Generalized Anxiety Disorder (GAD)

Generalized anxiety disorder facts

• Generalized anxiety disorder (GAD) is a mood disorder that is characterized by multiple and/or nonspecific worries that interfere with the person's life in some way.
• The most common anxiety disorders are specific phobias. Other anxiety disorders include social anxiety disorder, panic disorder, generalized anxiety disorder, obsessive compulsive disorder, and posttraumatic stress disorder.
• GAD is quite common, affecting millions of people.
• While there is no single cause of GAD, there are many factors that increase the risk of developing this disorder.
• Signs and symptoms of anxiety can include those that are emotional or behavioral and ways of thinking that are responses to feeling as if one is in danger.
• The similarities and differences in symptoms of anxiety in adults compared to children and adolescents depend on the diagnosis.
• There seem to be gender differences in the expression of anxiety.
• If a medical or mental healthprofessional suspects that you have GAD, you will likely undergo an extensive medical interview and physical examination.
• Treatment of GAD usually involves some combination of lifestyle changes, psychotherapy, and/or medication.
• As anything that is ingested carries risk of side effects, it is important for the anxiety disorder sufferer to work closely with the prescribing doctor to decide whether treatment with medications is an appropriate intervention, and if so, which medication should be administered.
• There are many possible complications associated with anxiety.
• Various lifestyle choices and family interventions can help prevent anxiety.
• GAD usually requires treatment for it to resolve.
• There are many support groups for people who suffer from generalized anxiety disorder.

What is generalized anxiety disorder (GAD)?

Generalized anxiety disorder (GAD) is a mood disorder that is characterized by multiple and/or nonspecific worries. The fear associated with GAD interferes with the person's ability to sleep, think, or function in some other way. Symptoms of anxiety are even described in the word itself. Specifically, the word anxiety comes from the Latin word anxietas, which means to choke or upset. The symptoms therefore include emotional or behavioral symptoms as well as ways of thinking that are responses to feeling as if one is in danger.

What are the different types of anxiety?

Anxiety can range from the constructive kind that elevates performance as with performance anxiety, to disorders of anxiety, in that the individual suffers from a level of fear, angst, or dread that interferes with his or her ability to function. The most common anxiety disorders are specific phobias. Other anxiety disorders include social anxiety disorder, panic disorder, generalized anxiety disorder, obsessive compulsive disorder, and posttraumatic stress disorder.

How common is generalized anxiety disorder?

GAD is quite common. In fact, it is the most common anxiety disorder seen by most primary care doctors. About 5% of people will develop GAD over the course of their lifetime. That translates to millions of GAD sufferers. This illness usually begins when individuals are in their early 20s. Panic and generalized anxiety occur in about 0.7% of children in any one-year period, up to 20% over the course of childhood.

What are causes and risk factors for anxiety?

While there is no single cause of GAD, women tend to develop this condition and most other anxiety disorders more often than men, and individuals with a family history of anxiety and depression are more at risk for having GAD. Younger adults are more likely to have GAD or social anxiety disorder compared to older adults. Other risk factors for developing social anxiety disorder include being of Native-American ethnicity and having a low income. Being of Asian, Hispanic, or black ethnicity, as well as residing in a more populated region, seems to reduce the risk of social anxiety disorder.

Inhibited temperament, parental anxiety, and having family and friends who somehow support avoidant coping mechanisms are risk factors for developing an anxiety disorder. Adolescents who smoke have been found to be at risk for developing anxiety. In children, girls, particularly those who begin puberty early, seem to be more likely to develop anxiety than their age peers of both genders.

Life stresses, involving health problems and family disagreements, have been found to be associated with developing an anxiety disorder. Certain other life stresses put people at risk for developing anxiety as well. For example, in a study of African-American, Afro-Caribbean, and non-Hispanic white individuals, non race-based discrimination was found to be a risk factor for developing anxiety in each of those groups while race-based discrimination was found to increase the likelihood of only the African-American people in developing anxiety.

What are anxiety symptoms and signs?

Common symptoms and signs of anxiety can include

• restlessness or feeling edgy,
• becoming tired easily,
• trouble concentrating,
• feeling as if the mind is going "blank,"
• irritability,
• muscle tension,
• sleep problems (trouble falling or staying asleep or having sleep that is not restful).

