Generalized anxiety disorder (GAD) - causes, symptoms & treatment

Say you’ve got a huge presentation in front of all your colleagues; you’re nervous,

you’ve got quite a bit of stress leading up to the presentation. That stress is completely

normal, and really—probably useful in certain situations since it can make you more alert

and careful. After the presentation’s over you feel the stress start to fade away, right?

Well...for 3% of the population, the stress doesn’t go away, and maybe that stress isn’t

even brought on by a specific event and is always just sort of always there. Either way,

at this point it’s considered to be anxiety. That anxiety might even get worse over time,

and causes things like chest pains or nightmares.

Sometimes the anxiety’s so severe that it causes someone to be anxious about leaving

the house or doing everyday things, like going to work or school. This anxiety may be a sign

of Generalized Anxiety Disorder, sometimes shortened to GAD. GAD’s characterized by

excessive, persistent, and unreasonable anxiety about everyday things, like money, family,

work, and relationships; even sometimes the thought of getting through the day causes

anxiety. If the anxiety’s persistent, then it doesn’t seem to go away, if it’s excessive,

it’s usually more than someone else might feel, and if it’s unreasonable, they probably

shouldn’t have a reason to feel anxious about it.

People who have GAD might even understand that their anxieties are excessive and unreasonable,

but they feel it’s out of their control and don’t quite know how to stop it. People

with severe GAD might be completely debilitated and have trouble with the simplest daily activities,

or they might be only mildly affected and be able to function socially and hold down

a job. Sometimes the feelings might worsen or improve over time.

In addition to having feelings of worries and anxiety, other symptoms include edginess

and restlessness, difficulty concentrating or feeling like the mind just goes blank,

and also irritability. These psychological symptoms can also lead to physical manifestations

of symptoms like digestive problems from eating more or eating less. They might also have

muscle aches and soreness from carrying tension in their muscles. Finally difficulty sleeping

is a really common symptom that can have a serious impact on physical well-being, since

the body’s not resting and can lead to issues of chronic fatigue.

Although the decision that someone’s worry is excessive and unreasonable has a subjective

quality, diagnosing GAD is aided by the diagnostic and statistical manual of mental disorders,

or DSM-V, this manual gives a list of criteria to meet in order to be diagnosed with GAD.

First, the excessive worry and anxiety has to have been present for more days than not

over the course of 6 months. In other words, a person should have the symptoms of excess

or unreasonable worry on 90 or more days out of 180 days. Generally, people can’t quantify

or track their feelings in that way, so again, this is meant to offer a general guideline,

right? Okay second—the person finds it hard to control their anxiety, meaning that they

have a hard time calming themselves or “self-soothing” to help themselves regain control over their

feelings. Third, an adult must have three or more of the symptoms listed previously.

In children though, typically defined as “school-age”, so between 6 and 18 years old, only one symptom

is needed for the diagnosis of GAD. Another criteria is that the anxiety causes impairment

in important daily activities like school or work. For example, they might miss deadlines

or find it difficult to even go to work because of their symptoms. Fifth, the symptoms are

not attributable to the physiologic effects of a drugs or medication, or due to a medical

condition like hyperthyroidism which creates an excess of thyroid hormone, which can sometimes

cause symptoms of anxiety and worry. Finally, their anxiety isn’t better explained by

another mental disorder like social phobia or panic disorder.

Just like a lot of mental disorders, it’s unclear exactly why some individuals develop

generalized anxiety disorder, but it’s thought to be a combination of genetic and environmental

factors, as it seems to run in families. It also has been shown to be twice as prevalent

in females than in males.

Treating GAD, like many mental disorders, may involve psychotherapy, medication, or

a combination of the two. If it’s psychotherapy, cognitive behavior therapy has been effective

since it teaches the patient to think and behave in different ways, and react differently

to situations that would usually causes anxiety and worry. Medications like benzodiazepines

or antidepressants might be prescribed as well, benzodiazepines are a type of psychoactive

drug that have a relaxing and calming effect. Antidepressants might also be prescribed,

like selective serotonin reuptake inhibitors, or SSRIs, which regulate the serotonin levels

in the brain and help elevate mood. Even though both medications and cognitive behavior therapy

have similar effectiveness in the short-term, cognitive behavior therapy has major advantages

over medication in the long term, due to unwanted effects of the medications like tolerance,

dependence, and withdrawal.