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GAD – Generalized Anxiety Disorder

by Mike on June 22, 2008

It is normal to feel anxious and worried from time to time. That’s part of the human condition. In fact, anxiety triggers the “fight or flight” mechanism in our bodies that help us to perform at our peak. But if you are very anxious or worried without reason for a long time, and that worry disrupts daily life, you may have Generalized Anxiety Disorder, or GAD. It causes long-standing, excessive and unrealistic anxiety and worry, well beyond what’s appropriate for the situation.

What are the criteria for diagnosing GAD?

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) has quite stringent requirements for diagnosing someone as having GAD in order to separate it from “normal” anxiety and worry. (1) The criteria are:

  1. Excessive anxiety and worry … occurring more days than not for at least six months…
  2. The person finds it difficult to control the worry.
  3. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not in the past 6 months).
  • Restlessness or feeling keyed up or on edge
  • Being easily fatigued
  • Irritability
  • Muscle tension
  • Difficulty falling or staying asleep, or restless unsatisfying sleep
  • Difficulty concentrating or the mind going blank

Symptoms can also include nausea, vomiting and chronic stomach aches.

  1. The focus of the anxiety and worry is not confined to features of other disorders, such as Social Anxiety Disorder, worrying about having a Panic Attack, etc
  2. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  3. The disturbance is not due to the direct … effects of a substance [such as a drug], general medical condition, and does not [present itself] exclusively during a Mood Disorder … [or] a Psychotic Disorder…

How many people have GAD?

Three to five percent of people over 18 in America suffer from symptoms of GAD in any given year. That’s 9,132,838 to 15,221,397 according to the census bureau’s population count at the time of writing! Of course, having symptoms is not the same as being diagnosed with GAD. The National Institute of Mental Health (NIMH) estimates about 3.2 million people are diagnosable as having GAD. (2) Women are more than twice as likely to be diagnosed with GAD than men. The disorder generally starts at an earlier age and builds up more gradually than other Anxiety Disorders.

Does GAD happen alone or with other mental disorders?

The NIMH states that GAD rarely occurs alone, and that there usually some other mental condition that accompanies it. The National Comorbidity Survey in 2005 found that 58 percent of those diagnosed with major depression also had an anxiety disorder. Of those, 17.2 percent had GAD. It also found that 9.9 percent of people diagnosed with Panic Disorder also had GAD.

In addition, GAD often coexists with substance abuse and other conditions associated with stress, such as irritable bowel syndrome.

What are the symptoms of GAD?

The symptoms of GAD read like a laundry list of human misery. Be reminded that you must have several of these symptoms and they have to persist over a long period of time for them to be considered to be indicative of GAD.

  • Restlessness
  • Feeling a lump in your throat
  • Edginess
  • Difficulty concentrating
  • Fatigue
  • Irritability
  • Impatience
  • Being easily distracted
  • Muscle tension, muscle aches
  • Twitching, trembling
  • Lightheadedness
  • Having to urinate frequently
  • Hot flashes
  • Trouble falling or staying asleep
  • Excessive sweating
  • Shortness of breath
  • Stomachache
  • Gastrointestinal discomfort or diarrhea
  • Headache
  • Exaggerated startle response

What are the causes of GAD?

Unfortunately, the physical causes of GAD are not fully understood. Researchers think that it might involve neurotransmitters in the brain such as serotonin and norepinephrine. There has been much less study of Anxiety in general and GAD in particular than other common mental disorders, such as Depression.

Psychiatrists generally agree that there likely are several things that cause GAD. Among them are biology, genetics, one’s environment and the life situation one is in. Research has shown that GAD may run in families. Environmental factors include trauma and stressful events such as abuse, death, divorce, changing jobs. The use and withdrawal from addictive substances have been shown to trigger GAD, as well.

Risk factors include childhood experiences such as adversity and hardships. Witnessing traumatic events at any age can aggravate GAD. Stressful life situations such serious or prolonged illness, major financial problems, or life-changing events can cause GAD to grow. One’s personality definitely plays a role. For example, unmet psychological needs, such as an unfulfilling relationship, or security issues are risk factors.

Can GAD be prevented?

Anxiety disorders cannot be prevented. The seeds of GAD are sown in early childhood, usually bloom in early adulthood, and if untreated, gradually increase over one’s lifetime, especially during times of stress.

How is GAD treated?

The NIMH states that GAD is most often treated with medication and/or Cognitive Behavioral Therapy. However, since GAD commonly occurs with other mental disorders, their treatment may take precedence over treatment for GAD. For example, severe Depression must be treated before any effective long-term treatment for GAD can take place.

Talk therapies work well with GAD, with Cognitive Behavioral Therapy (CBT) seeming to work best. It combines the controlled exposure methods of Behavioral Therapy with the reduction and elimination of unproductive, intrusive thought patterns of Cognitive Therapy. This is a relatively short-term treatment that has low recidivism rates. The patient receiving CBT treatment has considerable work to do both inside and outside of the therapy session.

The most common medications used for GAD are the Benzodiazepines, which are fast-acting sedatives. They usually are prescribed only for short-term relief due to their habit-forming properties. Some brands are Xanax, Librium, Klonopin, Valium and Ativan.

SSRI’s (selective serotonin reuptake inhibitors) are antidepressants that influence brain chemistry to block the reuptake of serotonin in the brain. Some SSRI’s that are prescribed for GAD are Prozac, Paxil and Lexapro. Other classes of antidepressants target the serotonin, norepinephrine and dopamine chemicals in the brain. Some brands are Effexor, BuSpar, and Lyrica. As stated above, researchers believe these work because GAD seems to affect the serotonin and norepinephrine neurotransmitters in the brain.

There are many non-traditional treatments for GAD, as well. Most focus on the long-term reduction of symptoms, rather than claiming a cure. Meditation is frequently very effective with GAD, as is Yoga. Herbs such as Kava are claimed to be effective, but have not been held up to the same medical scrutiny as prescription drugs. Some hold that acupuncture and changes in diet can have a dramatic effect on GAD.

Above all, the most effective preventative for GAD is early diagnosis and treatment. Seeking professional psychiatric care is imperative. Good treatment will give you the tools to fight back against the effects of GAD over a lifetime.

FOOTNOTES

(1) DSM-IV is the abbreviation for the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, which is a publication of the American Psychiatric Association. It is a primary American source for mental health professionals that lists categories of mental disorders and the criteria for diagnosing them. It is used by clinicians and researchers, insurance companies, pharmaceutical companies and policy makers. The American Psychiatric Association has more information on the DSM-IV. 

(2) The website of the NIMH was consulted for several of the statistics and statements in this article.

Other resources used in this article were:

Mayo Clinic Staff. Generalized anxiety disorder. (2007). Retrieved June 24, 2008 from the Mayo Clinic Web site: http://www.mayoclinic.com/health/generalized-anxiety-disorder/DS00502

Hauser, John. Anxiety: Generalized Anxiety Disorder. (2005). Retrieved June 24, 2008 from the Psych Central Web site: http://psychcentral.com/disorders/anxiety/gad.html

Mental Health Net. Symptoms – Generalized Anxiety Disorder. (2001). Retrieved April 29, 2005 from the Mental Health Net Web site: http://mentalhelp.net/poc/view_doc.php?type=doc&id=544&cn=1