Anxiety that is associated with specific (specific or simple phobia) or social fears (social phobia) may also result in avoidance of certain situations or an elevation to the level of panic symptoms. In addition to the more general symptoms of anxiety previously described, worry that is associated with a traumatic event (posttraumatic stress disorder) may also result in the following symptoms:

• Avoidance of people, places, or situations that are reminiscent of the traumatic event
• Re-experiencing the trauma in repeated nightmares or flashbacks
• Difficulty trusting others
• Excessive attention to staying safe or keeping loved ones safe (for example, hypervigilance)
• A tendency to startle easily
• A sense of a bleak or foreshortened future

When anxiety intensifies to the level of becoming a panic attack, signs and symptoms can include

• palpitations;
• chest pain, chest tightness, feeling like one is having a heart attack;
• shortness of breath or trouble breathing;
• sweating of the palms;
• nausea or other stomach upset;
• trembling or shaking;
• feeling dizzy, unsteady, lightheaded, or faint;
• derealization (feelings of unreality) or depersonalization (feeling detached from oneself);
• fear of losing control or going insane;
• numbness or tingling sensations;
• chills or hot flashes;
• feeling like one is choking;
• a sense of impending doom;
• feeling like one is dying.

Anxiety symptoms and signs in children and teenagers

The similarities and differences in symptoms of anxiety in adults compared to children and adolescents depend on the specific condition that is causing the anxiety. For example, symptoms of obsessive compulsive disorder (OCD) are quite similar in children and teens compared to adults except that children and teens are less likely to recognize that their thoughts or behaviors are irrational. That is also true of minors who suffer from social phobia or specific phobia.

In addition to some of the differences in the symptoms themselves, before puberty, males seem to develop OCD more commonly than girls, and after puberty, females seem to have OCD more often than males. In children and adolescents, boys and girls seem to develop panic disorder and generalized anxiety disorder at equal rates. Disorders that tend to occur with OCD (co-morbid) are more commonly attention deficit hyperactivity disorder (ADHD) and tics in prepubescent people, versus other anxiety disorders and depression in teens and adults.

Symptoms of anxiety in children and teens tend to be consistent with how they express feelings in general. For example, lacking the higher ability to express feelings verbally compared to older children, younger children tend to express anxiety by complaining of physical symptoms like stomach upset or headaches. They are also more likely to cry, have tantrums, or become clingy. Compared to anxiety symptoms in children, in teens, the symptoms of anxiety will more closely approximate those in adults. However, adolescents are more likely than adults to exhibit anxiety by becoming irritable or angry.

Children with an anxiety disorder tend to develop the illness in early childhood, with symptoms being persistent, coming and going into adulthood.

Anxiety symptoms and signs in men and women

Studies indicate that men seem to experience different types of effects of anxiety compared to women. Specifically, men tend to exhibit more psychological symptoms of anxiety, like tension, irritability, and a sense of impending doom. In contrast, women tend to develop more physical symptoms like chest pain, palpitations, shortness of breath, and nausea. Further, it seems that women with such physical symptoms of anxiety are more at risk for developing heart problems.

How is generalized anxiety disorder diagnosed?

Many health care professionals may help individuals with GAD: licensed mental health therapists, family physicians, or other primary care professionals, specialists whom you see for a medical condition, emergency physicians, psychiatrists, psychologists, psychiatric nurses, and social workers. If one of these professionals suspects that you have GAD, you will likely undergo an extensive medical interview and physical examination. As part of this examination, you may be asked a series of questions from a standardized questionnaire or self-test to help assess your risk of anxiety. Anxiety may be associated with a number of other medical conditions or can be a side effect of various medications. For this reason, routine laboratory tests are often performed during the initial evaluation to rule out other causes of your symptoms. Occasionally, an X-ray, scan, or other imaging study may be needed. Well-recognized diagnostic criteria for generalized anxiety disorder are as follows:

• Excessive anxiety and worry that occurs more days than not for at least six months. The worries are either generalized or are 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 previously described symptoms (with at least some symptoms present for more days than not for the past six months).
• The focus of the anxiety and worry is not confined to features of other mood or to a thought disorder (such as social phobia, OCD, PTSD,schizophrenia, etc.).
• The anxiety, worry, or physical symptoms cause clinically significant distress or impairment an important area of functioning, like work, school, or socially.
• The illness is not due to the direct physical effects of a substance (like a drug of abuse or a medication) or a general medical condition (likehyperthyroidism) and does not only occur during a mood disorder, psychotic disorder, or a pervasive developmental disorder.

