Last Updated on April 13, 2023 by Mike Robinson

The Generalized anxiety disorder is characterized by indiscriminate concern about anything. Concern can be useful as it prepares you for vital challenges (pass a test, do a job well), although in this disorder, such concern is unproductive and undesirable.

This excess of concern interferes with the functioning in daily life, since the person anticipates the disaster in different areas: money, death, family, friendships, relationships, work…

Each year 6.8 million Americans and 2% of European adults experience generalized anxiety disorder (TAG).

It is given twice as often in women as in men and is more common in people with a history of substance abuse and family members with a history of anxiety disorders.

Once the TAG is developed, it can be chronic, although it can be controlled with a correct treatment. In the United States it is the leading cause of disability at work.

Difference between “normal” and generalized anxiety disorder

Worries, fears and doubts are a normal part of life. It is normal to be anxious about qualifying on a test or worrying about home economics.

The difference between this type of normal concerns and those of the TAG is that those of the TAG are:

• Excessive
• Intruders
• Persistent
• Debilitating.

For example, after seeing a story about a terrorist attack in another country, the normal person may feel temporarily worried.

However, a person with GAD may stay up all night or worry for days about whether there may be a close attack.

Normal Concerns:

• Concern does not interfere with daily activities and responsibilities
• There is ability to control worry
• Concern is unpleasant but does not cause significant stress
• Concerns are limited to a small number and are realistic
• Worries or doubts last for a short period of time.

TAG:

• Concerns interfere with work, social or personal life
• Worry is uncontrollable
• Worry is extremely unpleasant and stressful
• The concern extends to all kinds of issues and the worst is expected
• Concern has been given daily for at least six months.

Symptoms of Generalized Anxiety

The TAG may include:

• Persistent concerns or obsessions that is disproportionate to the event
• Inability to put aside a concern
• Inability to relax
• Difficult to focus
• Worry about excessive worry
• Stress about making wrong decisions
• Difficulties handling uncertainty or indecision.

There may be the following physical signs:

• Fatigue
• Irritability
• Muscle tension
• Tremors
• Be easily startled
• Sweat
• Nausea, diarrhea, or irritable bowel syndrome
• Headaches.

Symptoms in children and adolescents

In addition to the above symptoms, children and adolescents with GAD may have excessive concerns about:

• School or sports performance
• Punctuality
• Earthquakes, wars, catastrophic events.

You may also experience:

• Excessive anxiety to fit
• Be a perfectionist
• Redo tasks because they are not perfect the first time
• Spending too much time doing homework
• Lack of selfesteem
• Search for approval

Symptoms of autonomic activation

1) Palpitations, throbbing heart, or fast heart rate.

2) Sweating

3) Tremors

4) Dry mouth (not due to dehydration or medication).

Symptoms concerning chest and abdomen

5) Difficulty breathing

6) Feeling of choking

7) Chest pain or discomfort

8) Nausea or abdominal discomfort.

Symptoms concerning brain and mind

9) Feeling unstable, dizzy or weak

10) Feelings that objects are unreal (derealization) or that one is distant or not really “here” (depersonalization)

11) Fear of losing control going crazy or fainting

12) Fear of dying.

General Symptoms

13) Hot flashes or chills

14) Sensations of homing or numbness

Tension symptoms

15) Muscle tension or aches and pains

16) Restlessness and inability to relax

17) Feeling of excitement or mental tension

18) Feeling of a knot in the throat or difficulty swallowing

Other non-specific symptoms

19) Exaggerated response and surprises or jolts

20) Difficulty concentrating or blank mind out of worry or anxiety

21) Persistent irritability

22) Difficulty sleeping because of concern.

Causes

As in other mental conditions, the exact cause of GAD is not known, although it may include genetic factors and other risk factors.

Genetics

One-third of the variance of GAD is attributed to genes. People with a genetic predisposition to GAD are more likely to develop GAD, especially in response to a life stressor.

Substance use

Long-term use of benzodiazepines may worsen anxiety, while reducing benzodiazepines may decrease their symptoms.

Also, long-term alcohol consumption is associated with anxiety disorders, with evidence that prolonged abstinence may result in the disappearance of symptoms.

