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:
• 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.
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 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 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 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