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Generalized Anxiety Disorder: What is it exactly?




Generalized Anxiety Disorder: An Overview

Generalized anxiety disorder is a form of anxiety that is chronic, lasts for at least six months and is not accompanied by obsessions, phobias or panic attacks. A person with generalized anxiety disorder experiences constant worry and anxiety without all the comorbid symptoms of other anxiety disorders. To be given a diagnosis of this anxiety disorder, you must be focused on two or more specific, stressful life experiences such as significant concern related to work, finances, relationships or other issues most days for a minimum of six months. Individuals with generalized anxiety disorder often spend a lot of time worrying and tend to have several or many significant concerns. However, it is very difficult to manage any control over your worries and anxiety when you have this disorder. Also, the worries tend to be significantly out of proportion to the actual threat involved.




If you have generalized anxiety disorder, you will most often have at least three of the following six symptoms, most days for a minimum of six months:

• Irritability
• difficulty concentrating
• difficulties with sleep
• being fatigued easily
• feeling restless
• tension in the muscles

Another important aspect of generalized anxiety disorder is that you will experience a significant level of distress and impairment in daily activities related to work, school and social experiences.

Most often, before a physician will diagnose you as having this anxiety disorder he/she will have ruled out most possible medical causes of chronic anxiety such as thyroid problems, drug-induced anxiety and hyperventilation. Generalized anxiety disorder also often occurs at the same time as depression. A competent psychologist or mental health clinician will quickly try to distinguish whether the anxiety should be treated as the primary or secondary disorder. It is often difficult to tell which came first.

This anxiety disorder can develop at any age. Among children and adolescents, the focus of worries will tend to be related to school or performance in sports. The source of concern among adults can be related to a variety of circumstances. It is believed that generalized anxiety disorder affects approximately 4% of the population in the United States and may be slightly more common among women (55% to 60%) than men.

Generalized anxiety disorder is not usually associated with any specific phobias. However, Aaron Beck M.D., has suggested that the disorder may be related to some “basic fears” of a broad-based nature. They may include:

• fear of being unable to cope
• fear of failure
• fear of disease and death
• fear of abandonment or rejection
• fear of losing control

Generalized anxiety disorder may be exacerbated by any circumstance that increases your perception of danger or seems threatening. The underlying cause is unknown although it is believed to be related to some combination of heredity and experiences in childhood such as excessive expectations of parents, fears of abandonment or rejection by others.

Treatment for Generalized Anxiety Disorder:

Cognitive Behavioral Therapy

Often some form of cognitive behavioral therapy is used to treat generalized anxiety disorder. Utilizing this type of psychotherapy involves identifying themes of worry and fearful self-talk which is then challenged and replaced by more positive, constructive thoughts. More realistic, positive thoughts are used to replace counterproductive thoughts which are then practiced and internalized over time. Cognitive behavioral therapy may also utilize guided imagery to replace negative with more positive themes of mental imagery.

Medication

Medications may be recommended for generalized anxiety disorder in moderate to severe cases. These medications may involve the use of both anxiety medications and antidepressants. Frequently, the anxiety medication Buspar may be used. At other times SSRI antidepressants may be used such as Luvox, Zoloft, Paxil or Serzone either alone or in conjunction with| Buspar.

Relaxation Training

Relaxation training for generalized anxiety disorder usually involves some type of deep breathing and relaxation techniques to reduce the generalized worry and feeling of anxiety. Also, a consistent exercise program may also be included.

Problem-solving

Problem-solving usually takes the form of systematically working through and solving issues in our lives that seem to be a focus of worries. The focus becomes on solutions as opposed to the worries themselves. If there is no practical solution to a problem, the focus then becomes on ways to cope with the situation rather than continuing to worry about it. Sometimes, we may need to learn to accept things that we cannot change.

Distraction

Distraction can also be used at times to help cope with worries that are not amenable to treatment with cognitive behavioral therapy or problem-solving. Distraction may involve diverting your attention to other activities such as listening to music, talking on the telephone, exercising, cooking, reading or solving puzzles.

Personality and Lifestyle Changes

Intervention along these lines tend to focus on the use of methods usually described to assist with panic disorder such as increased downtime, stress management, regular exercise, and eliminating stimulants and sweets from your diet. It may also involve resolving problems with others, changing attitudes toward perfectionism, a need to please others or an excessive need to feel in control.

