Question
Generalized Anxiety Disorder
Answer
- Introduction
A generalized anxiety disorder is an excessive, uncontrollable and often irrational worry about everyday things that is disproportionate to the actual source of worry. This constant worry often affects day to day functioning, concentration, sleep, quality of life and often leads to more acute forms of anxiety and depression. The lifetime prevalence of generalized anxiety disorder is between 4-7% with a median age of onset being 31 years. The prevalence is double in females than in males. It is a chronic condition with the average duration being 2+ years. It is a commonly under diagnosed condition and to be diagnosed with it, it must be filed in the primary diagnosis category. In the ICD-10, the diagnosis is code F41.1 and in the DSM-IV-TR it is 300.02. Symptoms must occur at least 6 months in order for the diagnosis to apply.
1.1 Definition
Anxiety is generally known in society, and the subject has been researched hugely but Generalised Anxiety Disorder (GAD) is not so known to the general public and health professionals. This is a serious and chronic condition which is characterised by excessive worry, anxiety, occurring more days than not for a period of at least six months. The National Institute of Mental Health (NIMH) defined GAD as: “excessive, uncontrollable and often irrational worry about everyday things that is disproportionate to the actual source of worry. This means that people with this disorder always think disaster is just around the corner and there is no way to stop it. Often they are aware that this is unnecessary but feel unable to control it.” The excessive worrying can cause physical symptoms and another part of the definition refers to the individual also feeling physical symptoms, whereas many with anxiety do not. This then leads to the individual feeling mental tension, anxiety, or they may avoid certain activities, which only in the short term lessens the anxiety, but will reinforce the idea that extraordinary/invisible danger will not be and end up making the person more isolated and depressed. The last part of the NIMH definition refers to the fact that the constant worrying affects the person day to day and prevents them from having relaxed periods.
1.2 Prevalence
A considerable amount of the literature on Generalized Anxiety Disorder (GAD) has demonstrated that it is a condition that is, contrary to past beliefs, relatively common. It is the most frequent anxiety disorder diagnosed and its sufferers are more likely to experience its symptoms throughout their life compared to those with most other anxiety disorders. It has been found to be most prevalent in clinical settings, occurring in 8-10% of the general population presenting to a physician’s office. This is more common than the lifetime prevalence rates of other chronic medical or psychiatric illnesses such as heart disease or diabetes. GAD manifests more frequently in women than in men, with approximately 60% of those with a diagnosis being female. Childhood and adolescence are also particularly vulnerable times, with research suggesting the average age of onset to be 20 years, often occurring in relation to major life transitions such as beginning college or marriage. This has important implications as the early onset of GAD is associated with an increased likelihood of comorbidity with other anxiety and mood disorders. Finally, those of lower socioeconomic status are more likely to suffer from GAD and it is often experienced as chronic muscle tension and worrying in response to environmental stress. The high prevalence of GAD and the chronic nature of its presentation highlight the significance of the following research into its treatment and effective management.
1.3 Symptoms
Excessive anxiety and worry are present more days than not for at least 6 months. The person finds it difficult to control the worry. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months): Note: Only one item is required in children. – Restlessness or feeling keyed up or on edge. – Being easily fatigued. – Difficulty concentrating or mind going blank. – Irritability. – Muscle tension. – Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep). The focus of the anxiety and worry is not confined to features of an Axis I disorder, e.g. the anxiety or worry is not about having a Panic Attack (as in Panic Disorder), being embarrassed in public (as in Social Phobia), being contaminated (as in Obsessive-Compulsive Disorder), obtaining perfect weight (as in Anorexia Nervosa), having a serious illness (as in Hypochondriasis), or being away from home or close relatives (as in Separation Anxiety Disorder).
- Causes
2.1 Biological Factors
2.2 Environmental Factors
2.3 Psychological Factors
- Diagnosis
3.1 Diagnostic Criteria
3.2 Assessment Tools
3.3 Differential Diagnosis
- Treatment
4.1 Psychotherapy
4.1.1 Cognitive Behavioral Therapy
4.1.2 Exposure Therapy
4.1.3 Acceptance and Commitment Therapy
4.2 Medications
4.2.1 Selective Serotonin Reuptake Inhibitors
4.2.2 Benzodiazepines
4.2.3 Buspirone
4.3 Lifestyle Changes
4.3.1 Exercise
4.3.2 Stress Management Techniques
4.3.3 Sleep Hygiene
- Prognosis
5.1 Long-term Outlook
5.2 Relapse Prevention
- Coping Strategies
6.1 Self-Help Techniques
6.2 Support Systems
6.3 Mindfulness and Meditation