Generalized Anxiety Disorder

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“The only thing we have to fear is fear itself”. FDR said that in his first inaugural speech in 1933 in an effort to calm the nation in experiencing the Great Depression I. He did accomplish that aim but the statement, itself, is somewhat scary.

If you fear snakes then you fear something that is objective and tangible, but if you are afraid of fear itself then that is very amorphous and difficult to grasp. Such is generalized anxiety disorder (GAD). Generalized anxiety disorder is a condition of having excessive, uncontrollable and irrational worry, lasting for six months or more.

Every day, this can interfere with a sufferer’s functioning as they typically anticipate disaster. Instead of “hoping for the best and preparing for the worst”, they worry about the bad and expect the worst. Issues about health, money, family, friendship, work, and even death loom large on a daily basis.

Symptoms

It is generally determined and diagnosed in people who exhibit

1) excessive anxiety and worry on 50%+ days in six months about various events or activities;

2) a difficulty to control the worry;

3) the worry and anxiety being associated with three or more (or just one for children) of the following: restlessness or on edge; irritability; difficulty in concentration or mind going blank; being easily fatigued; sleep disturbance; muscle tension;

4) not simply social phobia or anxiety, OCD, PTSD or others;

5) the worrying causing adverse and significant obstacles or impairments in functioning; and

6) not a direct or sole result of substance abuse or a general medical condition.

Other symptoms include fidgeting, trembling, twitching, agitation, restlessness, headaches, muscle aches, sweating, nausea, insomnia, numbness in hands and feet, rashes, occurrences of difficulty in breathing or swallowing, hot flashes, the need to go to the bathroom frequently, and being easily startled, any of which must be ongoing for six or more months.

It is estimated that 3.1% of Americans (or over 9.8 million people), perhaps as much as 5% of Canadians and 2% of European adults are affected each year. GAD often begins in childhood, but can begin in adulthood, and appears in about twice as many women as men.

Depression often accompanies GAD and depression in children is a strong indicator of GAD in adulthood. It is the most common anxiety disorder among the elderly. Anxiety disorders (not only GAD but also obsessive-compulsive disorder, social anxiety disorders, post-traumatic stress disorders and others) result in costs of $42 billion per year in the United States, according to a study in 1999.

Now, undoubtedly, it is far, far higher. It is very treatable, but only about 33% of sufferers receive such treatment. There are a variety of causes of GAD. The first is of heredity or genetics. Like the genetic tendency of obesity, genetics may not, in and of itself, cause GAD but in conjunction with another stressor or trigger, generalized anxiety disorder can appear. Perhaps, or perhaps not, related to this is an individual’s brain chemistry.

Generalized Anxiety DisorderNeurotransmitters transmit information from one nerve cell to the next in the brain, and if these nerve cell pathways connect to the regions involved in thinking and emotion are not functioning normally then GAD can result. In such cases, though, medications and psychotherapies are very effective treatments.

The use and withdrawal of substances, such as benzodiazepines, alcohol, tobacco, and even caffeine can result in GAD and/or make underlying anxiety issues worse.

Other triggers can be constant sadness, trauma, physical or mental abuse, the death of a loved one, divorce, changing jobs or schools, even residing in a large city (which often means more and higher expenses, and higher stress levels), and even a supposedly joyous event (such as having a baby–postpartum depression).

Yet other triggers, or perhaps just correlations, are gender (again, GAD occurs in twice as many women as men); age (again, GAD is prevalent in children and the elderly); personality factors, especially among children (GAD more often appears in very shy or introverted children, and in those who cannot tolerate uncertainty); social factors (a lack of social connections, a feeling of a threatening environment, and being an immigrant–especially long-term, rather than recent, immigrants); and medical conditions (migraines, obstructive sleep apnea, irritable bowel syndrome, chronic fatigue syndrome and premenstrual syndrome.

Treatments are medication and therapy, with the most effective–especially for the long-term–being cognitive behavioral therapy (CBT). Prescribed medicines are usually SSRIs (selective serotonin reuptake inhibitors) which can cause nausea, diarrhea, constipation, headache, sexual dysfunction and others; benzodiazepines (which, ironically, is one of the above-mentioned triggers) which can result in drowsiness, impaired motor coordination and sense of balance; pregabalin; psychotropic drugs such as buspirone, duloxetine, imipramine, venlafaxine, afobazole, tricyclic antidepressants and some MAO inhibitors; as well as others.

In addition to the above-mentioned and well-regarded cognitive behavioral therapy, there is also the Intolerance of uncertainty therapy (IUT). This focuses on helping patients tolerate, cope and accept uncertainty in their lives, and could be very effective in those above-mentioned children who cannot tolerate uncertainty.

Acceptance and commitment therapy (ACT) acts with three goals in mind:

1) reduce the use of avoidance in dealing with feelings, thoughts, memories and sensations; 2) increased use of E-prime (in which “I’m hopeless” becomes “I feel hopeless” or similar statements); 3) and reinforcing goals and commitments to it in changing behaviors. It is considered to work better in conjuction this medication.

Motivational interviewing is intended to

1) express empathy; 2) show the contrast between desired and undesired behaviors; 3) proceed to avoid direct confrontation; and 4) encourage self-sufficiency. It is sometimes used in conjunction with CBT, and there have been some studies that show that such usage is more efficient than CBT alone.

If you do have considerable GAD symptoms then do seek treatment. You do not want to be one of the 67% who do not receive such treatment.