Generalized anxiety disorder is characterized by exaggerated and excessive worry and anxiety about any day-to-day event without any apparent reason for this concern. In fact, it is one of the anxiety disorders with the most annoying and disabling symptoms, as it appears in many different situations.

People who suffer from this disorder always expect things to go wrong and cannot stop worrying about their health , money, family, work or college.

What is generalized anxiety disorder?

This fear or worry is irrational, unreal and disproportionate, and everyday life becomes a constant worry. Therefore, anxiety ends up dominating the individual’s life, negatively affecting his or her normal functioning in different areas of his or her life, such as social activities, work or interpersonal relationships. In addition, generalized anxiety disorder also affects the ability to vividly imagine possible future situations, causing attention to focus more on negative feelings perceived in the present.

Differences between GAD and other anxiety disorders

Anxiety is a normal reaction of individuals to situations of stress and uncertainty. However, when several anxious symptoms cause distress or some degree of functional impairment in the life of the individual suffering from it, the anxiety disorder is diagnosed. There are different types of anxiety disorders: panic disorder, phobic disorder, obsessive-compulsive disorder (OCD)…

All of them, including GAD, have in common that make it difficult for the person who suffers from GAD to function in different areas of his life . For example: social and family relationships, work, school. But among the different types of anxiety disorders, there are differences. And knowing how to distinguish between these different phenomena is important, because if there’s another diagnostic category that explains what’s going on better than that of generalized anxiety disorder, the mental health expert will rule out GAD.

So, let’s see some keys to differentiate diagnostic categories, taking into account that the diagnosis can only be made by duly qualified and trained psychologists or psychiatrists.

Persistent anxiety

In the case of generalized anxiety disorder, the worry and anxiety reactions are not limited to what is typical of other disorders; for example, the possibility of having a panic attack and running out of air (panic disorder), feeling humiliated in public (social phobia), suffering from pollution (obsessive-compulsive disorder), or having a serious illness (hypochondria). Unlike the above, the main characteristic of generalized anxiety disorder (GAD) is having excessive and irrational worry and anxiety that is persistent (at least half the days for at least 6 months) and difficult to control over a number of events or activities such as work, school, friends, and family.

In addition, according to the DSM-V, to diagnose GAD, the disorder does not have to be due to the direct physiological effects of a substance (drug) or disease (e.g., hyperthyroidism) or occur exclusively during an affective disorder, post-traumatic stress disorder, psychotic disorder, or pervasive developmental disorder.

Symptoms of generalized anxiety disorder

Following the diagnostic criteria for GAD as defined by the DSM-V Diagnostic and Statistical Manual of Mental Disorders, anxiety and worry are associated with three (or more) of the following six symptoms . In the case of children, only one of the items is required.

  • Restlessness or feeling agitated.
  • Fatigue easily.
  • Difficulty concentrating or having a blank mind
  • Irritability.
  • Muscle tension.
  • Sleep disorders (difficulty in falling or staying asleep, little or restless sleep)

In addition, anxiety, worry or physical symptoms cause clinically significant discomfort or impairment in social, occupational, or other important areas of functioning.

Unlike DSM-V, according to the ICD-10 Diagnostic Criteria (World Health Organization, WHO), concerns need not be excessive and difficult to control. In addition, it requires the presence of the following symptoms:

  • Autonomous symptoms : palpitations or tachycardia, sweating, trembling or shaking, dry mouth (not due to medication or dehydration).
  • Chest and abdomen related : difficulty breathing, choking sensation, pain or discomfort in the chest, nausea or abdominal discomfort.
  • Related to state of mind: feeling dizzy, unstable or faint; unrealization or depersonalization; fear of losing control, going crazy or losing consciousness; fear of dying
  • General symptoms : hot flushes or chills; dazed or tingling sensations; muscle tension, aches or pains; restlessness or inability to relax; feeling of being on the edge or under pressure, or of mental tension; feeling of a lump in the throat or difficulty in swallowing.
  • Other nonspecific symptoms : exaggerated response to small surprises or shocks; difficulty concentrating or “blank mind” due to worry or anxiety; persistent irritability; difficulty falling asleep due to worrying.

The ICD-10 specifies the presence of 4 of the 22 symptoms for the diagnosis of this pathology, and it is necessary that at least one of the symptoms is from the autonomous group. Despite the differences between the DSM and the ICD, the degree of agreement between the two is quite high: a study by Andrews, Slade and Peters (1999) concluded that 77% of the subjects diagnosed by one of these systems had a positive diagnosis in the other as well.

In any case, the symptoms of GAD must be present almost constantly for at least 6 months in a row.

Causes

GAD is no different from other psychological disorders in that it has a multi-causal origin. There is not one single cause that produces the appearance of generalized anxiety disorder in a person, but many. The main ones are the following:

  • Genetic predispositions to experience stress.
  • Having experienced traumatic experiences.
  • Personality factors: shyness and fear of the image given.
  • Gender factors: Women have GAD more often.

The neurological basis of generalized anxiety disorder

Little is known about the neurological basis of generalized anxiety disorder, beyond evidence that it is associated with lower than normal activation in the prefrontal cortex and anterior cingulate cortex. On the other hand, alert emotions such as fear are related to the functioning of the cerebral amygdala.

Much more research is needed to understand this disorder.

Examples of generalized anxiety disorder

To better illustrate this pathology, some examples are shown below:

  • A doctor who is continually concerned that he does not diagnose patients correctly . Every time he is called on the phone he thinks he is a superior to tell him that he is working badly. In addition, he is continually worried that his new patient will be a previous one who has relapsed.
  • A woman who is always worried that her partner is going to leave her , that she is going to be fired from her job and that someone in her family is going to become seriously ill.
  • A parent who is always worried that his 4-month-old child will choke while eating , that he won’t hear him crying at night if he needs help, and that he might become seriously ill and die.

Treatment for this psychological imbalance

Like all other anxiety disorders, ADD can be effectively treated with psychotherapy and medication.

Cognitive-behavioral therapy (CBT), allows patients to acquire tools to manage and control anxiety and worry. In addition, alternative treatments, such as relaxation techniques, meditation or yoga, may be beneficial in combination with CBT.

In particular, the use of self-instructions and the technique of systematic desensitization are common, as well as the Mindfulness sessions, whose objective is to help the person orient his or her attentional focus towards the present.

Bibliographic references:

  • Mochcovitch, M. (2014). A systematic review of fMRI studies in generalized anxiety disorder: Evaluating its neural and cognitive basis. Journal of affective disorders, 167, pp. 336 – 342.
  • Solomon, C. (2015): Generalized Anxiety Disorder. The New England Journal of Medicine, 373(21), pp. 2059 – 2068.
  • Wu, J. (2015): Episodic future thinking in generalized anxiety disorder. Journal of anxiety disorders, 36, pp. 1 – 8.