What is the treatment for anxiety?

There are a variety of treatments available for controlling anxiety, including several effective medications and specific forms of psychotherapy. In terms of medications,buspirone (Buspar) is known to be quite effective for treating GAD. However, it seems to be less effective in managing many other disorders that often co-occur (are comorbid) with GAD. Therefore, specific members of the selective serotonin reuptake inhibitor (SSRI) and the selective serotonin and norepinephrine reuptake inhibitor (SSNRI) drug classes, which are also approved by the U.S. Food and Drug Administration (FDA) for effective treatment of GAD, are prescribed more often. Examples of SSRI medications includefluoxetine (Prozac), sertraline (Zoloft),paroxetine (Paxil), citalopram (Celexa), andescitalopram (Lexapro). Examples of SNRI medications are duloxetine (Cymbalta) andvenlafaxine (Effexor). Although buproprion (Wellbutrin) is primarily known to primarily treat depression, preliminary research suggests that it may also be helpful in the treatment of anxiety.

Benzodiazepine medications likeclonazepam (Klonopin) and lorazepam(Ativan) are more useful in stopping severe anxiety symptoms, like those that occur in panic disorder or in posttraumatic stress disorder rather than the ongoing worry that is usually associated with GAD. Althoughalprazolam (Xanax) is often used to treatpanic attacks, its short duration of action can sometimes result in having to take it several times per day. Medications from the beta-blocker family (for example,propranolol [Inderal]) are sometimes used to provide rapid relief of the physical symptoms associated with a panic attack. Some individuals who suffer from severe panic attacks may benefit from treatment with neurontin (Gabapentin), which was initially developed to treat seizures, or may benefit from a neuroleptic medication like risperidone (Risperdal), olanzapine(Zyprexa), quetiapine (Seroquel), or aripiprazole (Abilify). Zolpidem (Ambien) has been found helpful in treating the insomnia that can often be a symptom of anxiety.

Before SSRIs and SSNRIs became available, medications from the group known as the tricyclic antidepressants (TCAs) were often used to address panic disorder. Although TCAs have been found to be equally effective in treating panic attacks, SSRIs and SSNRIs have been proven to be safer and better tolerated. Therefore TCAs are used much less often than they used to be. When used in the appropriate person with close monitoring, these medications can be quite effective as part of treatment for panic disorder.

For individuals who may be wondering how to avoid panic attacks using treatment without prescribed medications, natural remedies may be an option. While treatment like hypnosis and herbal supplements that containkava have been found to be helpful for some people with some anxiety disorders, the research data are still considered to be too limited for many physicians to recommend treatment with other natural remedies like valerianor passionflower. Also, care should be taken when taking any dietary supplements, since dietary supplements and "natural" remedies are not regulated in terms of quality, content, or effectiveness.

The psychotherapy component of treatment for anxiety disorders is at least as important as the medication treatment. In fact, research shows that psychotherapy alone or the combination of medication and psychotherapy treatment are more effective than medication alone in overcoming anxiety for both adults and children. It has also been found to be potentially effective for people with autism in addition to anxiety. The most common type of therapy used to treat anxiety is cognitive behavioral therapy (CBT). This form of therapy seeks to help those with an anxiety disorder identify and decrease the irrational thoughts and behaviors that reinforce anxiety symptoms and can be administered either individually, in group therapy, and even in partner-assisted therapy. CBT that seeks to help the anxiety sufferer decrease the tendency to pay excessive attention to potential threats has also been found to be helpful.

Behavioral techniques that are often used to decrease anxiety include relaxation techniques and gradually increasing exposure to situations that may have previously precipitated anxiety in the individual. Helping the anxiety sufferer to understand and how to handle the emotional forces that may have contributed to developing symptoms (anxiety-focused psychodynamic psychotherapy) has also been found to be effective in teaching an individual with panic disorder how to prevent an anxiety attack or to decrease or stop a panic attack once it starts.

