Symptoms and Treatment for Generalized Anxiety Disorder

“My child is driving out in the rain. I hope he doesn’t get into an accident.” “I am home alone and I hear a scratching noise. It must be a burglar!” These may be the thoughts of someone with Generalized Anxiety Disorder . Generalized anxiety disorder (GAD) is a mental health condition in which a person is often worried or anxious about many things and finds it hard to control this anxiety. It is classified as an anxiety disorder. When we are anxious, we tend to see the world as a threatening and dangerous place. In the case of an anxious person thinking there may be a burglar trying to get into the house, the person may prepare himself to either run out of the house, fight off an attack, or run to the phone and call for help. Although this anxious response may be helpful if there actually was a burglar, it was not helpful if the thought was wrong. There was no real danger. (“Realistic Thinking,” n.d.). All of us worry about something at some point, but people with GAD experience this symptom much more often. It is obvious that someone with GAD always worries, even when there is little or no reason to worry.

The symptoms of Generalized Anxiety Disorder fall into three categories: emotional, behavioral, and physical. Emotional symptoms include: constant worries running through your head, feeling like your anxiety is uncontrollable; there is nothing you can do to stop the worrying, intrusive thoughts about things that make you anxious; you try to avoid thinking about them, but you can’t, an inability to tolerate uncertainty; you need to know what’s going to happen in the future, and a pervasive feeling of apprehension or dread. Behavioral symptoms include: inability to relax, enjoy quiet time, or be by yourself, difficulty concentrating or focusing on things, putting things off because you feel overwhelmed, and avoiding situations that make you anxious. Physical symptoms of GAD include: feeling tense, having muscle tightness or body aches, having trouble falling asleep or staying asleep because your mind won’t quit, feeling edgy, restless, or jumpy, and stomach problems such as nausea and diarrhea. (Smith, M.A., and Segal, Ph.D., 2014). Of course, depending on the time and day, the symptoms will fluctuate. Depending on how much stress a person with GAD is going through in the specific time frame, it can make the symptoms worse. About 4 million adult Americans suffer from GAD during the course of a year. It most often begins in childhood or adolescence, but can begin in adulthood. It is more common in women than in men.

Children and teens often don’t experience Generalized Anxiety Disorder the same way adults do. In children, the worrying will center on certain things such as future events, past behaviors, social acceptance, family matters, their personal abilities, and school performance. Typically, it is a parent or other adult’s job to recognize the signs of a child/teen’s symptoms of GAD, because the children don’t realize that their anxiety is disproportionate to the situation. Some big warning signs in children are: “What if” fears about situations in the future, perfectionism, excessive self-criticism, fear of making mistakes, feeling that they’re to blame for any disaster, and their worry will keep tragedy from occurring, the conviction that misfortune is contagious and will happen to them, and need for frequent reassurance and approval. (Smith, M.A., and Segal, Ph.D., 2014). Of course, along with these symptoms, children and teens can also experience the same symptoms as adults. It is very important that adults monitor their children’s actions and feelings, and the child be open about how they are feeling, both mentally and physically. Although Generalized Anxiety Disorder is more common in people over the age of 18, it can be present in anyone of any age and gender.

“Carrie has always been a worrier, but it never interfered with her life before. Lately, however, she’s been feeling keyed up all the time. She’s paralyzed by an omnipresent sense of dread, and worries constantly about the future. Her worries make it difficult to concentrate at work, and when she gets home she can’t relax. Carrie is also having sleep difficulties, tossing and turning for hours before she falls asleep. She also gets frequent stomach cramps and diarrhea, and has a chronic stiff neck from muscle tension. Carrie feels like she’s on the verge of a nervous breakdown.” (“Carrie’s Story,” 2014). Generalized Anxiety Disorder is hard to deal with. People with GAD are unable to turn off these anxious thoughts, and the thoughts keep running through their heads on endless repeat. GAD can affect all areas of life, including relationships with friends and family, career, school and family relationships. According to a national survey done by the Anxiety Disorders Association of America, (2014) seven out of ten people with Generalized Anxiety Disorder agreed that their chronic anxiety had an impact on their relationships with spouses or significant others. Two-thirds of these also reported that GAD had a negative effect on their friendships as well.

Dr. Culpepper (2004) explained that anxiety expresses itself neurologically through higher cortical activity. For example, this activity can be activated by sudden noises or memories. Anxiety disorders usually emerge when patients are in their 20s or early 30s; however, anxiety disorders originate much earlier in life, with most anxiety developing during childhood and adolescence. Genetic background and early upbringing are two predictors of anxiety disorders. Twenty to thirty percent of patients with panic or GAD have relatives with the same disorder, and thus patients with a family background of anxiety are more likely to develop an anxiety disorder than patients without a family background of anxiety. Early adverse experiences can lead to an expression of a preexisting genetic vulnerability to stress and disease. Studies indicate that children raised in environments with neglect, separation, or abuse are more likely to develop anxiety disorders than children raised in stable environments. Therefore, Generalized Anxiety Disorder is thought to be caused by three factors: genetics, brain chemistry, and environmental factors. Explanations of these would be genetics, being family history of anxiety can cause someone to be more at risk for anxiety; brain chemistry leads to the fact that Generalized Anxiety Disorder has been associated with abnormal functioning of certain nerve cell pathways that connect particular brain regions involved in thinking and emotion; and lastly, it has been shown that environmental factors such as trauma such as abuse, death of a loved one, divorce, and changing jobs or schools all lead to GAD.

