What is Generalized Anxiety Disorder (GAD)?

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What is Generalized Anxiety Disorder (GAD)?

"I just dread being alone at night. I don’t know why, but I do......"

"My thoughts won’t shut off. They’re constantly running, making me worry, worry, worry......"

"Will I ever be my old self again?"

"I can’t remember ever feeling relaxed and calm....What would that be like?"

"I’m always on edge....."

"I hate having to go to work anymore. I haven’t always been this way....."

Generalized anxiety disorder is a relatively common anxiety problem, affecting 3-4% of the population, that turns daily life into a state of worry, anxiety, and fear. Excessive thinking and dwelling on the "what ifs" characterizes this anxiety disorder. As a result, the person feels there’s no way out of the vicious cycle of anxiety and worry, and then becomes depressed about life and the state of anxiety they find themselves in.

Generalized anxiety usually does not cause people to avoid situations, and there isn’t an element of a "panic attack" involved in the prognosis, either. It’s the thinking, thinking, thinking, dwelling, dwelling, ruminating, ruminating, and inability to shut the mind off that so incapacitates the person. At other times, thoughts seem almost non-existent because the anxious feelings are so dominant. Feelings of worry, dread, lack of energy, and a loss of interest in life are common. Many times there is no "trigger" or "cause" for these feelings and the person realizes these feelings are irrational. Nevertheless, the feelings are very real. At this point, there is no "energy" or "zest" in life and no desire to want to do much.

Emotional Fear

This emotional fear and worry can be quite strong. If a loved one is ten minutes late, the person with generalized anxiety fears the very worst -- something’s dreadfully wrong (after all, they’re ten minutes late!), there’s been an accident, the paramedics are taking the person to the hospital and his injuries are just too critical to resuscitate him....."Oh, my God!.....WHAT AM I GOING TO DO?" Feelings of fear and anxiety rush in from these thoughts, and the vicious cycle of anxiety and depression runs wild.

Some people with generalized anxiety have fluctuations in mood from hour-to-hour, whereas others have "good days" and "bad days". Others do better in the morning, and others find it easier at the end of the day. These anxiety feelings and moods feed on themselves, leading the person to continue in the pattern of worry and anxiety -- unless something powerful breaks it up.

Causes of GAD

GAD is associated with irregular levels of neurotransmitters in the brain. Neurotransmitters are chemicals that carry signals across nerve endings. Neurotransmitters that seem to involve anxiety include norepinephrine, GABA (gamma-aminobutyric acid), and serotonin.

Norepinephrine is concentrated in the locus ceruleus (nerve cluster that lies near the brain’s fourth ventricle). Increased activity in the locus ceruleus is associated with anxiety, and decreased activity in the locus ceruleus diminishes anxiety. Increased levels of GABA and serotonin seem to reduce anxiety. All of these neurotransmitters interact during heightened anxiety.

The psychodynamic theory of psychology sees anxiety as an alerting mechanism that arises when our unconscious motivations clash with the constraints of our conscious mind. This conflict is intensified in people with GAD. Behavioral theory holds that anxiety results from not knowing how to behave in a given situation. The possibility of suffering negative consequences because of inappropriate behavior may result in hesitation and inaction. The anxiety may be generalized to similar situations. For example, anxiety over taking a particular test may be generalized to taking all tests in the future.

Risk Factors

There are biological and environmental risk factors for GAD, which include the following:

Environmental stressors (e.g., work, school, relationships)
Genetics
Sleep deprivation, sleep inconsistency

Stressful situations in the following areas can intensify symptoms:

Financial concerns
Health
Relationships
School problems
Work problems

Research has shown a 20% risk for GAD in blood relatives of people with the disorder and a 10% risk among relatives of people with depression. There also seems to be a correlation between GAD and other psychiatric disorders, including depression, phobia disorder, and panic disorder. Anxiety is a risk factor for sleep disorders such as insomnia.

Physical Symptoms of GAD

Physical manifestations of generalized anxiety may include headaches, trembling, twitching, irritability, frustration, and inability to concentrate. Sleep disturbances may also occur. Elements of social phobia and/or panic may sometimes be present, such as high levels of self-consciousness in some situations, and fear of not being able to escape from enclosed spaces.

It is also common, but not universal, for people with generalized anxiety to experience other problems, such as a quickness to startle from it, a lack of ability to fully relax, and the propensity to be in a state of constant motion. It is difficult for some people with generalized anxiety to settle down enough to have a quiet, reflective time where they can calm down, relax, and feel some peace and tranquility. Strategies to peacefully calm down and relax are one part in overcoming this problem.

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Normal life stresses aggravate generalized anxiety. The person who typically performs well at work and receives a sense of accomplishment from it, all of a sudden finds that work has become drudgery. If work is perceived as a negative environment, and the person no longer feels fulfilled, then considerable worry takes place over these situations. As a result, the anticipatory anxiety about going to work can become quite strong.

Treatment for Generalized Anxiety Disorder

Generalized anxiety has been shown to respond best to cognitive-behavioral therapy, an active therapy that involves more than just talking to a therapist. In CBT, the person gradually learns to see situations and problems in a different perspective and learns the methods and techniques to use to alleviate and reduce anxiety. Sometimes medication is a helpful adjunct to therapy, but for many people it is not necessary. Research indicates that generalized anxiety is fully treatable and can be successfully overcome over the course of about three to four months if the person is motivated and works toward recovery.

Generalized anxiety must be chipped away from all sides and that is what CBT is designed to do. No one has to live with generalized anxiety disorder. Treatment for GAD has been shown to be both effective and successful.

It's important to seek a therapist who understands anxiety and the anxiety disorders. Remember, that just because a person has a degree behind their name, does not mean they understand and can treat an anxiety disorder. Feel free to ask questions of any professional and make sure your therapist understands and knows how to treat generalized anxiety. It is usually a good idea to see a specialist in this area (they don’t charge more), but they do have a practice that is geared toward the anxiety disorders.

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What is Generalized Anxiety Disorder (GAD)?

Emotional Fear

Causes of GAD

Risk Factors

Physical Symptoms of GAD

Treatment for Generalized Anxiety Disorder

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