Generalized Anxiety Disorder

Signs and Symptoms of GAD

The key pathological feature of generalized anxiety disorder is excessive worry. Children, teens, and adults may experience this worry, which is out of proportion to the true impact of events or situations.

People with generalized anxiety disorder (GAD) suffer from chronic and pervasive anxiety and worries about all-encompassing life situations. Common worries are inadequacy in interpersonal relationships, job responsibilities, finances, and health of family members.

Because of this worry, huge amounts of time are spent in preparing for activities. Putting things off and avoidance are key symptoms and may result in lateness or absence from school or employment and overall social isolation. Family members and friends are overtaxed as the person with this disorder seeks continual reassurance and perseverates about meaningless details.

According to the criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; American Psychiatric Association, 2000), this excessive or ongoing anxiety and worry lasts for at least six months and is centered on numerous issues or events.

Individuals diagnosed with GAD experience significant distress or impairment (e.g., in social or occupational functioning), have difficulty controlling worry, and have at least three of the following symptoms: restlessness, easy fatigue, irritability, muscle tension, or sleep disturbance.

Most frequently, the onset of GAD occurs in childhood or adolescence. In the Untied States, about 3 percent or more of the population shows symptoms of GAD each year (Kessler, Chiu, Demler, & Walters, 2005). GAD is diagnosed more frequently in women than in men.

Researchers have tried to explain the cause of this disorder from different perspectives. Family pedigree studies have found an increased likelihood of the disorder among blood relatives of a person with GAD. This suggests the possibility that GAD is an inherited disorder. Consistently, the link between GAD and dysfunction in the activity of gamma-aminobutyric acid (GABA) had been reported (Roy-Byrne, 2005).

GABA is a neurotransmitter in the brain that carries inhibitory messages from one neuron to another, thus preventing the receiving neuron from firing. People with GAD are thought to have malfunctions in this GABA system, leading to a persistent rise in anxiety (because GABA fails to prevent the neurons from firing).

Cognitive theorists (e.g., Beck, Brown, Steer, Eidelson, & Riskind, 1987) assume that GAD is caused by dysfunctional ways of thinking, particularly holding a belief that danger is omnipresent. Research has consistently supported the idea that people with GAD have such beliefs (e.g., Riskind & Williams, 2005).

More recently, other cognitive theorists have supplemented the original cognitive model of GAD. For instance, Adrian Wells (2005) has proposed the metacognition theory of generalized anxiety disorder, which emphasizes that people’s beliefs about worrying are the most pathogenic of their anxiety-related beliefs. Specifically, they value worrying as a means of problem solving but at the same time believe that worrying is both psychologically and physically harmful because society tells them that this is so. Thus they worry about worrying (called metaworrying). Another explanatory perspective on GAD is the sociocultural one, maintaining that societal conditions are related to development of GAD.

Treatment

The most effective treatments for GAD are cognitive therapy, stress management training, and medication. All these treatments produce moderate relief, though people can still be anxious.

Cognitive therapy is used to change negative thinking patterns. Clients are encouraged to be aware of their dysfunctional thinking patterns that provoke their anxiety and to replace these thoughts with appropriate assumptions. Two stress management techniques that have been utilized for GAD are meditation and progressive muscle relaxation (progressively tensing and relaxing the various muscle groups throughout the body).

Antianxiety medications (anxiolytics) such as benzodiazepines are also used to treat people with GAD. BenzodiazepinesOpens in new window enhance the ability of GABA to bind to receptor sites on receiving neurons, thus inhibiting the action of the receiving neuron, resulting in low bodily arousal and lessened levels of anxiety.

Because benzodiazepines can cause physical dependency and side effects, they are usually prescribed for short periods of time. Other medications that show promise in the treatment of GAD include some antidepressants, beta blockers, and other antianxiety medications that work through different mechanisms than do the benzodiazepines. These newer drugs appear to have much less potential for addiction.