Generalized Anxiety Disorder

It’s normal to feel anxious from time to time, especially if your life is stressful. However, excessive, ongoing anxiety and worry that are difficult to control and interfere with day-to-day activities may be a sign of generalized anxiety disorder.

Generalized Anxiety Disorder (GAD) is characterized by persistent and excessive worry about several things. People with GAD may anticipate disaster and may be overly concerned about money, health, family, work, or other issues. These feelings are either unusually intense or out of proportion to the real troubles and dangers of the person’s everyday life.

GAD affects 6.8 million adults. Women are twice as likely to be affected. The risk is highest between childhood and middle age

Although the exact cause of GAD is unknown, there is evidence that biological factors, family background, and life experiences, particularly stressful ones, play a role.

• Genetics : Some research suggests that family history plays a part in making it more likely that a person will have GAD. This means that the tendency to develop GAD may be passed on in families. But no anxiety genes have been identified, and families may also pass down the tendency through lifestyle or environment
• Brain chemistry : GAD has been linked to problems with certain nerve cell pathways that connect brain regions involved in thinking and emotion. These nerve cell connections depend on chemicals called neurotransmitters that send information from one nerve cell to the next. If the pathways that connect brain regions don’t work well, problems related to mood or anxiety may result. Medicines, psychotherapies, or other treatments that are thought to work on these neurotransmitters may improve the signaling between circuits and help to improve symptoms related to anxiety
• Environmental factors : Trauma and stressful events such as abuse, the death of a loved one, divorce, and changing jobs or schools may contribute to GAD. The condition can also worsen when stress feels out of hand. The use of and withdrawal from addictive substances (including alcohol, caffeine, and nicotine) can also worsen anxiety

People with GAD don’t know how to stop the worry cycle and feel it is beyond their control, even though they usually realize that their anxiety is more intense than the situation warrants

All anxiety disorders may relate to a difficulty tolerating uncertainty and therefore many people with GAD try to plan or control situations. Many people believe worry prevents bad things from happening, so they view it is risky to give up worry.

Living with generalized anxiety disorder can be a long-term challenge. In many cases, it occurs along with other anxiety or mood disorders

When their anxiety level is mild to moderate or with treatment, people with GAD can function socially, have full and meaningful lives, and be gainfully employed. Many people with GAD may avoid certain situations because they have the disorder, or they may not take advantage of opportunities due to their worry. Some people can have difficulty carrying out the simplest daily activities when their anxiety is severe.

Generalized anxiety disorder symptoms can vary. They may include:

• Persistent worrying or anxiety about several areas that are out of proportion to the impact of the events
• Overthinking plans and solutions to all possible worst-case outcomes
• Perceiving situations and events as threatening, even when they aren’t
• Difficulty handling uncertainty
• Indecisiveness and fear of making the wrong decision
• Inability to set aside or let go of a worry
• Inability to relax, feeling restless, and feeling keyed up or on edge
• Difficulty concentrating, or the feeling that your mind “goes blank”

Physical signs and symptoms may include:

• Fatigue
• Trouble sleeping
• Muscle tension or muscle aches
• Trembling, feeling twitchy
• Nervousness or being easily startled
• Sweating
• Nausea, diarrhea or irritable bowel syndrome
• Irritability

Treatment 

The most effective treatment is usually a combination of medications and psychotherapy. Research shows that using both has a more lasting positive effect than either one alone. Cognitive behavioral treatment (CBT) has been more researched and specifically targets thoughts, physical symptoms and behaviors including the over-preparation, planning and avoidance that characterize GAD. All therapies help people to understand the nature of anxiety itself, to be less afraid of the presence of anxiety, and to help people make choices independent of the presence of anxiety.

There are several medication choices for GAD, usually the SSRIs either alone or in combination with therapy.

Relaxation techniques, meditation, yoga, exercise, and other alternative treatments may also become part of a treatment plan.

Other anxiety disorders, depression, or substance abuse often accompany GAD, which rarely occurs alone; co-occurring conditions must also be treated with appropriate therapies

In general, the outlook is good. With appropriate treatment, about 50% of patients improve within 3 weeks of starting treatment, and 77% improve within 9 months

Coping Strategies

• Take a time-out. Practice yoga, listen to music, meditate, get a massage, or learn relaxation techniques. Stepping back from the problem helps clear your head
• Eat well-balanced meals. Do not skip any meals. Do keep healthful, energy-boosting snacks on hand
• Limit alcohol and caffeine, which can aggravate anxiety and trigger panic attacks
• Get enough sleep. When stressed, your body needs additional sleep and rest
• Exercise daily to help you feel good and maintain your health
• Take deep breaths. Inhale and exhale slowly
• Count to 10 slowly
• Do your best. Instead of aiming for perfection, which isn’t possible, be proud of however close you get
• Accept that you cannot control everything. Put your stress in perspective: Is it as bad as you think?
• Welcome humor. A good laugh goes a long way
• Maintain a positive attitude. Try to replace negative thoughts with positive ones
• Get involved. Volunteer or find another way to be active in your community, which creates a support network and gives you a break from everyday stress
• Learn what triggers your anxiety. Is it work, family, school, or something else you can identify?
• Talk to someone. Tell friends and family you’re feeling overwhelmed and let them know how they can help you. Talk to a physician or therapist for professional help
• Get help early. Anxiety, like many other mental health conditions, can be harder to treat if you wait
• Keep a journal. Keeping track of your personal life can help you and your mental health professional identify what’s causing your stress and what seems to help you feel better
• Prioritize issues in your life. You can reduce anxiety by carefully managing your time and energy
• Avoid unhealthy substance use. Alcohol and drug use and even nicotine or caffeine use can cause or worsen anxiety. If you’re addicted to any of these substances, quitting can make you anxious. If you can’t quit on your own, see your doctor or find a treatment program or support group to help you