Understanding Generalized Anxiety Disorder – Diagnosis and Treatment
Life is very unpredictable, and despite how good you have it in life, it is totally normal to experience some worry and anxiety from time to time.
The situations that might cause someone to worry are endless – your kid not getting home by a certain time, hearing that your company has plans to lay off some staff, walking home in the dark, hearing screams outside your home, you name it.
Feeling anxious in such situations is normal, and in most cases, the anxiety eases up in a short while after you learn that everything is okay.
Sometimes, however, the anxiety and worry does not let up.
Some people find themselves in a constant state of worry, even when there is no apparent cause for their worry.
They have no ability to control their feelings of worry and anxiety.
Sometimes, these feelings become so powerful that they even interfere with the person’s ability to perform normal, day to day activities, such as going to work or school, or even interacting with others.
If you find yourself in such a constant state of worry for a period of over six months, there is a chance that you might be suffering from generalized anxiety disorder (GAD).
People suffering from generalized anxiety disorder experience exaggerated and excessive anxiety about normal, everyday activities and events.
They are constantly in a state of dread, afraid that something terrible is about to happen.
They worry that they will lose their jobs, that they will get an accident if they drive or get into a car, that their spouse is cheating, that their kid will be kidnapped, you name it.
Most of the times, the amount of worry and anxiety they experience about a situation is unrealistic or out of proportion.
Try as they can, they can’t stop thinking about disastrous outcomes.
Generalized anxiety disorder occurs in both children and adults. In most cases, diagnosing the condition is usually a huge challenge.
Generalized anxiety disorder often occurs together with other mood and anxiety disorders, therefore it can be easily mistaken for something else.
In addition, its symptoms are similar to those of other mental conditions such as obsessive-compulsive disorder, panic disorder and other kinds of anxiety disorders.
To make matters even worse, someone suffering from general anxiety disorder does not experience panic attacks, which is the distinctive feature of anxiety disorders.
Without experiencing panic attacks, many of those suffering from the condition tend to dismiss it as a case of simply “worrying too much” and therefore do not seek medical help.
All these factors make it difficult to diagnose and treat the condition.
It’s good to note that there is a difference between generalized anxiety disorder and phobias.
Someone with a phobia has a fear of a particular thing – such as dogs, snakes, heights, spiders, small spaces, crowded places, public speaking, and so on.
Someone suffering from generalized anxiety disorder, on the other hand, is fearful of life in general.
They are in a state of constant terror over everything.
They picture the worst-case scenario for every situation. If their kid has not gotten home by a certain time, they start imagining that the kid has been kidnapped or hit by a bus, instead of something more realistic, such as the bus being late by a few minutes.
Unlike with phobias where you can avoid the reason behind your phobia, there is no “off” button for someone suffering from generalized anxiety disorder. The sense of dread is unending since the worry is triggered by life in general.
Despite the fact that generalized anxiety disorder is difficult to diagnose, it is one of the most common mental disorders in the United States. In any given year, about 6.8 million adults in America suffer from generalized anxiety disorder, with women being more likely to be affected.
WHAT CAUSES GENERALIZED ANXIETY DISORDER?
Despite being one of the most common mental disorders, the exact cause of generalized anxiety disorder has not been identified.
Still, there are some factors that are associated with an increased risk of experiencing generalized anxiety disorder.
In many cases, generalized anxiety disorder is triggered by stressful events in life, such as loss of a job, the death of a loved one, abuse, changing schools or jobs, and so on.
Traumas resulting from abuse during childhood can also contribute to the development of generalized anxiety disorder.
A person’s genetics might also contribute to the development of generalized anxiety disorder.
Some studies have shown that people whose first degree relatives have generalized anxiety disorder have an increased risk of also being affected by the condition, as well as other mood and anxiety disorders.
Brain chemistry also plays a role in the development of generalized anxiety disorder.
