Generalized Anxiety Disorder (GAD)
Basics
Generalized anxiety disorder (GAD) is chronic excessive worry about an array of activities or events. The anxiety of GAD is characterized by disproportionate unease, fear, or dread. The anxiety is not limited to one specific worry or concern, and it lasts longer than 6 months. Paying bills or doing laundry might trigger anxious feelings in some, whereas others will feel anxious about duties at work, or will fear that something bad will happen to a loved one. During any given year, about 3% to 5% of the adult population will suffer from GAD; however, few people with the disorder seek treatment.
People with GAD have a sustained “fight or flight” response to stressful situations. Anxiety is a healthy response to a stressful situation. When people are in danger, their brains release hormones that prepare them to fight or run away—commonly called the “fight or flight” response. To prepare the body for action, the heartbeat quickens and the muscles tense up; blood becomes more likely to clot in case of an injury. Normally, this reaction subsides once a person no longer feels threatened. In people with GAD, however, this response is sustained over months, which can cause a host of negative effects for physical health and mental well-being.
Causes
A mix of genetic and environmental factors are involved in GAD. Twin studies have shown that genes account for about 37% of the cause of GAD, while environmental factors account for about 62% of the cause.
GAD is thought to occur when certain chemical receptors in the brain do not function properly. The brain chemical gamma-aminobutyric acid (GABA) has an anti-anxiety effect when it binds with certain receptors in the limbic system, the region of the brain that regulates emotions. If these receptors dont allow GABA to bind, a feeling of anxiety results. Abnormalities in other neurotransmitters, such as serotonin, the catecholamines, and cholecystokinin, have also been implicated in GAD.
An underlying psychological conflict, medical problems, or certain drugs can also cause generalized anxiety Table 01. Patients may be highly insecure and self-critical, which can lead to anxiety. Medical problems such as head trauma, brain infections, heartbeat irregularities, thyroid dysfunction, and asthma have also been linked to GAD. Prescription drugs, illegal drugs, alcohol, and caffeine can also produce symptoms of GAD.
Table 1. Medical and Substance-related Causes of Anxiety
| Cardiovascular | Metabolic | Neurologic | Respiratory | Medications | Substances |
|---|---|---|---|---|---|
| Heart rhythm irregularitiesHeart failure | Overactive thyroid glandUnderactive thyroid glandLow blood sugar | Brain infectionHead traumaSeizures | Allergic reactionAsthmaChronic obstructive pulmonary disease | Blood-pressure-lowering medicationsThyroid medicationsInsulin and other diabetes medications | AlcoholCaffeineCocaineAmphetamines |
Symptoms
Generalized anxiety disorder produces a range of psychological and physical symptoms that can interfere with a persons ability to function. The hallmark of the disorder is excessive concern over at least two different issues that lasts for six months or longer Table 02. The characteristic anxiety of GAD often results in physical complaints such as muscle tension, headaches, and a rapid heartbeat. Patients may find it hard to get a good nights sleep, which may cause irritability and fatigue. Those with GAD are often jumpy or shaky, and say that they feel “on edge.” Some have difficulty concentrating, and become exhausted easily.
Table 2. Symptoms of Generalized Anxiety Disorder
| Psychological | Physical |
|---|---|
| Worry that is disproportionate to the situation; for example, a feeling of dread or unease when planning a meal or making a phone callWorry that is hard to controlDisturbed sleepRestlessness, irritability, feeling ?on edge?Difficulty concentrating | FlushingChillsDizzinessChest pain, palpitations, or tachycardiaHyperventilationChokingRapid heartbeatMuscle tensionHeadachesFatigueDry mouthVomitingDiarrheaNauseaIncreased need to urinate |
Risk Factors
Although GAD can strike a person at any point in life, its origins are often traced to youth. Many adults with GAD report having had excessive fears as a child, or experiencing social inhibition during their teenage years.
