Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is often accompanied by trouble sleeping or concentrating, and persistent feelings of irritability, tension, restlessness, weakness, or exhaustion. While these symptoms can be shared by both generalized anxiety disorder and panic disorder, panic disorder is associated with recurring panic attacks and worrying about oncoming panic attacks, where individuals with GAD describe their anxiety as being constantly present in their daily lives.

In addition to the uncontrollable worry, patients with GAD also experience a variety of arousal symptoms, such as restlessness, difficulty concentrating, irritability, and being easily fatigued. Physiological symptoms can result from the constant state of apprehension and may include nausea, headaches, and dry mouth, among others. Generalized anxiety disorder causes its sufferers great distress and trouble functioning in several different areas, such as school, work, at home with family, or in social contexts with friends.

Patients with GAD worry about things that most people worry about from time-to-time, such as health, finances, grades, work difficulties, or family problems. However, while most people can control their anxiety regarding these issues, those with GAD are unable to stop thinking about these everyday issues, often fearing the worst outcome. Quite often the worry of individuals with GAD is disproportionate to the actual likelihood of their feared outcome. For instance, someone might be unable to stop worrying that they are not performing well at school and will have to drop out, despite a complete lack of evidence that their academic performance has been poor.

These symptoms can be categorized into three main categories:

Physical Symptoms:

• Restlessness
• Fatigue
• Light-headedness
• Trembling
• Bodily aches and pains
• Muscle tension
• Headaches
• Nausea and stomachaches
• Rapid pulse and difficulty breathing
• Difficulty swallowing
• Sweating
• Trouble sleeping
• Frequent need to go to bathroom
• Easily startled

Cognitive Symptoms:

• Chronic rumination and irrational worrying
• Overthinking all possible worst-case scenarios
• Perceiving events and situations as threatening, even if they are not
• Difficulty in handling uncertainty
• Indecisiveness; fear of making a wrong decision
• Difficulty in concentration; feeling that their mind “goes blank”

Behavioral Symptoms;

• Avoidance in attending school, work, or social events
• Perfectionistic tendencies
• Spending excessive time doing work or homework
• Requiring excessive reassurance about performance
• Isolation from friends and/or family
• Inability to leave the house due to fear of something bad happening

Prevalence of generalized anxiety disorder

The lifetime prevalence of GAD for individuals between 18 and 29 years old is 4.1%. About 32% of annual cases are classified as severe. Onset of GAD can occur at any age, with the median age of onset being 30 years old. Females are three times more likely to be impacted than males.

ERP involves the gradual exposure and habituation to triggering anxiety inducing events (a feared object, situation, or place) to help people learn new ways of coping with their anxiety. It is called “response prevention” because the goal is to modify the habitual unhelpful response/thoughts and replace them with healthier behaviors and thoughts. ERP is an intensive practice of repeated exposures to the trigger. For many, CBT and ERP combined with medication provide much needed relief for people suffering from generalized anxiety disorder.

Newsletter:
Read Anxiety Institute’s newsletter about general anxiety disorder.

Anxiety and Depression Association of America, ADAA:
https://adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad

Cuijpers, P., Sijbrandij, M., Koole, S., Huibers, M., Berking, M., & Andersson, G. (2014). Psychological treatment of generalized anxiety disorder: a meta-analysis. Clinical Psychology Review, 34(2), 130-140.

Cummings, C. M., Caporino, N. E., & Kendall, P. C. (2014). Comorbidity of anxiety and depression in children and adolescents: 20 years after. Psychological Bulletin, 140(3), 816.

National Institute of Mental Health (NIMH): An organization with the National Institute of health dedicated to mental health research;
https://www.nimh.nih.gov/health/publications/generalized-anxiety-disorder-gad/index.shtml