Imaging studies carried out on GAD patients show that the condition is associated with increased activity in the amygdala, a part of the brain that is responsible for processing negative emotions.
Researchers believe that this heightened activity in the amygdala is what causes the inaccurate interpretation of social cues, leading to situations being blown out of proportion.
This is why people suffering from generalized anxiety disorder may feel worried even in situations that are not threatening.
The likelihood of developing generalized anxiety disorder is also influenced by the amount of gray matter in some parts of the brain.
Specifically, generalized anxiety disorder is associated with increased volume of gray matter in a section of the brain known as the right putamen.
Increased volume of gray matter in the right putamen is also linked with maltreatment during childhood.
Therefore, the increase in gray matter in the right putamen could be a pointer of the role of childhood maltreatment in the development of generalized anxiety disorder.
Aside from genetics, brain chemistry and stressful activities, there are other factors that have also been linked with increased risk of suffering from generalized anxiety disorder.
One of these is withdrawal from the use of addictive substances such as caffeine, alcohol and nicotine.
Some behavioral scientists also suggest that GAD could be a learned behavior.
Children learn how to react to challenging and stressful situations from their caregivers, and if the caregiver exhibits anxious behavior, a child might pick up the same behavior.
Excessive use of social media can also aggravate the intensity of generalized anxiety disorder.
Social media presents people with the same social cues that someone might encounter in real-life interactions.
Since people with GAD have the tendency to inaccurately interpret social cues, the same might happen when using social media, thus intensifying the feelings of worry and anxiety.
SYMPTOMS OF GENERALIZED ANXIETY DISORDER
The major symptom of generalized anxiety disorder is an excessive and unending feeling of worry and anxiety about everything and the tendency to blow things out of proportion.
However, generalized anxiety disorder is also accompanied by physical symptoms, which include:
- Muscle tension
- Frequent bowel movement
- Trouble falling asleep
- Heart palpitations
- Breathing difficulties
- Cold chills and hot flashes
In addition to the above physical symptoms, someone suffering from GAD will also have difficulty concentrating (the mind sometimes goes blank), they tend to overthink plans and prepare for worst-case scenarios.
They find it challenging handling uncertainty, they tend to perceive all situations as threatening even when there is no obvious threat, they are indecisive out of fear of making the wrong decision, they tend to avoid stressful situations, and have trouble controlling their emotions.
People suffering from GAD may also experience other anxiety disorders such as clinical depression, phobias, panic disorder, obsessive-compulsive disorder, as well as problems with alcohol and drug abuse.
Even when not completely consumed by their worry, a person suffering from generalized anxiety disorder might still feel anxious and have a constant sense of dread, a feeling that something bad is just about to happen.
Sometimes, the feeling of anxiety can become so intense that it interferes with a person’s ability to engage in normal, day to day activities of life, thus affecting other areas of a person’s life.
The feelings of worry may depend on the person’s age.
For instance, in addition to the worries experienced by adults, children and teenagers suffering from generalized anxiety disorder might also experience worry about fitting in, being a perfectionist, or about their performance in sporting events and academics.
They might experience low self-confidence, avoid social situations and may have an excessive strive for approval.
Sometimes, a person might have trouble determining whether they are experiencing normal anxiety or whether they have generalized anxiety disorder.
If you find yourself in such a situation, you should see a doctor if:
- You find that you have unending feelings of worry that are interfering with other areas of your life, such as work, school, or relationships.
- You experience depression or other mental health concerns alongside your anxiety problems.
- You find yourself using alcohol and drugs as a way of coping with your anxiety.
- You find yourself having suicidal thoughts.
HOW GENERALIZED ANXIETY DEPRESSION IS DIAGNOSED
There are a number of approaches that doctors might take to diagnose generalized anxiety disorder.
Normally, the doctor will start by asking detailed questions about your medical history and the symptoms you are experiencing.
Some of the questions the doctor might ask include:
- What symptoms have you experienced?
- Which things do you worry about the most?
