Generalized Anxiety Disorder

Generalized anxiety disorder, or GAD, is a psychiatric problem in which anxiety is not a temporary state but a chronic condition. While it is normal for all individuals to worry about an upcoming event such as an examination or job interview, patients with GAD are in a perpetual state of anxiety and therefore are unable to relax or feel at peace. The disorder may become so severe that it interferes with school, work or relationships. GAD is a very common disorder, affecting millions of individuals in the United States alone. More than twice as many women as men suffer from the disorder.

Causes of GAD

While precise causes for GAD have not been determined, from my twenty plus years of experience in working with these individuals it seems that often times this kind of anxiety is related to a loss or separation, either real or imagined. It is important to assess and determine the extent of the anxiety because it can range from over-whelming to having a dramatic life or death quality. Hormonal changes, like those that occur prior to or during menstruation or during menopause, may be a factor in the development of the disorder, accounting for the fact that females are noticeably more prone to the disorder than men. GAD is thought to be exacerbated by environmental factors like trauma or abrupt and unanticipated life changes.

Symptoms of GAD

Symptoms of GAD, which most commonly begin during childhood or adolescence, may begin in adulthood as well. These symptoms may be both psychological and physiological. Often diffuse, these symptoms may be accompanied by a fear of dying.

Psychological Symptoms

  • Excessive worry about small things
  • Perpetual worry
  • Anxiety without a perceived cause
  • Fear or dread
  • Inability to relax
  • Restlessness, irritability, tension
  • Difficulty concentrating
  • Extreme or frequent startle response

Physiological Symptoms

  • Insomnia or other sleep disturbances
  • Headaches, fatigue, nausea, lightheadedness
  • Muscle aches, muscle twitching
  • Palpitations, chest pain
  • Gastrointestinal distress
  • Other aches and pains
  • Frequent urge to urinate
  • Breathlessness
  • Hot flashes or sweating
  • Trembling
  • Difficulty swallowing
  • Lump in the throat
  • Dry mouth

Diagnosing GAD

Generalized anxiety disorder is typically diagnosed through a full medical history and a psychological evaluation. In order to be diagnosed with GAD, a patient has to meet the following criteria:

  • Experience extreme anxiety for at least 6 months
  • Be unable to overcome or control anxiety
  • Have difficulty with everyday activities because of anxiety
  • Have anxiety unrelated to another medical or psychiatric disorder

In addition, in order to be diagnosed with GAD, adults must experience three of the following and children must experience at least one:

  • Fatigue
  • Sleep disturbances
  • Irritability
  • Restlessness
  • Muscle tension
  • Difficulty concentrating

Treatment for Generalized Anxiety Disorder

In my practice Generalized anxiety disorder is typically treated with insight oriented and supportive psychotherapy.  At times it is important, and helpful, to lend support to the individual in the form of problem solving, judgement, and self-regulation of the emotions. Advice on specific issues is not helpful but looking closely, together, at what makes one anxious or doubt one's capacities is far more valuable. Helping the individual think out loud about the anxiety is a technique, that when done correctly, in an empathic environment, leads to a better understanding of one's thoughts, feelings, and experience with the intense anxiety.

In rare, and extreme cases, medication can be used as an adjunct to the psychotherapy treatment. Medications may differ in the length of time they require to provide symptomatic relief. Sometimes patients are given benzodiazepines, such as Xanax or Valium, to use temporarily until other medications, such as antidepressants, take effect. Several varieties of psychotherapy may be used in treating GAD and the treatment of choice will depend on my initial assessment of the frequency and severity of the anxiety.  I have found that meeting with individuals more frequently is particularly helpful.

Alternative therapies, including various relaxation techniques and meditation are reported to assist some patients in maintaining a sense of calm but it must be noted that these techniques rarely lead to long lasting change. Maintaining a healthy lifestyle, including eating a healthy diet, getting regular exercise, and avoiding alcohol, caffeine and other stimulants can also help relieve the symptoms of GAD. A strong support system of family and friends is also beneficial but because of the intense anxiety these close relations are sometimes difficult to maintain.

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