By Paul Susic Ph.D. Licensed Psychologist


Other Specified Anxiety Disorder Symptoms and Related DSM–5 Diagnosis





Other Specified Anxiety Disorder 300.09 (F41.8):

Information related to Other Specified Anxiety Disorder as well as the specific symptoms follow below. While some of these Other Specified Anxiety Disorder symptoms may be recognized by family, teachers, legal and medical professionals, and others, only properly trained mental health professionals (psychologists, psychiatrists, professional counselors etc.) can or should even attempt to make a mental health diagnosis.




A multitude of factors are considered in addition to the psychological symptoms in making a proper diagnosis, including medical and psychological testing considerations. This information is for information purposes only and should never replace the judgment and comprehensive assessment of a trained mental health clinician.

Other Specified Anxiety Disorder diagnostic criteria 300.09 (F41.8):

This category applies to presentations in which symptoms characteristic of an anxiety disorder that causes clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the anxiety disorders diagnostic class. The other specified anxiety disorder category is used in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific anxiety disorder. This is done by recording “other specified anxiety disorder” followed by the specific reason (e.g. “generalized anxiety not occurring more days than not”).

Examples of presentations that can be specified using the “other specified” designation include the following:

1. Limited-symptom attacks.
2. Generalized anxiety not occurring more days than not.
3. Khyal “wind attacks”:
4. Ataque de nerios (attack of nerves).

Diagnostic Information and Criterion for Anxiety Disorders adapted from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition American Psychological Association by Paul Susic Ph.D. Licensed Psychologist



Generalized Anxiety Disorder Overview: Must Know Information







Fundamentals of Generalized Anxiety Disorder:

Generalized Anxiety Disorder is most frequently identified by its recurrent, prolonged pattern of excessive anxiety and worry. Individuals with this anxiety disorder usually agonize over relatively expected concerns including daily finances, health, family concerns, responsibilities at work, or even such minor issues as car repairs and household chores.




The focus of worries and anxiety may frequently shift back and forth between several different concerns and the sensations may vary between dread, terror and mild tension.

Some studies have found that Generalized Anxiety Disorder may affect between 2% and 3% of the general population. For many individuals with this disorder, they are aware that the intensity, duration and frequency of their worries and anxiety may be well out of proportion with the actual circumstances or precipitating event. Given this awareness, they still have a tremendous difficulty in controlling or limiting this uncomfortable sensation. Constant worry or anxiety can impair an individual’s ability to concentrate and may affect their memory and even decision-making ability. These concerns also may lead to a loss of confidence over a period of time. Everyday activities such as socializing with others and maintaining relationships or even working consistently may become very difficult and sometimes even impossible.

This anxiety disorder may also produce an intense range of physical symptoms such as heart palpitations, nausea, headaches and unusual sweating. Many people who have this disorder do not realize that it is actually very treatable. They frequently assume that their intense feelings of anxiety are normal and are reluctant to seek treatment. Unfortunately, constant anxiety and worry can also lead to drug abuse and alcoholism. Some people do not seek treatment until they have had intense and prolonged physical discomfort for an extended period of time resulting in possibly alcoholism or drug abuse.

Treatment for Generalized Anxiety Disorder:

Although Generalized Anxiety Disorder is developed over a long period of time and has a chronic nature, it actually responds to treatment better than some other anxiety disorders such as Panic Disorder and Obsessive-Compulsive Disorder. Also, relaxation techniques such as deep breathing and or meditation have been found to relieve the symptoms of Generalized Anxiety Disorder.
Venlafaxine (Effexor) and paroxetine (Paxil) have both been approved by the FDA to treat Generalized Anxiety Disorder. Some other classifications of medications are also used to treat this anxiety disorder including serotonin norepinephrine reuptake inhibitors, SSRIs, tricyclics, and benzodiazepines such as alprazolam (Xanax) and diazepam (Valium).




As with many of the other anxiety disorders, prolonged symptoms of Generalized Anxiety Disorder can sometimes lead to depression and drug or alcohol abuse. Also, some anxiety medications such as benzodiazepines should be limited to a short course of treatment to avoid dependence and tolerance and can be a relatively serious concern when used for more than a short period of time. Antidepressants and buspirone are frequently better choices because they do not cause dependence, tolerance and withdrawal symptoms.
Psychotherapy such as cognitive behavioral treatment is also frequently used and is very effective for helping individuals with Generalized Anxiety Disorder. Psychologists and other mental health professionals are frequently able and willing to assist with individuals experiencing Generalized Anxiety Disorder.

By Paul Susic Ph.D. Licensed Psychologist

Inspired by the Johns Hopkins Medical Guide to Health after 50