- When did you first realize that you have some anxiety?
- Do any of your symptoms affect your ability to carry out daily activities?
- Are there some activities you avoid because of your anxiety?
- Do you experience anxiety occasionally or is it constant?
- Is there anything that seems to trigger or intensify your feelings of anxiety?
- Is there anything that seems to reduce your anxiety?
- Do you have any other underlying physical or mental health conditions?
- Have you had any traumatic experiences either recently or in the past?
- Are there any of your first degree relatives who struggle with anxiety or other mental conditions?
- Are you a regular user of any recreational drugs or alcohol?
When answering these questions, you should be honest with your doctor.
Telling the truth makes it easier for the doctor to come up with an accurate diagnosis and come up with the right treatment plan.
Aside from the above questions, if the doctor has reason to believe that there is an underlying medical condition behind your anxiety, he might do a physical exam or order for blood or urine tests as part of the diagnosis.
TREATMENT OF GENERALIZED ANXIETY DISORDER
There are two major options for the treatment of generalized anxiety disorder: medication and psychotherapy.
The choice of treatment will depend on the degree to which the condition is interfering with your ability to carry out your daily activities.
Sometimes, the doctor might recommend a combination of the two treatment options, since it might take some time to figure out the treatment that is most effective on you.
In extreme cases where anxiety is hindering a patient’s ability to carry out daily tasks, medication is usually the go-to form of treatment.
There are various kinds of medications that are used to treat GAD, such as:
Antidepressants: These are the kind of medications most commonly used to treat GAD. These medications may take a few weeks before they start being effective.
However, they are much safer compared to other medications and are the best option for long-term treatment.
Examples of antidepressants include Cymbalta (duloxetine), Paxil (paroxetine), Zoloft, Lexapro (escitalopram), Effexor (venlafaxine), Buspirone, and Prozac.
Benzodiazepines: In very extreme cases, a class of medication known as benzodiazepines may be used to relieve intense feelings of acute anxiety.
Also known as minor tranquilizers or sedative hypnotics, these medications help reduce the physical symptoms of anxiety, such as restlessness and muscle tension, making it much easier for the patient to perform daily functions.
However, benzodiazepines are sedating, can be addictive and can lead to decreased attention and memory.
Because of this, they should only be used for short-term treatments.
In addition, they are not a good choice for someone who has problems with drug abuse and alcoholism. Examples of benzodiazepines include Ativan, Librium, Xanax, and Valium.
Before you start using any medications for the treatment of generalized anxiety disorder, you should have a conversation with your doctor about any risks and side effects that might be associated with the medications.
This is a form of treatment where a person suffering from generalized anxiety disorder works on their anxiety symptoms with the help of a therapist.
Psychotherapy is also referred to as psychological counseling or talk therapy.
One of the best kinds of psychotherapy for the treatment of generalized anxiety disorder is cognitive behavioral therapy.
Studies have shown that cognitive behavioral therapy is more effective compared to other GAD treatments.
Cognitive behavioral therapy focuses on teaching patients different ways of behaving, thinking and reacting to situations that may cause worry and anxiety.
Patients undergoing cognitive behavioral therapy usually experience a reduction in the symptoms of anxiety after about 10 sessions, though sometimes treatment can extend up to 20 sessions.
Cognitive behavioral therapy may involve different kinds of interventions, including:
Relaxation training: We saw earlier that people with generalized anxiety disorder usually have a hard time relaxing. They are constantly edgy and experience a lot of muscle tensions. This intervention teaches the patient how to relax.
This is usually the first intervention in cognitive behavioral therapy. It lays the ground for other interventions.
Once they learn how to relax their bodies, patients will have an easier time relaxing their minds and letting go of worries.
This intervention may involve relaxation techniques such as deep breathing and bio-feedback.
Cognitive restructuring: This intervention involves examining whether the patient has any unhelpful patterns of thinking that may contributing to their worry and anxiety, and then teaching the patient new ways of thinking when they find themselves in challenging situations.
