What is Generalized Anxiety Disorder?
Generalized anxiety disorder is one of the most frequent mental health conditions, affecting up to 20% of adults each year. It’s a disorder that creates feelings of fear, worry, and a constant sensation of being overwhelmed. People with this condition worry persistently, excessively, and unrealistically about everyday matters.These worries can span various areas – finances, family issues, health, and even future anxieties. It’s uniquely characterized by the worry being hard to control and typically being accompanied by a variety of psychological and physical symptoms.
According to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), the criteria for diagnosing generalized anxiety disorder are as follows:
- Consistent, excessive anxiety and worry persisting for at least 6 months
- Difficulty in controlling the worry
- The anxiety is tied to at least three of the following symptoms for a minimum of six months:
- Constant restlessness, feeling on edge
- Getting tired easily
- Challenges with concentration or a blank mind, irritability
- Muscle tension
- Problems with sleep
- Irritability
- The anxiety significantly distresses the individual or hinders their social and occupational functioning.
- The anxiety can’t be explained by any physical cause.
What Causes Generalized Anxiety Disorder?
The causes of generalized anxiety disorder could be different for different people and might include various factors:
Stress is one such factor that can lead to generalized anxiety disorder. Medical conditions like diabetes, or other related health issues such as depression, can also trigger this disorder.
Another factor that could play a role is your genes. If your parents or siblings have generalized anxiety disorder, you have a 25% higher risk of developing the same condition.
Your environment can also contribute to this disorder. Experiences like child abuse can lead to generalized anxiety disorder.
Last but not least, substance use disorder is another cause associated with generalized anxiety disorder.
Risk Factors and Frequency for Generalized Anxiety Disorder
About 1 in 4 children experience anxiety between the ages of 13 and 18, with it usually starting from around 11 years of age. Severe anxiety disorder has a prevalence of approximately 6% within the 13 to 18 age group. Anxiety amongst children under the age of 18 generally falls between 5.7% to 12.8%. Anxiety occurs twice as much in women than men.
The diagnosis of generalized anxiety disorder (GAD) was first introduced by the American Psychiatric Association 20 years ago. Before this, GAD was viewed as a key part of anxiety neurosis, alongside panic. Over time, it was recognized that while GAD and panic often occur together, they are different enough to be considered individual disorders. Therefore, they were separated in the diagnostic manual.
GAD was defined as having an uncontrollable and widespread anxiety or worry that is not connected to a specific life problem. This worry is seen as excessive or unrealistic given the individual’s life circumstances and it must persist for a month or longer. Other related physical symptoms linked to mental processes were also needed to confirm a diagnosis. Early studies into this definition suggested that GAD was seldom seen without another anxiety or mood disorder. GAD and major depression frequently occurred together, which led some to argue that GAD could be viewed as an early warning sign, leftover symptom, or an indicator of severity for other disorders, rather than a separate disorder.
The rate of comorbidity (presence of two or more disorders in a single individual) of GAD with other disorders decreases as GAD’s duration increases. This led to a recommendation to increase the duration required for diagnosis to 6 months. Further adjustments were made to the definition of excess worry and the number of required psychophysiological symptoms.
Changes in the way GAD was diagnosed caused delays in gathering data about this disorder’s occurrence. However, newer data has challenged the idea that GAD should be looked at as an early sign or leftover symptom of another disorder. Instead, it suggests that GAD is a fairly common disorder that, while often observed with other mental disorders, does not have higher comorbidity rates than most other anxiety or mood disorders.
Signs and Symptoms of Generalized Anxiety Disorder
People with anxiety often come to doctors with physical symptoms, instead of psychological issues, which can make identifying the problem a bit tricky. Common physical symptoms can include things like shortness of breath, heart palpitations, feeling tired, headaches, dizziness, and not being able to sit still. Mental symptoms can include excessive worry, emotional mood swings, difficulty focusing, and trouble sleeping.
Many things can contribute to increasing the likelihood of someone having generalized anxiety. Typically, these might involve:
- Being female
- Being unmarried
- Having poor health
- Having low levels of education
- Being under a lot of stress
The average age that people first start showing signs of generalized anxiety is around 30 years old. There are many ways doctors can measure how severe a person’s anxiety is, with one commonly-used tool being the GAD-7, which has been proven to be effective for diagnosis and measuring severity.
Testing for Generalized Anxiety Disorder
First, it’s important to address any physical or behavioral symptoms that arise. It’s also crucial to look into any stresses on the mental and social front, challenges faced in social interactions, and developmental issues. Your doctor will want to know about past medical history, like any physical injuries, mental health conditions, and substance abuse.
