion to the actual or anticipated event. Some of the risk factors for this condition are having a family history of anxiety disorder, neurotic personality factor, difficult childhood, and over-protective parenting.
Generalized anxiety disorder can be diagnosed for children, adult, and elderly. Although the median age of onset for this diagnosis is 30 years. It is a chronic condition although the intensity of symptoms may fluctuate over time. Research shows that females tend to get diagnosed with this condition, almost as twice as males.
Non-pathological Anxiety and Generalized Anxiety
Everyone worries about various things in daily life. What differentiates general worry from the kind experienced in a condition such as GAD is manifold1. The worries in GAD are far more excessive, pervasive in everyday functioning, distressing and time consuming. In addition, anxiety in GAD is always accompanied by physical manifestations like restlessness, feeling fatigued, etc. People with this condition may feel that they have no control over negative events in their life and feel helpless. They may spend more time completing their task to make sure that they don’t do anything wrong and feel uncertain about how things will work out in future.
Diagnosis and Assessment
The assessment and diagnosis of generalized anxiety disorder can only be done by trained professionals such as psychiatrists and clinical psychologists. Diagnosis of GAD is based on either of the two diagnostic systems in mental health; the International Classification of Diseases-10 Classification of Mental and Behavioural Disorders (10th Revision) and the Diagnostic and Statistical Manual of Mental Disorders (5th ed., DSM-5., American Psychiatric Association, 2013). Various self report and self monitoring tools are applied to bolster the diagnostic procedure.
The primary aim of treatments applied to GAD is to target the distress caused by the physical and psychological symptoms of anxiety experiences in GAD. In addition, the following treatment methods also focus on reducing the pervasive disadvantage posed by clinical symptoms for everyday functioning3.
Psychotherapy Approaches: The cognitive behavioral therapeutic approach has been found to be one of the most effective treatment methods for GAD4. The cognitive elements of CBT focus on cognitive biases and automatic thoughts underlying worry and anxiety. For example, instead of concentrating on the worst possible scenarios, cognitive restructuring helps an individual to focus on more adaptive alternatives5. Additionally, exposure techniques are also used as a way of preventing overly cautious behaviors in GAD. For example providing graded, imaginal exposure to worst possible outcomes of experiencing anxiety and worry followed by generating possible alternatives to the situation5.
Pharmacological Treatments: Benzodiazepines are often used to relieve a person of the physical symptoms of GAD. This is because this line of treatment decreases physiological arousal and promotes muscle relaxation6. In addition certain antidepressants are also prescribed for alleviating psychological symptoms. In any case, this mode of treatment is prescribed under professional discretion, often in combination with psychotherapy.
1. American Psychiatric Association. (2013). Anxiety disorders. In Diagnostic and statistical manual of mental disorder (5th ed.). Washington, DC: Author.
2. World Health Organization (1993). Neurotic, stress related and somatoform disorders. In International classification of diseases-Classification of mental and behavioural disorders (5th ed.). Geneva: Author.
3. Andrews, G., Creamer, M., Crino, R., Hunt, C., Lampe, L., and Page, A. (2003). Anxiety disorders-Clinician guides and patient manuals. New York;NY:Cambridge University Press.
4. Barlow, D.H., Esler, J.L., and Vitali, A.E. (1998). Psychosocial treatments for panic disorders, phobias, and generalized anxiety disorder. In Nathan, P.E., & Gorman, J.M. (Eds.), A guide to treatments that work (pp.288-318). New York;NY:Oxford University Press.
5. Lawrence, A.E., & Brown, T.A. (2008). Anxiety disorders: Generalize anxiety disorder. In Tadman, A., Kay, J., Lieberman, J.A., First, M.B., & Maj, M. (Eds.). Psychiatry (pp. 1494-1509). West Sussex;England:Wiley Blackwell. .
6. Hoehn-Saric, R., McLeod, D.R., and Zimmerli, W.D. (1988). Differential effects of alprazolam and imipramine in generalized anxiety disorder: Somatic versus psychic complaints . The Journal of Clinical Psychiatry 49, 293 –301.
Generalized Anxiety Disorder