Cognitive restructuring lays an emphasis on helping patients avoid having negative predictions about future events.
Systematic exposure: The aim of this intervention is to help people suffering from generalized anxiety disorder face their fears.
Essentially, this intervention encourages patients to think about the worst-case scenarios of situations that cause them extreme worry, and then the patients get to take part in these activities.
With time, the patient learns that their worst-case predictions that cause them so much worry are nothing but mere imaginations that will never happen.
This way, the patients gradually learn to stop making worst-case predictions and worrying too much.
Mindful training: This intervention teaches the people suffering from generalized anxiety disorder how to focus their attention on the present moment.
Normally, people with anxiety spend a lot of time in the future, worrying about how things might go bad.
Refocusing their attention to the present takes them from this worrisome state of mind.
Problem-solving training: Many of those suffering from GAD feel anxious when they find themselves in an unpredictable situation, or when they feel like their obligations are too overwhelming.
Problem solving training teaches the patients how to manage and solve the problems associated with stress-inducing situations, which in turn makes them feel more at ease even in these situations.
Lifestyle Changes to Reduce the Intensity of GAD
While it is always a great idea to seek medical attention if you have generalized anxiety disorder, there are some other lifestyle changes that can also help reduce the effects of anxiety. These include:
Exercising: If you feel like you are struggling with anxiety, you should makes exercise a part of your daily routine. Exercising releases endorphins and other feel good hormones that can help reduce stress and anxiety.
You can start with simple exercises like jogging and then increase the intensity of your exercises gradually. Getting involved in sporting activities is another great way of exercising.
Get enough sleep: Lack of enough sleep can contribute in intensifying your feelings of anxiety. Therefore, you should make sure that you get about 7 – 9 hours of sleep each night.
If you have sleeping problems, you should see a doctor.
Eat healthy: A healthy diet can also help reduce the effects of anxiety. To manage anxiety, you should focus on a diet that is high in fruits, vegetables, whole grains, legumes, and lean protein, such as fish.
Incorporate relaxation techniques into your routine: Activities that help you relax, such as yoga and meditation, can also help be useful in managing anxiety.
If possible, you should make these activities part of your daily routine.
Avoid unhealthy substance use: The use of substances like alcohol and recreational drugs can cause or intensify anxiety.
Other addictive substances like caffeine and nicotine can also worsen anxiety.
Avoid using these substances, and if you are already addicted, join a support group or seek a treatment program that can help you quit the addiction.
HOW TO COPE WITH GAD
In addition to treatment and the lifestyle changes highlighted above, there are some social coping strategies that can also help people with GAD to have better control over their anxiety and improve their social life. These include:
Getting involved: When someone has GAD, they might tend to pull away from others and avoid social interactions. Not only does this make someone lonely, but it also makes them feel greater unease when in social situations.
To avoid this, someone suffering from GAD should try and get themselves involved in activities that require group participation. Doing this allows them to feel purposeful, gradually makes them comfortable in social situations and helps keep their minds occupied.
Find someone to talk to: If you are struggling with anxiety, you don’t have to suffer alone. Find someone you can trust and share what you are going through with them. Opening up to someone makes it a lot easier to cope with your anxiety.
Alternatively, you can join a support group where you will find compassion, support and understanding from people who are going through similar challenges in life.
Break the cycle: If the feelings of anxiety start creeping up on you, find something to do, such as delving into a hobby, reading a book or taking a brisk walk to get your mind away from the worrisome thoughts.
Generalized anxiety disorder is a serious mental disorder that can make it difficult for someone to function normally in public and live their best life.
In extreme cases, it can even lead to suicide.
Fortunately, it is a condition that can be treated through psychotherapy and medication.
If you find yourself experiencing the symptoms associated with the condition, you should seek medical attention in order for the condition to be diagnosed and treated early enough.
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