The recovery of benzodiazepines tends to take much longer than that of alcohol, but it can restore previous health.

Smoking tobacco has also been established as a risk factor for developing anxiety disorders, as is caffeine consumption.

Physiological mechanism

GAD has been associated with a disruption of the functioning of the amygdala and its processing of fear and anxiety.

Sensory information enters the amygdala through the complex basolateral nucleus. The basolateral complex processes memories related to fear and communicates the importance of threats to other places in the brain, such as the medial prefrontal cortex and sensory cortex.

Diagnosis

People with GAD may visit a doctor many times before discovering their disorder.

They ask doctors about their headaches and sleeping problems, although they do not always discover their true pathology.

Also Read: Blood Phobia: Symptoms, Causes, Treatment

Firstly it is advisable to go to a doctor to make sure there is no physical problem that is causing the symptoms. The doctor can then refer the patient to a mental health specialist.

Diagnostic Criteria for Generalized Anxiety Disorder – DSM V

The diagnostic criteria for generalized anxiety disorder, as defined by DSM V, published by the American Psychologists Association (APA) is:

1. Excessive anxiety and worry (apprehensive expectation), which occurs most days over a period of 6 months in relation to a number of activities or events.
2. The individual finds it difficult to control the concern.
3. Anxiety and worry are associated with three or more of the following six symptoms (with at least some of the symptoms present on most days over a 6-month period).

Note: in children, only one item is enough):

• Restlessness
• Fatigue easily
• Difficulty concentrating or mind blank
• Irritability
• Muscle tension
• Sleep disorder.

1. Anxiety, worry, or physical symptoms cause significant discomfort or social, occupational, or other major dysfunctions in life.
2. The disturbance can not be attributed to the effects of a substance (eg, drug, medication) or other medical condition (eg hyperthyroidism).
3. The disturbance is not best explained by another mental disorder (eg anxiety or worry about having panic attacks, negative assessments in social phobia, obsessions in obsessive compulsive disorder, separation of attachment figures in separation anxiety disorder, memories Traumatic events in post-traumatic stress, weight gain in anorexia nervosa, physical complaints in somatic disorder, physical defects in body dysmorphic disorder or misconceptions in schizophrenia or delusional disorder).

Criteria according to ICD-10

1. A period of at least 6 months with prominent tension, concern and feelings of apprehension, about daily events and problems.
2. At least four symptoms from the following list of items must be present, with at least one of items 1 through 4.
3. The disorder does not meet the criteria for panic attack disorder , phobias, obsessive compulsive disorder or hypochondria .
4. Most commonly used exclusion criteria: not supported by a physical disorder such as hyperthyroidism, an organic mental disorder or substance use disorder.

When to seek help from a professional

As discussed previously, some anxiety is normal, although it is advisable to go to a professional if:

• You feel too much worry and interfere with work, personal relationships or other important areas of life.
• Feeling depressed, problems with alcohol or other drugs
• Other problems related to anxiety
• Suicidal thoughts or behaviors.
• Worries do not usually go away on their own and in fact often get worse.

Treatment

Behavioral-cognitive therapy (CBT) is more effective in the long term than medication (such as SSRIs), and although both treatments reduce anxiety, CBT is more effective in reducing depression .

Generalized anxiety is a disorder based on psychological components that includes cognitive avoidance, concerns, ineffective problem solving and emotional processing, interpersonal problems, intolerance to uncertainty, emotional arousal, poor understanding of emotions …

To combat the cognitive and emotional aspects, psychologists often include some of the following components in the intervention plan: relaxation techniques , cognitive restructuring, progressive stimulus control, self-control, mindfulness , resolution techniques Of problems, socialization, training in emotional abilities, psychoeducation and acceptance exercises.

Cognitive-behavioral therapy (CBT)

The cognitive-behavioral therapy (CBT) is a method that requires working with the patient to understand how thoughts and emotions influence their behavior.

The goal of therapy is to change negative thought patterns that guide anxiety, replacing them with more positive and realistic thoughts.

Elements of therapy include exposure strategies to allow the patient to confront their anxiety gradually and to feel more comfortable in the situations that provoke it.