Women are more likely than men to have GAD.
There appears to be a genetic component to GAD. People who have a first-degree relative with GAD are more likely to suffer from GAD themselves.
Diagnosis
Generalized anxiety disorder (GAD) is chronic excessive worry about an array of activities or events. The anxiety of GAD is characterized by disproportionate unease, fear, or dread. The anxiety is not limited to one specific worry or concern, and it lasts longer than 6 months. Paying bills or doing laundry might trigger anxious feelings in some, whereas others will feel anxious about duties at work, or will fear that something bad will happen to a loved one. During any given year, about 3% to 5% of the adult population will suffer from GAD; however, few people with the disorder seek treatment.
People with GAD have a sustained “fight or flight” response to stressful situations. Anxiety is a healthy response to a stressful situation. When people are in danger, their brains release hormones that prepare them to fight or run away—commonly called the “fight or flight” response. To prepare the body for action, the heartbeat quickens and the muscles tense up; blood becomes more likely to clot in case of an injury. Normally, this reaction subsides once a person no longer feels threatened. In people with GAD, however, this response is sustained over months, which can cause a host of negative effects for physical health and mental well-being.
A mix of genetic and environmental factors are involved in GAD. Twin studies have shown that genes account for about 37% of the cause of GAD, while environmental factors account for about 62% of the cause.
GAD is thought to occur when certain chemical receptors in the brain do not function properly. The brain chemical gamma-aminobutyric acid (GABA) has an anti-anxiety effect when it binds with certain receptors in the limbic system, the region of the brain that regulates emotions. If these receptors dont allow GABA to bind, a feeling of anxiety results. Abnormalities in other neurotransmitters, such as serotonin, the catecholamines, and cholecystokinin, have also been implicated in GAD.
An underlying psychological conflict, medical problems, or certain drugs can also cause generalized anxiety Table 01. Patients may be highly insecure and self-critical, which can lead to anxiety. Medical problems such as head trauma, brain infections, heartbeat irregularities, thyroid dysfunction, and asthma have also been linked to GAD. Prescription drugs, illegal drugs, alcohol, and caffeine can also produce symptoms of GAD.
Table 1. Medical and Substance-related Causes of Anxiety
| Cardiovascular | Metabolic | Neurologic | Respiratory | Medications | Substances |
|---|---|---|---|---|---|
| Heart rhythm irregularitiesHeart failure | Overactive thyroid glandUnderactive thyroid glandLow blood sugar | Brain infectionHead traumaSeizures | Allergic reactionAsthmaChronic obstructive pulmonary disease | Blood-pressure-lowering medicationsThyroid medicationsInsulin and other diabetes medications | AlcoholCaffeineCocaineAmphetamines |
Generalized anxiety disorder produces a range of psychological and physical symptoms that can interfere with a persons ability to function. The hallmark of the disorder is excessive concern over at least two different issues that lasts for six months or longer Table 02. The characteristic anxiety of GAD often results in physical complaints such as muscle tension, headaches, and a rapid heartbeat. Patients may find it hard to get a good nights sleep, which may cause irritability and fatigue. Those with GAD are often jumpy or shaky, and say that they feel “on edge.” Some have difficulty concentrating, and become exhausted easily.
Table 2. Symptoms of Generalized Anxiety Disorder
| Psychological | Physical |
|---|---|
| Worry that is disproportionate to the situation; for example, a feeling of dread or unease when planning a meal or making a phone callWorry that is hard to controlDisturbed sleepRestlessness, irritability, feeling ?on edge?Difficulty concentrating | FlushingChillsDizzinessChest pain, palpitations, or tachycardiaHyperventilationChokingRapid heartbeatMuscle tensionHeadachesFatigueDry mouthVomitingDiarrheaNauseaIncreased need to urinate |
Although GAD can strike a person at any point in life, its origins are often traced to youth. Many adults with GAD report having had excessive fears as a child, or experiencing social inhibition during their teenage years.
