Generalized anxiety disorder

Generalized anxiety disorder
Generalized anxiety disorder
Specialty	Psychiatry, psychology

General anxiety disorder or generalized anxiety disorder (GAD) is an anxiety disorder that is characterized by excessive and uncontrollable worry about everyday things. The frequency, intensity, and duration of the worry are disproportionate to the actual source of worry, and such worry often interferes with daily functioning. It affects approximately 5% of the total population, yet is more prevalent in women and much more prevalent in youth, where 12% to 20% are affected (Achenbach, Howell, McConaughy & Stranger, 1995). People with GAD often have a variety of symptoms such as tension, startle ness, restlessness, hyperactivity, worrying, fear, and rumination. These symptoms must be consistent, persisting at least every other day and persist for at least 6 months (DSM-IV; American Psychiatric Association, 1994, as cited in Heimberg, 2004).

GAD sufferers often worry excessively over things such as their job, their finances, and the health of themselves and their family. However, GAD sufferers can also worry over more minor matters such as deadlines for appointments, keeping the house clean, and whether or not their workspace is properly organized.

Only about 30% of the causes of GAD are inherited, yet certain traits cause people to become more prone to obtaining it. People with general nervousness, depression, inability to tolerate frustration, and feelings of being inhibited are more likely to be shown in GAD patients. People with GAD tend to have more conflicts with others and are very hard on themselves, they also tend to avoid common situations for fear of worry and anxiety (Leahy, 2000 as cited in Hemiberg, 2004, pg 270). In youth GAD often leads too lower levels of social supports, academic underachievement, underemployment, substance use and high probability of obtaining other psychiatric disorders (Velting, Setzer, & Albano, 2004 as cited in Gosch, 2006, pg 247). GAD differs from other anxiety disorders in the sense that there is no clear stimulus that elicits anxiety or was associated with how it began. It also lacks the clear avoidance and escape behaviors of phobias and unlike panic attacks associated with most disorders, GAD stays fairly moderate in its anxiety levels (Deffenbacher and Suinn, 1987, pg 332).

Diagnosis

According to the Diagnostic and Statistical Manual IV-Text Revision (DSM-IV-TR), the following criteria must be met for a person to be diagnosed with Generalized Anxiety Disorder.

Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least six months, about a number of events or activities (such as work or school performance).
The person finds it difficult to control the worry.
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 for the past 6 months). Note: Only one item is required in children.
1. restlessness or feeling keyed up or on edge
2. being easily fatigued (difficulty concentrating or mind going blank)
3. irritability
4. muscle tension
5. sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)
6. excessive sweating
The focus of the anxiety and worry is not confined to features of an Axis I disorder, e.g., the anxiety or worry is not about having a panic attack (as in panic disorder), being embarrassed in public (as in social phobia), being contaminated (as in obsessive-compulsive disorder), being away from home or close relatives (as in Separation Anxiety Disorder), gaining weight (as in anorexia nervosa), having multiple physical complaints (as in somatization disorder), or having a serious illness (as in hypochondriasis), and the anxiety and worry do not occur exclusively during posttraumatic stress disorder.
The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism) and does not occur exclusively during a Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental Disorder.

Prevalence

The World Health Organization's Global Burden of Disease project did not include generalized anxiety disorders. [1]. In lieu of global statistics, here are some prevalence rates from around the world:

Australia: 3 percent of adults. [2]
Canada: Between 3-5 percent of adults. [3]
Italy: 2.9 percent [4]
Taiwan: 0.4 percent [5]
United States: About 2.8 percent of the adult U.S. population ages 18 to 54, approximately 4 million Americans, has GAD during the course of a given year. ^{[citation needed]}

GAD most often strikes people in childhood or adolescence, but can begin in adulthood, too. It affects women more often than men. About two-thirds of individuals with GAD are female.(1)

GAD is very prevalent among the elderly.(1)

Potential Causes of GAD

Some research suggests that GAD may run in families, and it may also grow worse during stress. GAD usually begins at an earlier age and symptoms may manifest themselves more slowly than in most other anxiety disorders. Some people with GAD report onset in early adulthood, usually in response to a life stressor.(1) Once GAD develops, it is chronic.(1)

Treatment

Treatments for GAD include medications and cognitive behavioural therapy. A combination of the two has proved the most effective in alleviating symptoms; medication alone may reduce some anxiety but will not eliminate it entirely.

SSRIs and SNRIs are commonly used to treat GAD. Examples include SSRIs such as sertraline (Zoloft), paroxetine (Paxil, Seroxat), citalopram (Celexa), escitalopram (Lexapro, Cipralex) and the SNRI venlafaxine (Efexor). The antiepileptic pregabalin (Lyrica) is also used. Benzodiazepenes such as diazepam and alprazolam are sometimes used in the short-term in order to alleviate extreme cases of anxiety, but they are not safe for continuous use because of the high risk of dependency. The anti-anxiety drug buspirone (BuSpar) is sometimes used in addition to or instead of SSRIs in the treatment of GAD.

SSRIs and SNRIs are generally considered the most effective treatment because both anxiety and depression are thought to be associated with the neurotransmitter serotonin; thus a great deal of people who experience depression also experience anxiety symptoms (there is, however, no scientific proof of this). When both disorders are diagnosed, this is called comorbidity. Other antidepressant drugs such as tricyclics and MAO inhibitors are not used in the treatment of GAD.

GAD and Comorbid Depression

In the National Comorbidity Survey (2005), 58% of patients diagnosed with major depression were found to have an anxiety disorder; among these patients, the rate of comorbidity with GAD was 17.2%, and with panic disorder, 9.9%. Patients with a diagnosed anxiety disorder also had high rates of comorbid depression, including 22.4% of patients with social phobia, 9.4% with agoraphobia, and 2.3% with panic disorder. For many, the symptoms of both depression and anxiety are not severe enough (i.e. are subsyndromal) to justify a primary diagnosis of either major depressive disorder (MDD) or an anxiety disorder.

Patients can also be categorized as having mixed anxiety-depressive disorder, and they are at significantly increased risk of developing full-blown depression or anxiety. Appropriate treatment is necessary to alleviate symptoms and prevent the emergence of more serious disease.

Accumulating evidence indicates that patients with comorbid depression and anxiety tend to have greater illness severity and a lower treatment response than those with either disorder alone. In addition, social function and quality of life are more greatly impaired.

In addition to coexisting with depression, research shows that GAD often coexists with substance abuse or other conditions associated with stress, such as irritable bowel syndrome. Patients with physical symptoms such as insomnia or headaches should also tell their doctors about their feelings of worry and tension. This will help the patient's health care provider to recognize whether the person is suffering from GAD.

External links

(US) National Institute of Mental Health - Information on generalized anxiety disorder
Generalized Anxiety Disorder (GAD) Resources

Stress and Anxiety Clinical Research Unit at the University of Ottawa Institute of Mental Health Research http://www.rohcg.on.ca/roh-internet/webpage.cfm?site_id=1&org_id=1&morg_id=0&gsec_id=197&parent_item_id=237&item_id=1331

Note

(1) Barlow, D. H., & Durand, V. M. (2005). Abnormal psychology: An integrative approach. Australia; Belmont, CA: Wadsworth.