To make sure these symptoms are not due to any physical ailments, your doctor might conduct a few tests such as:
- Tests to check thyroid functions
- Blood sugar tests
- Heart scans or echocardiography
- Tests to detect any harmful substances or drugs in your body, known as a toxicology screen
For people experiencing generalized anxiety disorder, there’s a screening tool called the Generalized Anxiety Disorder 7-Item Questionnaire. It can be really helpful to monitor the symptoms and the progress over time.
Treatment Options for Generalized Anxiety Disorder
There are two main treatments for generalized anxiety disorder: cognitive behavioral therapy (CBT) and medication. Usually, a combination of both approaches works best, and it may take some time and effort to figure out what suits each patient best.
Cognitive behavioral therapy involves educating patients about their disorder, helping them change negative thought patterns, and gradually making them confront situations that trigger their anxiety.
Medication is given to patients who do not show improvement after CBT. In cases where the anxiety symptoms are severe, both medication and CBT are initiated together. The types of medications can vary.
Antidepressants are usually the first choice. These include drugs like Lexapro, Cymbalta, Effexor XR, and Paxil. These have a response rate of 30% to 50%. A study showed that 81% of children with anxiety disorders responded to a combination of a specific antidepressant called sertraline hydrochloride and cognitive behavioral therapy.
In certain cases, antipsychotic drugs may also be used, especially if behavioral issues are present alongside anxiety.
Benzodiazepines, including diazepam and clonazepam, are used for quick relief of symptoms or for short-term treatment. These work well for patients who understand the psychological basis of their symptoms. However, since there’s a risk of abuse and dependency, these are not suitable for patients with a history of alcohol or drug misuse.
Buspirone, a non-benzodiazepine drug, is another option. It does not cause dependency and is less likely to make patients drowsy compared to benzodiazepines. However, it tends to take 2 to 3 weeks before the effects kick in, which can limit its use.
It’s important to start all these medications at a low dose and then gradually increase it. They need to be taken for at least four weeks to gauge their effectiveness. Once the symptoms are under control, these medications need to be taken for a minimum of a year before slowly stopping them. These drugs can come with their own side effects, such as weight gain and diabetes, which means patients need to be checked regularly when using these medications.
In addition to medications, psychotherapy can also be used, and it has been shown to be effective.
Educating patients about their condition is vitally important as it can help alleviate their anxiety. Avoiding triggers like caffeine, alcohol, nicotine, and stress, along with promoting good sleep, can also help manage anxiety.
There are also alternative remedies available, but they come with little or no scientific proof of their effectiveness. Some agents, like Kava, may harm the liver, while others, like St John’s wort and hydroxytryptophan, can interfere with antidepressants and potentially cause serotonin syndrome.
What else can Generalized Anxiety Disorder be?
When trying to diagnose Generalized Anxiety Disorder (GAD), doctors need to consider other health conditions that can cause similar symptoms:
- Hyperthyroidism (an overactive thyroid)
- Pheochromocytoma (a rare tumor of the adrenal gland)
- Chronic Obstructive Pulmonary Disease (a type of lung disease)
- Transient Ischemic Attack (often called a mini-stroke)
- Epilepsy (a neurological disorder causing seizures)
- Bipolar Disorder (a mental health condition causing extreme mood swings)
- The use of stimulants like caffeine, decongestants, or the asthma medication albuterol
These conditions are considered during the diagnosis process to ensure an accurate diagnosis is made.
What to expect with Generalized Anxiety Disorder
The outlook for individuals suffering from generalized anxiety disorder can be uncertain. A lot of these patients may stop taking prescribed medications due to their high costs and unpleasant side effects. Recurrence of the disorder is quite common and patients frequently seek doctors who understand their needs. This disorder is notably challenging to cure using traditional medicine, leading many to explore alternative therapies, but these are often unsuccessful. Generally, the quality of life for these patients tends to be low.
Possible Complications When Diagnosed with Generalized Anxiety Disorder
Generalized anxiety disorder can lead to or worsen a range of other mental and physical health conditions. These might include:
- Depression, which often occurs alongside anxiety disorders
- Insomnia or difficulties sleeping
- Problematic drug or alcohol use
- Problems with the digestive system
- Social isolation or difficulty in social settings
- Issues with functioning at work or school
- Decreased quality of life
- Increased risk of suicide
Preventing Generalized Anxiety Disorder
It’s essential for people suffering from anxiety disorders to know the importance of regularly taking their prescribed medications, which might include medicines to help them feel less anxious, tackle depression or improve sleep. Additionally, engaging with any recommended cognitive therapy methods can be highly beneficial. It can also be helpful to quit consuming caffeine or other substances that stimulate the body, as these could aggravate anxiety symptoms.