Women are more likely than men to have GAD.
There appears to be a genetic component to GAD. People who have a first-degree relative with GAD are more likely to suffer from GAD themselves.
To determine what is causing your symptoms, your doctor will start with a medical history. Because anxiety is associated with other medical conditions and medications used to treat them, tell your doctor about any illnesses you have and mention the drugs you are taking for them. Your doctor will ask whether anyone in your family suffers from an anxiety disorder or depression.Your doctor will also ask about other possible factors that could be contributing to your anxiety, such as heavy caffeine consumption, alcohol or drug abuse, or any stressful events in your life.
Your doctor will perform a physical examination to help diagnose GAD.
Anxiety can manifest physically. It can increase heart rate and blood pressure, cause muscle tension, and interfere with breathing. In addition to examining these things, your doctor will also look for a furrowed brow, perspiration, dilated pupils, bitten nails, overly washed hands, and a tremor to assess the severity of your anxiety.
Prevention and Screening
Treatment
Hospitalization is rare for GAD alone. However, if you or someone close to you has suicidal thoughts, delusions, or difficulty providing self-care, seek medical help immediately. GAD often occurs in tandem with other psychological disorders, some of which alone or in combination can cause suicidal intent or a desire to inflict harm on oneself. In such cases, emergency intervention is necessary.
Maintain a balanced lifestyle that includes socializing, exercise, work, and recreation. Some people with debilitating anxiety isolate themselves from outside people and activities, which can worsen symptoms. Getting adequate exercise and nutrition, spending time with friends, and having gratifying work can help to stabilize feelings of anxiety in someone with GAD.
Your doctor is the best source of information on the drug treatment choices available to you.
Psychotherapy for GAD includes insight-oriented psychotherapy and behavioral techniques such as relaxation. While drugs can ameliorate the symptoms of GAD, psychotherapy can help address the underlying issues behind the symptoms, and teach patients how to cope with them.
A therapist will listen without judging, help identify situations that trigger anxiety, and suggest ways to prevent anxiety and deal with it when it arises. By exploring feelings and actions, patients often develop insights into their emotions, and are able to lower their anxiety levels.
Behavioral techniques can be used to modify responses to anxiety-producing stimuli. Deep muscle relaxation helps make patients aware of tension in their bodies.This is done while sitting upright in a chair with the hands resting in the lap. Each muscle — beginning with the forehead and working down to the thighs — is tensed for 15 seconds, and is then slowly released.
Another relaxation technique that can be used involves deep breathing. While sitting or lying down, breathe in slowly. The chest and stomach should both expand outward. The breath should be held for a second or two, and then exhaled slowly in a controlled manner. Deep breathing has a calming affect, and can be used to avert anxiety.
Certain herbs may be helpful for quelling anxiety. Discuss herbal medicines with your doctor before you take them. European research suggests that the herb kava may be as good as prescription drugs for treating anxiety. In some studies, patients experienced lower anxiety levels after seven days of taking kava. No side effects were reported after six months of use.
Valerian, a well-known herbal sleep aid, also appears to have a calming effect. It seems to influence brain receptors for GABA. At normal doses, there are no dangerous side effects.
Avoid St. Johns wort if you are taking prescription medication for GAD.
People with GAD are likely to have substance abuse problems (particularly with alcohol), be depressed or demoralized, or be hypochondriacal. People with GAD often become dependent on alcohol or other substances as a result of trying to self-medicate. Others become hypochondriacal as they struggle to find an explanation for their anxiety.
Many GAD patients have additional mental illnesses. More than 80% of people with GAD suffer from major depression, dysthymia, or another anxiety disorder, such as social phobia.
Generalized anxiety disorder can be overcome in a few months if the patient is motivated to work toward his or her recovery. With proper treatment — which may involve medication, psychotherapy, or both — the majority of people with anxiety disorders improve.