Generalized Anxiety Disorder

Generalized Anxiety Disorder 

Definition

Generalized anxiety disorder is a condition characterized by "free floating" anxiety or apprehension not linked to a specific cause or situation.

Description

Some degree of fear and anxiety is perfectly normal. In the face of real danger, fear makes people more alert and also prepares the body to fight or flee (the so-called "fight or flight" response). When people are afraid, their hearts beat faster and they breathe faster in anticipation of the physical activity that will be required of them. However, sometimes people can become anxious even when there is no identifiable cause, and this anxiety can become overwhelming and very unpleasant, interfering with their daily lives. People with debilitating anxiety are said to be suffering from anxiety disorders, such as phobias, panic disorders, and generalized anxiety disorder. The person with generalized anxiety disorder generally has chronic (officially, having more days with anxiety than not for at least six months), recurrent episodes of anxiety that can last days, weeks, or even months.

Causes and symptoms

Generalized anxiety disorder afflicts between 2-3% of the general population, and is slightly more common in women than in men. It accounts for almost one-third of cases referred to psychiatrists by general practitioners.

Generalized anxiety disorder may result from a combination of causes. Some people are genetically predisposed to developing it. Psychological traumas that occur during childhood, such as prolonged separation from parents, may make people more vulnerable as well. Stressful life events, such as a move, a major job change, the loss of a loved one, or a divorce, can trigger or contribute to the anxiety.

Psychologically, the person with generalized anxiety disorder may develop a sense of dread for no apparent reason-the irrational feeling that some nameless catastrophe is about to happen. Physical symptoms similar to those found with panic disorder may be present, although not as severe. They may include trembling, sweating, heart palpitations (the feeling of the heart pounding in the chest), nausea, and "butterflies in the stomach."

According to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, a person must have at least three of the following symptoms, with some being present more days than not for at least six months, in order to be diagnosed with generalized anxiety disorder:

While generalized anxiety disorder is not completely debilitating, it can compromise a person's effectiveness and quality of life.

Diagnosis

Anyone with chronic anxiety for no apparent reason should see a physician. The physician may diagnose the condition based on the patient's description of the physical and emotional symptoms. The doctor will also try to rule out other medical conditions that may be causing the symptoms, such as excessive caffeine use, thyroid disease, hypoglycemia, cardiac problems, or drug or alcohol withdrawal. Psychological conditions, such as depressive disorder with anxiety, will also need to be ruled out.

In June 2004, the Anxiety Disorders Association of America released follow-up guidelines to help primary care physicians better diagnose and manage patients with generalized anxiety disorder. They include considering the disorder when medical causes for general, vague physical complaints cannot be ruled out. Since generalized anxiety disorder often co-occurs with mood disorders and substance abuse, the clinician may have to treat these conditions as well, and therefore must consider them in making the diagnosis.

Treatment

Over the short term, a group of tranquilizers called benzodiazepines, such as clonazepam (Klonipin) may help ease the symptoms of generalized anxiety disorder. Sometimes antidepressant drugs, such as amitryptiline (Elavil), or selective serotonin reuptake inhibitors (SSRIs), such as paroxetine (Paxil), escitalopram (Lexapro), and venlafaxine (Effexor), which also has norepinephrine, may be preferred. Other SSRIs are fluoxetine (Prozac) and sertraline (Zoloft).

Psychotherapy can be effective in treating generalized anxiety disorder. The therapy may take many forms. In some cases, psychodynamically-oriented psychotherapy can help patients work through this anxiety and solve problems in their lives. Cognitive behavioral therapy aims to reshape the way people perceive and react to potential stressors in their lives. Relaxation techniques have also been used in treatment, as well as in prevention efforts.

Prognosis

When properly treated, most patients with generalized anxiety disorder experience improvement in their symptoms.

Prevention

While preventive measures have not been established, a number of techniques may help manage anxiety, such as relaxation techniques, breathing exercises, and distraction—putting the anxiety out of one's mind by focusing thoughts on something else.

Resources

Periodicals

"Guidelines to Assist Primary Care Physicians in Diagnosing GAD." Psychiatric Times (July1,2004):16.

Sherman, Carl. "GAD Patients Often Require Combined Therapy." Clinical Psychiatry News (August 2004): 12-14.

Organizations

American Psychiatric Association. 1400 K Street NW, Washington DC 20005. (888) 357-7924. http://www.psych.org.

Anxiety Disorders Association of America. 11900 Park Lawn Drive, Ste. 100, Rockville, MD 20852. (800) 545-7367. http://www.adaa.org.

National Institute of Mental Health. Mental Health Public Inquiries, 5600 Fishers Lane, Room 15C-05, Rockville, MD 20857. (888) 826-9438. http://www.nimh.nih.gov.

Key terms

Cognitive behavioral therapy — A psychotherapeutic approach that aims at altering cognitions—including thoughts, beliefs, and images—as a way of altering behavior.

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generalized anxiety disorder

n.

An anxiety disorder characterized by consistent feelings of anxiety for a period of at least six months and accompanied by symptoms such as fatigue, restlessness, irritability and sleep disturbance.