Often, a combination of psychotherapy and medications produces good results. Improvement is usually noticed in a fairly short period of time, about two to three months. Thus, appropriate treatment for anxiety can prevent symptoms or at least substantially reduce their severity and frequency, bringing significant relief to many people with anxiety. There are also self-care measures that people with anxiety can do to help make treatment more effective. Since substances like caffeine, alcohol, and illicit drugs can worsen anxiety, those things should be avoided. Other tips to prevent or manage anxiety symptoms include engaging in aerobic exercise and stress-management techniques like deep breathing, massage therapy, and yoga, since these self-help activities have also been found to help decrease the frequency and severity of symptoms. Although many people breathe into a paper bag when afflicted by the hyperventilation that can be associated with panic, the benefit received may be the result of the individual believing it will remedy the symptoms (placebo effect). Also, breathing into a paper bag when one is having trouble breathing can make matters worse when the hyperventilation is the result of conditions of oxygen deprivation, like anasthma attack or a heart attack.

People with an anxiety disorder may also need treatment for other emotional problems. Depression has often been associated with anxiety, as have alcohol and drug abuse. Recent research also suggests that suicideattempts are more frequent in people with an anxiety disorder. Fortunately, these problems associated with panic disorder can be overcome effectively, just like panic disorder itself. Sadly, many people with anxiety do not seek or receive treatment.

What are the side effects of anxiety medications?

As anything that is ingested carries risk of side effects, it is important for the anxiety disorder sufferer to work closely with the prescribing doctor to decide whether treatment with medications is an appropriate intervention and if so, which medication should be administered. The kinds of side effects caused by a medication are highly specific to the specific medication itself and the medication class as a whole. The person being treated should therefore discuss potential medications with their treating physician and be closely monitored for the possibility of side effects that can vary from minor to severe and can uncommonly even be life-threatening. Due to the possible risks to the fetus of a mother being treated for anxiety with medication, psychotherapy should be the first treatment tried when possible in pregnant women.

What are complications of generalized anxiety disorder?

There are many possible complications associated with anxiety. Mothers who struggle with anxiety during pregnancy are more likely to have babies who are of low birth weight. Children with anxiety often also suffer from depression, behavioral problems, and substance abuse. They are at risk for having anxiety as adults, as well as attempting suicide and becoming psychiatrically hospitalized. In terms of achievement, children and teens with anxiety experience a higher rate of failing in school and as adults, of having low paying jobs.

Can anxiety be prevented?

Just as inhibited temperament, parental anxiety, and family and friends supporting avoidant coping mechanisms are risk factors for developing an anxiety disorder, encouraging the use of healthier ways to deal with stress can help prevent anxiety. Educating parents on how anxiety fits into their understanding of childhood development and the role of over protecting parents in developing anxiety disorders have been found to help prevent anxiety disorders in children. Maintaining a regular exercise program can be key to minimizing and perhaps preventing anxiety.

What is the prognosis of generalized anxiety disorder?

Generalized anxiety disorder can be quite chronic, in that the average length of time the illness lasts is 20 years if untreated. It can significantly interfere with the lives of individuals who have it and usually requires treatment for it to resolve. Therefore, people with generalized anxiety disorder are usually thought to need treatment for at least a year to prevent its recurrence.

Are there support groups for those with generalized anxiety disorder?

The following are examples of support groups for anxiety disorders:

ABIL, Inc. (Agoraphobics Building Independent Lives)
ABIL1996@aol.com

A.I.M. (Agoraphobics in Motion)
anny@ameritech.net

Freedom From Fear
http://www.freedomfromfear.org

Phobics Anonymous
619-322-COPE

Where can people find additional information on generalized anxiety disorder?

American Academy of Child and Adolescent Psychiatry
http://www.aacap.org

American Counseling Association
http://www.counseling.org

American Psychiatric Association
http://www.psych.org

American Psychological Association
http://helping.apa.org

Anxiety Disorders Association of America
http://www.adaa.org/

National Anxiety Foundation
3135 Custer Dr.
Lexington, KY 40517-4001
606-272-7166

National Association of Social Workers
http://www.naswdc.org

National Mental Health Association
http://www.nmha.org

National Panic/Anxiety Disorder News, Inc.
http://www.npadnews.com

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