Generalized Anxiety Disorder


Generalized Anxiety Disorder is characterized by the following symptoms:

  • muscle tension
  • constant worry and tension
  • fatigue
  • restlessness
  • difficulty falling or staying asleep
  • difficulty concentrating
  • irritability
  • edginess
  • gastrointestinal discomfort or diarrhea

Sufferers of Generalized Anxiety Disorder (GAD) tend to become very anxious in multiple domains of their lives such as school, work, relationships, day to day activities, parenting, health, and even leisure activities. They find it very difficult to relax, and are always keyed up. They tend to catastrophize a great deal: perceive things to be a lot worse than they are, make mountains out of molehills, always expecting the worst. Symptoms can be persistent, chronic, and impair functioning.

Generalized Anxiety Disorder  is different from normal general anxiety. Normal anxiety is dependent on the situation, is not chronic and does not impair functioning. For example, it is normal to be anxious before receiving test results, when experiencing money problems, or before a speech. Anxiety only becomes problematic and falls under the heading of “disorder” when it interferes with your social/occupational/family life. Most people with this diagnosis know that their worry is excessive or irrational and yet cannot help it.

According to Anxiety Disorders Association of America, Generalized Anxiety Disorder affects 6.8 million Americans per year (3.1 % of the US population). Women are twice as likely as men to suffer from this disorder.

Generalized Anxiety Disorder shares many symptoms with Depression such as irritability, difficulty concentrating, fatigue, restlessness, and disturbance in sleep. What differentiates it from Depression is the presence of constant worry, anxiety, and tension.

Those that are diagnosed with GAD end up suffering from chronic tension, worsening a myriad of physical ailments as well. Recent research shows that individuals who suffer from Generalized Anxiety Disorder and heart disease are 74% more likely to suffer from a cardiac event than those that only suffer from heart disease. To read more about this research please visit http://www.medpagetoday.com.

As with most psychological disorders, the causes of GAD vary. First signs of the disorder can be seen as early as age 7 or may not show up until late 40’s. Most experts agree that anxiety disorders are caused by a combination of genetic predisposition/heredity and life experiences. In some cases GAD may be caused by an early trauma (or series of traumas) that ingrains the individual with the belief that they have little control over their environment and that terrible things can and will happen to them at any time.

GAD is co-morbid with drug abuse and dependence, particularly any drug that relaxes the individual. Abuse of narcotics (Heroin, Morphine, Vicodin, other opioids), muscle relaxers, Benzodiazepine drugs (Xanax, Ativan), alcohol, nicotine and marijuana are most common due to the calming affect of these drugs. Others may use repetitive calming activities to self soothe and become addicted to these behaviors (nail biting, skin picking, hair pulling, addiction to media (tv, internet, video games, phones, ipads, other gadgets), addiction to sex or food. Generalized Anxiety Disorder may also be diagnosed along with another disorder such as Depression, OCD, Panic Disorder, or Agoraphobia and this is common.

Treatment Approaches

Cognitive-Behavioral Therapy

This is a type of psychotherapy that addresses the distorted and faulty thinking patterns that lie at the root of extreme daily anxiety. It’s most important premise is that changing the way you perceive a situation will change the way you feel about it. This is a very popular therapy for GAD and other anxiety disorders because it is short term, cost effective (and so favored by insurance companies) and it is backed by research.

Medication

There are a number of SSRI (Selective Serotonin Re-uptake Inhibitors) that are typically used for the treatment of Generalized Anxiety Disorder. They include: Paxil, Prozac, and Zoloft. Another class of medications called Tricyclics have been effective including Imipramine (Tofranil), Norpramin (desipramine), and Anafranil (clomipramine). Another class of medications called Benzodiazepines can be prescribed for extreme anxiety. These include Klonapin, Ativan, and Xanax. Long term usage of Benzos is discouraged due to tolerance and the habit forming nature of these meds. Please see this article about the potential dangers of these medications: What you need to know about Anti-Anxiety Medication

Existential Psychotherapy

Existential psychotherapy can be effective for Generalized Anxiety Disorder in that it highlights the power of the individual to create the kind of life that he/she chooses. This allows for the individual to begin learning to let go of matters that he/she can’t control and focus on things that can be controlled. Existential therapy also focuses on identifying and making choices that change the way one interacts with the world at large. Once choices are illuminated, anxiety can be decreased and controlled.

Psychodynamic Psychotherapy

Psychodynamic therapy focuses on lifelong patterns of interaction that have been learned in childhood in the family of origin and maintained by the individual’s subconscious. This type of therapy can decrease anxiety by bringing into awareness where/when anxious reactions may have been learned, and what has maintained them, thereby reducing their validity and illuminating other possibilities.

EMDR

When the source of Generalized Anxiety Disorder is trauma, EMDR can be highly effective. EMDR can reduce anxiety by reprocessing trauma memories, taking the charge off of them, and installing new ways of reacting to situations that provoke anxiety.

Relaxation Training

This involves learning how to relax with the use of deep breathing, muscle relaxation techniques to decrease anxiety in the body (muscle tightness, racing heart, shortness of breath, etc..)

Biofeedback

A relaxation training technique using electrodes that detect heart rate, sweat, skin temperature and brainwaves.

Prognosis

The prognosis for Generalized Anxiety Disorder depends on the severity of the disorder and adherence to treatment. Most people that suffer with this condition, with the proper treatment, see marked improvement in their anxiety, and learn to control their own anxiety after therapy is done. Some may need ongoing medication support, but medication can also be used as training wheels in therapy. Many make significant gains in psychotherapy, and may be able to wean off their medication under the supervision of their psychiatrist.