CBT can be used alone or alongside the medication.

Components of CBT to treat GAD include: psychoeducation, self-observation, stimulus control techniques, relaxation techniques, self-management techniques, cognitive restructuring, exposure to concerns (systematic desensitization), and problem solving.

• The first step in treatment is psychoeducation, which requires giving information to the patient about the disorder and its treatment. The purpose of education is to desigmatize the disease, build motivation for treatment and give realistic expectations about treatment.
• Self-monitoring requires monitoring of anxiety levels and the events that triggered it. Its goal is to identify the signs that cause anxiety.
• Stimulus control aims to minimize the stimulatory conditions in which the concerns arise.
• Relaxation techniques reduce stress.
• With the cognitive restructuring is intended to build a more functional and adaptive vision about the world, the future and the patient.
• Problem solving focuses on solving current problems.

Acceptance and commitment therapy (TAC)

CAT is a behavioral treatment designed to achieve three goals: 1) reduce strategies to avoid thoughts, memories, feelings and feelings, 2) reduce the person’s response to their thoughts and 3) increase the ability of the person to maintain their commitment to change their behavior.

This therapy teaches to pay attention to the purpose, the present – mindfulness – and acceptance skills to respond to uncontrollable events.

It works best in combination with pharmacological treatments.

Therapy of intolerance to uncertainty

This therapy focuses on helping patients to develop skills to tolerate and accept uncertainty in life to reduce anxiety.

It is based on the psychological components of psychoeducation, awareness of concern, problem solving training, imaginative and real exposure, and recognition of uncertainty.

Motivational interview

A new approach to improving recovery rates in GAD is to combine CBT with motivational interviewing (MS).

It focuses on increasing the patient’s intrinsic motivation and works, among other personal resources, on empathy and self-efficacy.

It is based on open-ended questions and listening to promote change.

Medication

Different types of medication are used to treat GAD and should always be prescribed and supervised by a psychiatrist.

Although antidepressants can be safe and effective for many people, there may be risks for children, adolescents, and young adults.

• SSRIs (selective serotonin reuptake inhibitors) are usually the first line of treatment. Its side effects can be diarrhea, headaches, sexual dysfunctions, increased risk of suicide, serotonin syndrome …
• Benzodiazepines: are also prescribed and may be effective in the short term. They carry some risks as the physical and piscológica dependence of the drug. They can also reduce attention and have been associated with falls in older people. They are optimal to consume in the short term. Some benzodiazepines are alprazolam, chlordiazepoxide, diazepam and lorazepam.
• Other drugs: atypical serotonergic antidepressants (vilazodone, vortioxetine, agomelatine), tricyclic antidepressants (imipramine, clomipramine), serotonin-norepinephrine reuptake inhibitors (SNRIs) (venlafaxine, duloxetine)…

Risk factors

These factors may increase the risk of developing GAD:

• Genetics: More likely to develop it in a family with a history of anxiety disorders.
• Personality: A timid, negative or avoidant temperament may be more inclined to develop it.
• Gender: Women are diagnosed more frequently.

Complications

Having TAGs can influence:

• Problems in reconciling and maintaining sleep (insomnia).
• Concentration problems.
• Depression.
• Substance abuse.
• Digestive problems.
• Headaches.
• Heart problems.

Comorbidity

In a 2005 US survey, 58% of people diagnosed with major depression also had anxiety disorders. Among these patients the rate of comorbidity with GAD was 17.2%.

Patients with comorbid depression and anxiety tend to have greater severity and greater difficulty recovering than those with a single disease.

On the other hand, people with GAD have comorbidity with substance abuse of 30-35% and with drug abuse of 25-30%.

Finally, people with GAD may also have illnesses associated with stress, such as irritable bowel syndrome, insomnia, headaches and interpersonal problems.

Prevention

Most people with GAD need psychological treatment or medication, although making lifestyle changes can also help a lot.

• Stay physically active.
• Avoid tobacco and coffee.
• Avoid alcohol and other substances.
• Sleep long enough.
• Learn relaxation techniques.
• Eat healthy.