GAD: General Anxiety Disorders

Generalized Anxiety Disorder (GAD) is characterized by 6 months or more of chronic, exaggerated worry and tension that is unfounded or much more severe than the normal anxiety most people experience. People with this disorder usually expect the worst; they worry excessively about money, health, family, or work, even when there are no signs of trouble. They are unable to relax and often suffer from insomnia. Many people with GAD also have physical symptoms, such as fatigue, trembling, muscle tension, headaches, irritability, or hot flashes.

Fortunately, through research supported by the National Institute of Mental Health (NIMH), effective treatments have been developed to help people with GAD.

How Common is GAD? About 2.8% of the U.S. population (4 million Americans) have GAD during a year's time. GAD most often strikes people in childhood or adolescence, but can begin in adulthood, too. It affects women more often than men. What Causes GAD? Some research suggests that GAD may run in families and it may also grow worse during stress. GAD usually begins at an earlier age and symptoms may manifest themselves more slowly than in most other anxiety disorders.

What Treatments Are Available for GAD? Treatments for GAD include medications and cognitive-behavioral therapy.

Can People with GAD Also Have Other Physical and Emotional Illnesses? Research shows that GAD often coexist with depression, substance abuse, or other anxiety disorders. Other conditions associated with stress, such as irritable bowel syndrome, often accompany GAD. Patients with physical symptoms such as insomnia or headaches should also tell their doctors about their feelings of worry and tension. This will help the patient's health care provider to recognize that the person is suffering, from GAD.

The content of this fact sheet was adapted from material published by the National Institute of Mental Health.

For additional resources, please call 1-800-969-NMHA.

The Basics on Generalized Anxiety

By Dr. R. Reid Wilson, reprinted with permission

This is one of a series of excellent articles on anxiety taken from Dr. Reid's website, more information on which can be found at the bottom of this page.

The Symptoms

First, let's look further at the physical symptoms. Although the specific manifestations of anxiety vary for each person, this chronic state of tension can affect six major systems of the body.

  1. In the cardiovascular system, anxiety increases blood pressure, which causes tachycardia (rapid heartbeat), constriction of the blood vessels in the arms and legs, and dilation of the vessels surrounding the skeletal muscles. These changes produce symptoms of palpitations (an uncomfortable awareness of the heart rate), headaches, and cold fingers.

  2. In the gastrointestinal system, anxiety leads to reduced salivary secretions, spasms within the esophagus (the hollow muscular tube leading from the nose and mouth to the stomach), and alterations in the stomach, intestines, and anal sphincter. These systemic changes result in symptoms of dry mouth, difficulty swallowing, "butterflies" in the stomach, the gurgling sounds of gas in the intestines, and mucous colitis (an inflammation of the colon), causing spasms, diarrhea and/or constipation, and cramp-like pains in the upper stomach.

  3. In the respiratory system, anxiety leads to hyperventilation, or overbreathing, which reduces the carbon dioxide in the blood, with symptoms of "air hunger," deep sighs, and pins-and-needles sensations.

  4. In the genitourinary systems, the anxious person can experience the need for frequent urination. Men may have difficulty maintaining an erection during intercourse; women may have difficulty becoming sexually aroused or achieving orgasm.

  5. In the musculoskeletal system, the muscles become tense. Involuntary trembling of the body, tension headaches, and other aches and pains may develop.

  6. Through changes in the central nervous system, the anxious person is generally more apprehensive, aroused, and vigilant, feeling "on edge," impatient, or irritable. He may complain of poor concentration, insomnia, and fatigue.

    Generalized Anxiety or Panic Attacks?

    When someone complains about these symptoms, and if he has excessive worries, too, then he might be suffering from what we call generalized anxiety disorder. There is often a fine line between the diagnosis of panic disorder and that of generalized anxiety disorder. Three features distinguish them. First, the symptoms themselves: if an individual is chronically anxious (as he would be with generalized anxiety disorder) and also experiences episodes of panic, then panic disorder will be the more likely diagnosis.

    The second distinction is the kind of fearful thoughts associated with the problem. Most people with generalized anxiety disorder will worry about the kinds of interactions they will have with others: "Will I fail in this work setting?" "Are they going to accept me?" "I'm afraid he's going to leave me." "What if they discover how little I know?" "I'll never perform up to their expectations."

    With panic disorder, the imagined response of others is secondary to the fear of personal catastrophe or loss of control, and the person's internal statements and questions will reflect this apprehension: "What if I faint (become hysterical, have a heart attack, cause a scene . . .), and people see me?" The panic-prone person focuses more on his inability to be in 100 percent control of all his physical and mental capacities. The anxious person focuses more on his inability to cope with the expectations and responses of those around him.

    The third difference has to do with the person's response to his fears. The anxious person thinks about withdrawing from situations that increase his anxiety, and may procrastinate on performance tasks. The person with panic disorder, on the other hand, is quick to use avoidance as a way to diminish discomfort. In a matter of days he will begin to identify the situations that are associated with the symptoms and determine how he can steer clear of them. With panic, he immediately views avoidance as the single best solution to the problem.

    Treatment of Generalized Anxiety

    Mental health professionals have developed a variety of treatment approaches that have proved successful against this disorder. These often include cognitive behavioral therapies that seek to alter the way that generalized anxiety sufferers think about and respond to troubling situations.

    Some individuals report that they have regained control of their lives without medication or extensive psychological counseling by learning anxiety management techniques. Systematic tensing and relaxing of muscle groups, a technique known as progressive muscle relaxation, has helped a large percent of these sufferers. Some patients report that physical exercise programs, perhaps requiring no more than 30 minutes a day and no more strenuous than brisk walking, provide relief from generalized anxiety. Meditation, yoga, massage and biofeedback are other relaxation tools that may be beneficial for some people. Controlled breathing and refusing one's thoughts on the present may also reduce anxiety. These techniques do not provide instant relief. As a rule, they take effect gradually, and they must be practiced regularly for lasting benefit.

    Understanding their own thought processes and how they evaluate disturbing situations helps some people control their anxieties. Cognitive therapy is designed to reduce anxiety by giving individuals the skills to assess situations more realistically. Patients may be trained to identify anxious and unrealistic thoughts and develop techniques to change their responses. Cognitive therapy may be supported by instruction in altering behavior or by lifestyle changes designed to cut down on stress.

    Medication has also proven effective in relieving anxiety symptoms, particularly in providing fast relief from acute anxiety, and allowing other therapy to go forward.

    © Copyright 2003, reprinted with permission. Dr. R. Reid Wilson is a licensed psychologist specializing in the treatment of all anxiety disorders. He directs the Anxiety Disorders Treatment Program in North Carolina.

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