Generalised Anxiety Disorder

Generalized anxiety disorder (GAD) is characterized by a chronic persistent worry about a number of events and activities. The worry is not restricted to, or markedly increased in any particular set of circumstances. The major areas of worry are health, work, money, and family. GAD is also known as free-floating anxiety because it is not hooked to any specific object or event or situation.

Symptoms of GAD

All the symptoms of anxiety can occur in GAD but there is a characteristic pattern comprised of the following features:

1.Worry and apprehension: It is prolonged, widespread, not focused on any specific issue and difficult to control when compared to the ordinary worries and concerns of healthy people

2. Psychological arousal: may be evident as irritability, poor concentration, and sensitivity to noise.

3.Autonomic Over-activity: is often experienced as sweating, palpitations, dry mouth, epigastric discomfort and dizziness.

4.Muscle tension: may be experienced as restlessness, trembling, inability to relax, headache and pain in the back and the shoulders.

5.Hyperventilation: may lead to dizziness, tingling in the extremities and a feeling of shortness of breath.

6.Sleep disturbance: may be seen in the form of difficulty falling asleep and persistent worrying thoughts which may interfere with sleep. Sleep may be intermittent, un-refreshing and accompanied by unpleasant dreams.

7.Other features: include tiredness, depressive symptoms, obsessional symptoms and depersonalization which is never prominent throughout the illness.

These individuals also experience high levels of negative affect, chronic over arousal and a sense of uncontrollability. They may often fear that something terrible is going to happen to them or to others for whom they care, for example, loss of job, alienation from spouse. Usually individuals with GAD are able to function despite high levels of anxiety and less often visit clinics for treatment.

Causes of GAD

In general terms, GAD appears to be caused by stressors acting on a personality predisposed by combination of genetic factors and environmental influences in childhood. Clinical observations indicate that GAD often begins in relation to stressful events and some become chronic when stressful problems persist. Stressful events involving threat are particularly related to anxiety disorder.

  1. The Psychoanalytical Perspective: According to this view, GAD is the result of unconscious conflict between ego and id impulses. Freud believed that it was the primarily sexual and aggressive impulses that have been blocked from expression or punished upon expression which lead to GAD. According to the psychoanalytical view, the difference between specific phobias and GAD is that, in phobias defense mechanism of repression and displacement are operative but in GAD the defense mechanisms may have been broken down or are not operative. In GAD, the ego is readily over-whelmed because it has been weakened by development failure in childhood. Separation and loss are thought to be particularly important causes at this failure (Bowlby, 1969) because in early childhood anxiety is linked to separation from the mother.
  2. The Behavioral Perspective: It believes that GAD stems from classical conditioning of anxiety to many environmental cues in the same way as phobias are conditioned. The difference between the two lies only in the kind and number of environmental cues that have become sources of anxiety. Wolpe hypothesized that such conditioning is likely to occur when a person experiences extremely intense anxiety or if there is a lack of clearly defined environmental stimuli during the conditioning of anxiety.
  3. The Cognitive Perspective: They believe that experience with unpredictable and or uncontrollable events may promote both current anxiety as well as a vulnerability to anxiety in the presence of future stressors (Barlow 1988). Barlow also found that these individuals have a history of experiencing events in their lives as unpredictable and uncontrolled. This was also supported by a study carried out by Mineka et al, (1986) on two groups of monkeys called—– ‘masters’ and ‘yoked’ monkeys.

People with GAD process threatening information in a biased way focusing automatically move on the threatening cues in the environment. They are more inclined to interpret ambiguous stimuli as threatening and to rate negative events as more likely to occur to them.These individuals seem to have developed negative schemas in the course of growing up.Parental indifference and physical or sexual abuse may also play a role in GAD.

4. Personality: GAD occurs in people with anxious-avoidant personality disorders, but also in people with other personality disorders. GAD is also associated with anxious personality traits but it has not been shown that these traits preceded the disorder (Nestadt et al, 1992).

5.The Biological Perspective:  Family studies done by Brown (1942) found that GAD was more frequent (19.5%) among the first degree relatives of probands with GAD than among first degree relatives of control. Early twin studies (for example, Slater and Shields, 1969) showed a higher concordance for monozygotic twins, suggesting that the familial association has a genetic cause. However, evidence regarding genetic factors in GAD is mixed. It is not yet known that whether functional deficiency in GABA is a cause or a consequence of GAD.

Management

  • It begins by forming a clear plan of management agreed with the patient and when appropriate, a relative or partner.
  • The individual is then psycho-educated about the problem. To help deal with their anxiety the individual is given training in relaxation.
  • Cognitive-behavior therapy focuses on disputing the individual’s cognitive distortions, engaging in positive self talk, teaching effective stress coping strategies and help them to evaluate the situation realistically.
  • In addition to psychological treatments, medications like benzodiazepines, buspirone, beta-adrenergic antagonists, monoamine oxidase inhibitors and antidepressants can also be used. However, medication should be used selectively to bring symptoms under control quickly, while the effects of psychological treatments are awaited.

You can also read our Blogs on :

  1. Panic Disorder
  2. Phobic Anxiety Disorder
  3. Anxiety Disorders: “ Time to change, Say Goodbye to your Uneasiness’’
  4. Obsessive Compulsive Disorder
  5. General Anxiety Disorder

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