Generalised Anxiety Disorder
Generalised Anxiety Disorder (GAD) affects about 5% of the population. The onset of GAD can be at a relatively early age, with one third of people with GAD experiencing onset in childhood or adolescence. GAD is often chronic, but may have only a moderate impact on a person's ability to function in daily life. Therefore GAD often remains undetected.
What is Generalised Anxiety Disorder (GAD)?
The main feature of GAD is excessive anxiety and worry, occurring more days than not for at least six months, about a number of events or activities such as those related to work or study performance, health, finances or family issues. The worries are often about a variety of minor issues and events that are unlikely to occur. Realistic anxiety, such as financial concerns after losing a job, are not signs of GAD, but consistent, excessive chronic worry about certain events that are unlikely to occur is cause for concern. The person finds it extremely difficult to control the worry. Generally, the worries are future oriented, i.e., about what might happen, rather than what is happening. An intolerance of uncertainty is common in people with GAD.
The anxiety and worry in GAD is accompanied by other physical and emotional symptoms such as: restlessness or feeling on edge; being easily fatigued; difficulty in concentrating or mind going blank; irritability; muscle tension; shallow, uneven breathing; and sleep disturbance. Other symptoms include an increase in heart rate and blood pressure, sweating, feeling nauseous or sick, trembling and shaking and feeling as though you are going crazy and losing control. In some cases, people deal with the excessive, constant anxiety through the over use of alcohol, recreational or non-prescription drugs.
Normal Worry vs GAD Worry
Normal worries of everyday life are usually easy to control or switch off. Worries associated with GAD are more persistent, more pronounced, distressing, last longer, and may appear for no apparent reason. People with GAD often find it difficult or impossible to turn off the worry and anxiety. The person's ineffective efforts to divert attention away from the worry and back to the task at hand is often responsible for difficulties in concentration and memory. People with GAD have maladaptive beliefs about worrying, for example, believing that worrying 'helps avoid disappointment', 'protects loved ones', and 'helps find a better way of doing things'. The worrying appears to be related to lack of confidence and perceived lack of control in problem-solving, but is unrelated to actual problem-solving ability. People with GAD tend to express their worries in terms of what they perceive as personal inadequacies, and persevere excessively in repetitive thinking patterns that involve rumination of unresolved thoughts, holding on to worrisome images in their minds.
Causes of GAD
An absolute cause of GAD is not completely understood to date, but research has shown that biological, psychological, social/environmental and cultural factors all appear to have an influence in the development of GAD. It appears that GAD may be caused by stressors (often overestimating potential threat) acting on a person who is predisposed to high anxiety by a combination of genetic factors and environmental influences. During periods of high level stress, in some cases even after the stress has disappeared, the body may not be able to stop the physiological responses to the stress and the mind and body are unable to cope, therefore resulting in them becoming vulnerable to GAD. Also, some personality traits may play a role in the development of GAD, such as sensitivity, which may result in the person worrying over events that they cannot control. Parenting style, family environment and culture may also influence whether a person who has a vulnerability to developing GAD, ultimately does develop GAD.
Diagnosis
For a diagnosis of GAD, the anxiety, worry or physical symptoms must significantly interfere with a person's social, occupational or routine functioning. Multiple symptoms include mental tension, such as worry, feeling nervous and tense, poor concentration; physical tension, such as restlessness, tremors, and headaches; physical arousal, including dizziness, sweating, stomach pains and a dry mouth. These symptoms may last for months and often reoccur. A diagnosis of GAD would not be given if the above symptoms are due to the psychological effects of a substance or general medical condition, or if the symptoms occur exclusively during the course of other disorders.
It is common for people suffering from GAD to also experience other mental disorders, such as depression, panic disorder and social anxiety disorder. It is noted that GAD and Obsessive Compulsive Disorder (OCD) generally do not occur together. The worries in GAD and the obsessions in OCD are quite distinctive from one another and should not be confused. Obsessions are not excessive worries about everyday or life problems, but are intrusive and unwanted thoughts, images, impulses and urges that cause anxiety and are generally accompanied by compulsions (repetitive and ritualistic behaviours or thinking patterns) and/or avoidance.
Self help Strategies
Some individuals with GAD report that they have regained control over their lives without the use of medication or extensive psychological treatments, by learning anxiety management techniques. These techniques include controlled breathing exercises, progressive muscle relaxation (involving the systematic tensing and relaxing of muscle groups), regular physical exercise, meditation, yoga, massage and problem solving techniques. Education is another important factor in controlling GAD - understanding anxiety and its physical, emotional and mental symptoms helps to reduce the person's fear of fear and feelings of guilt and frustration, and enables a more accepting and proactive response to anxiety.
Treatment of GAD
A variety of treatment strategies have been shown to be helpful in ameliorating GAD. A combination of cognitive behavioural therapy, anxiety management techniques, and improving physical wellness have been known to be successful in bringing the worry process under the person's control and alleviating the impact of GAD. Medication may sometimes be used to relieve anxiety symptoms, but if used, is generally only recommended as a short-term measure.
Cognitive-Behaviour Therapy is a treatment that is often recommended for people with GAD to decrease the worrisome thoughts, diverting the attention away from the worry and intolerance of uncertainty. Therapy will usually focus on identifying and challenging or disputing unrealistic beliefs, attitudes, expectations or assumptions about situations that perpetuate worry and anxiety.
Relaxation techniques and improving physical wellness may also be part of an effective treatment approach. Regular practice of a relaxation technique such as progressive muscle relaxation (i.e., systematic tensing and relaxing of the various muscle groups), a program of regular exercise and healthy nutrition can help to reduce the physical symptoms of anxiety.