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Generalized Anxiety Disorder (GAD)

The definition of GAD has changed over the past few years. Doctors originally made little distinction between Panic disorder and General Anxiety Disorder. But, as Panic Disorder was studied and specific treatments were developed, GAD was better defined and recognized as a disorder that is separate and distinct from Panic Disorder. GAD does not include panic attacks or symptoms of severe depression but this distinction alone does not give most doctors enough to go on. General Anxiety Disorder criteria includes severe symptoms of worry or concern, muscle tension, increased arousal and startle reflex, distorted thinking and poor coping skills.

The onset of symptoms is gradual, although symptoms can be precipitated by extreme stress, like a family death, a divorce or other event. GAD is typically chronic, coming and going, with periods of symptoms, intermittent with remission. The symptoms of Generalized Anxiety Disorder always seem to get worse when the patient is under stress.

Perhaps the most common finding in GAD is that patients always expect the worst, worrying about finances, health problems, family safety issues and work problems, even when all others around them feel that everything is fine. They can’t relax, and often have trouble sleeping.

The focus of GAD can shift often, but it is usually focused on day-to-day issues and can include such minor issues as getting chores done, getting the car repaired or being late for a lunch date or appointment. Always, the intensity and duration of the worry and the frequency of focus is completely disproportionate to the real importance and weight of the issue.
Yet this worry is not something the patient can stop, and it interferes with performance and the patient’s ability to concentrate on other things.

Research seems to support the idea that Generalized Anxiety Disorder may run in families, and that the cause may be a chemical imbalance in the brain.

What are the symptoms?

The symptoms of Generalized Anxiety Disorder (GAD) can be varied, but they always involve extreme worry and the physical and emotional problems that constant stress can cause.

• Difficulty in brushing off worry or concern, thoughts and worries keep coming back and interrupting daily tasks
• Fatigue and sleep disturbance, inability to fall asleep or stay asleep
• Irritability, jumpiness
• Trembling, shaking
• Exaggerated ‘startle response’, easily surprised or frightened
• Difficulty in focusing or concentrating on a task, a feeling that your mind just goes blank while you are performing a task
• Muscle tension, aches or soreness in the muscles, an inability to relax
• Restlessness, feeling on edge, feeling fidgety
• Clammy hands, dry mouth, sweating
• Nausea, diarrhea, feeling a constant need to urinate, trouble swallowing

How is it diagnosed and treated?

People with GAD may experience only a few symptoms or they may feel overwhelmed by symptoms. The key signs a doctor will look for in Generalized Anxiety Disorder are anxiety and worry that are difficult or impossible to control, with duration of at least six months. The patient will exhibit at least three of the symptoms listed above, and these symptoms will cause significant distress and social impairment.

GAD is often difficult to diagnose because it doesn’t have dramatic symptoms like Panic Attacks. Doctors will perform a medical evaluation to rule out any physical disorders or problems that might cause similar symptoms. A psychiatric evaluation may also be in order if the patient is exhibiting other symptoms. Some patients have symptoms of Depression or Panic Disorder, coincident with GAD.

Treatment(s) can include:

• Medications like anti-anxiety medications, bastioned, benzodiazepines, antidepressants, SRIs
• Relaxation and meditation techniques
• Psychotherapy
• Biofeedback
• Interpersonal Therapy
• Psychodynamic Therapy
• Cognitive and behavioral therapy
• Exercise

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