The history of Generalized Anxiety Disorder is complicated. About a century ago, Sigmund Freud noted that chronic, free-floating anxiety occurred frequently in the general population, and yet, to this day, there is still limited information available about the natural history of this disorder. Its resemblance to normal everyday anxiety and the lack of distinctive features have led to poor diagnostic reliability and questions about the validity of the disorder (Woodman, M.D., 1997). As common as Generalized Anxiety Disorder is, it is surprisingly the least studied of the anxiety disorders. GAD was first defined in 1980. A major change in the study of anxiety disorders occurred this year, when changes in classification by the American Psychiatric Association separated anxiety neurosis into panic disorder, characterized by spontaneous episodes of intense anxiety, and GAD, a residual category for patients who have chronic, sustained anxiety without panic attacks. The distinction between these two disorders was defended at the time by the observation of a differential response to medication. Scientists noted that panic disorder responded to the medication imipram in while GAD responded best to imipramine as well as benzodiazepines if taken for a certain amount of time. Thus, GAD was given independent status in the DSM, with clearly defined symptom criteria.

Diagnosing Generalized Anxiety Disorder has a few different options. In order to diagnose, a doctor may: do a physical exam to look for signs that one’s anxiety might be linked to an underlying medical condition, order blood or urine tests if medical condition is suspected, ask detailed questions about your symptoms and medical history, or use psychological questionnaires to help determine a diagnosis. However, before a doctor performs these kind of tests, it is VERY important that the symptoms of GAD have lasted for at least six months, because if diagnosed too early, it can lead to prescribing medicine that isn’t necessary. The form of anxiety that particular person has may be short term. Generalized anxiety disorder often occurs along with other mental health problems, which can make diagnosis and treatment more challenging. Some disorders that commonly occur with generalized anxiety disorder include: phobias, panic disorder, depression, substance abuse, and PTSD. A lot of the diagnosing process depends on the patient and how honest they are about how they have been feeling and how often they feel the symptoms. Generalized Anxiety Disorder is commonly misdiagnosed due to the fact that patients either don’t share all their symptoms with their doctor, or over exaggerate how they are feeling. Just like any other psychological disorder, GAD can be difficult to diagnose because every individual is different.

Treatment options of Generalized Anxiety Disorder vary in a few ways. Main treatment for it involves psychotherapy and medications. Of course, depending of the severity of the disorder, there will be differences in the two types of treatment. The first treatment I am going to discuss is psychotherapy. Also known as talk therapy or psychological counseling, psychotherapy involves working with a therapist to reduce your anxiety symptoms. It can be an effective treatment for generalized anxiety disorder. Cognitive behavioral therapy is one of the most effective forms of psychotherapy for GAD. Generally a short-term treatment, cognitive behavioral therapy focuses on teaching you specific skills to gradually return to the activities you've avoided because of anxiety. In this type of therapy, you also learn to control gradually control anxious thoughts as they come about, and how to get rid of them without causing harm to yourself. Through this process, your symptoms improve as you build on your personal success. Throughout cognitive behavioral therapy, a patient will learn a number of different ways to change up one’s lifestyle for the better, which could help in reducing anxious thoughts and feelings. A big part of learning to change up lifestyle is to connect with others. The first step in this process would be identify any unhealthy relationship patterns. Once aware of any anxiety-driven relationship patterns, you can look for better ways to deal with any fears or insecurities you’re feeling. The second step would be to build a support system. Connecting to others is vital to a patient’s emotional health. A strong support system doesn’t necessarily mean a vast network of friends, but just a couple of trustworthy people to talk out problems with. If they start to feel overwhelmed with anxiety, they should call one of those people from the support system. Just talking out loud about their worries can make them seem less threatening. There are some physical ways in which a GAD patient can create an anxiety-reducing lifestyle. Some of those changes are: adopt healthy eating habits, limit caffeine and sugar, exercise regularly, avoid alcohol and nicotine, and get enough sleep.

Medications are also used to treat more severe cases of Generalized Anxiety Disorder. Usually medications are prescribed based on long-term or short-term treatment. For short term, doctors will prescribe anti-anxiety medications. An example of an anti-anxiety medication would be buspirone, which typically takes up to several weeks to become fully effective. Another sometimes prescribed short-term medication for GAD would be Benzodiazepines. These are generally prescribed in order to provide relief of general anxiety symptoms. Examples of this type of medication are Niravam, Xanax, Librium, Valium, and Ativan. It is very important that these types of medications be used on a SHORT-TERM basis, because they can be habit forming. These medications are not a good choice if the patient has had problems with drug or alcohol abuse. Long-term medications for GAD are generally antidepressants. However, the relief antidepressants provide for anxiety is not immediate, and the full effect isn’t felt for up to six weeks. Some antidepressants can also exacerbate sleep problems and cause nausea. Every medication has some kind of negative side effects, of course, but if the relief of the anxiety outweighs the side effects, then patients will be advised to continue taking the medications.

Living with Generalized Anxiety Disorder can be a long-term challenge. It is very important that one with the disorder always be in touch with their own feelings and emotions. No one wants to suffer with constant worry that can keep themselves from their average daily activity. There are ways to prevent GAD, of course. One method is to get help early. Just like any other mental health condition, anxiety can be harder to treat if one waits too long. Other personal ways of avoiding Generalized Anxiety Disorder are: Keep a journal, prioritize issues in your life and carefully manage time and energy, and avoid unhealthy substance abuse, which of course can make symptoms worse. With a supporting family and a feeling of determination, GAD can certainly be moderated and even eliminated, if the right treatment is involved.