What is Generalised Anxiety Disorder?

Generalised Anxiety Disorder is part of the group of Anxiety Disorders. What distinguished GAD from the other Anxiety Disorders (e.g. Panic Disorder and Agoraphobia, Separation Anxiety, Obsessive-Compulsive Disorder, and Social Phobia) is that the anxiety is not from anticipation from a single item such as being embarrassed in public (Social Phobia), being contaminated (Obsessive-Compulsive Disorder) or being away from home or close relatives (Separation Anxiety) and the anxiety and worry do not occur exclusively during Post Traumatic Stress Disorder.

The essential feature of Generalised Anxiety Disorder is excessive anxiety and worry occurring more days than not for a period of at least 6 months, about a number of events or activities.

Although people with GAD may not always identify their worry as being “excessive” they report distress due to constant worry, difficulty controlling the worry or experience difficulty in important areas of functioning.

Because it is clearly to one’s advantage to respond with anxiety in certain threatening situations, one can speak of normal anxiety in contrast to abnormal anxiety.

What is normal anxiety?

Anxiety is a diffuse, highly unpleasant, often vague feeling of apprehension, accompanied by one or more bodily sensations-for example, an empty feeling in the pit of the stomach, tightness in the chest, as pounding heart, perspiration, headache, or the sudden urge to void. Restlessness and a desire to move around are also common.

Anxiety is an alerting signal; it warns of impending danger and enables the person to take measures to deal with a threat.

As an alerting signal, anxiety can be considered as basically the same emotion as fear, it warns of an external or internal threat; it has lifesaving qualities. In this way it prompts the person to take the necessary steps to prevent the threat or at least to lessen its consequences. A few examples of warding of threats include getting down to hard work or preparing for an examination, dodging a ball thrown at one’s head, or running to catch the last commuter train. Anxiety prevents damage by alerting the person to carry out certain acts that forestall the danger.

Anxiety is normal for the infant who is threatened by separation from parents or loss of love, for children in their first day in school, for adolescents on their first date, for adults when they contemplate old age or death, and for anyone who is faced with illness. Anxiety is a normal part of growth, of change, of experiencing something new and untried, and of finding one’s own identity and meaning in life.

Abnormal or Pathological Anxiety

The intensity, duration, or frequency of the anxiety and worry is far out of proportion to the actual likelihood or impact of the feared event. The person finds it difficult to keep worrisome thoughts from interfering with attention to tasks at hand and has difficulty stopping the worry.

Adults with GAD often worry about everyday routine life circumstances such as possible job responsibilities, finances, misfortune to their children, household chores, car repairs, or being late for appointments.

Children and adolescents with GAD tend to worry excessively about how they perform in school and sports even when their performance is not being evaluated. They may also worry about catastrophic events such as earth quakes or nuclear war.

During the course of the disorder the focus of worry may shift from one concern to another.

GAD affects approximately 2 – 5 percent of the population and affects women twice as much as men. However, the ratio of women to men receiving inpatient treatment is closer to one-to-one.

The disorder most often develops in the 20’s, although persons of any age can be affected.

WHAT ARE THE SYMPTOMS?

GAD is characterised by:

* unrealistic or excessive worry about two or more life circumstances and

* the person finds it difficult to control the worry.

Individual patterns of anxiety vary widely. Some patients have cardiovascular symptoms, such as palpitations and sweating; some have gastrointestinal symptoms such as nausea, vomiting, feelings of emptiness, butterflies in the stomach, gas pains, and even diarrhea; some have urinary frequency; and some have shallow breathing and tightness in the chest. In some patients, muscle tension is experienced and they complain of muscle tightness or of spasms, headache and wry neck.

It has been reported that the cardiovascular and respiratory symptoms are fewer and less sever in GAD than in other Anxiety Disorders (e.g. Panic Disorder), but that the gastrointestinal and muscular symptoms are similar in intensity.

Although GAD like other illnesses has certain characteristic symptoms, the symptoms are not identical for each person. Other symptoms often associated with GAD include:

– restlessness or feeling keyed up on edge

– being easily fatigued

– difficulty concentrating or mind going blank

– irritability

– muscle tension

– sleep disturbance

Family and friends may notice deterioration in areas such as:

* social activities

* occupational or academic activities

* sleep schedule

* behaviour changes

* other important areas of functioning

WHAT CAUSES GENERALISED ANXIETY DISORDER?

There are a number of different factors believed to be associated with the onset of GAD. These are:

Biological

It is thought that certain abnormalities of neuronal systems (neurochemicals and neurohormones) in the brain and limbic system are involved in this disorder. Studies have demonstrated that patients with GAD have increased sympathetic nervous system response and slower adaptation to stressful stimuli.

Genetic

Anxiety as a general characteristic has a familial association. Certain studies have indicated that some aspects of this disorder may be inherited. Approximately 25 percent of first-degree relatives are affected, women more often than men.

Stress, Conflict, and Anxiety

Whether an event is perceived as stressful depends on the nature of the event and the resources, the defenses, and the coping mechanisms of the person. These all involve processes by which a person thinks, perceives and acts on external events or internal drives.

As mentioned earlier, anxiety usually leads to action designed to reduce or remove the threat. This action may be constructive, in which case the person uses coping mechanisms such as studying for an examination or by using a defense mechanism such as avoidance or denial. Defense mechanisms can be either adaptive or maladaptive depending on the consequences. Repression or denial is used many times in the course of the person’s life mainly to produce harmony with environment and self. Only if symptoms of pathological behaviour result can repression or any other defense mechanism be considered abnormal.

Cognitive-Behavioural theories

Persons may learn to have an internal response of anxiety by imitating the anxiety responses of their parents, or that anxiety is a conditioned response to a specific stimuli that becomes generalised. Also, patients with GAD are viewed as holding distorted, disabling thoughts with regard to events perceived as threatening to their physical or social well-being.

Patients with anxiety disorders tend to overestimate the degree of danger and the probability of harm associated with events and to underestimate their own ability to cope with perceived threats.

HOW CAN THE FAMILY HELP?

• 1. Family members can help by reducing the amount of external stressful situation that are likely to produce anxiety.
• 1. Encourage the person to talk freely about their worries and concerns, and demonstrate an understanding of their feelings.
• 2. Help the person to engage in techniques such as relaxation, meditation, and breathing exercises to reduce symptoms. A reduction of symptoms often allows the patient to function more effectively in their daily work and relationships, which provides new rewards and gratifications that are in themselves therapeutic.
• 3. Positively reinforce (i.e. reward) the person for any positive changes in their thinking and behaviour.
• 4. Encourage the person to face anxiety provoking situations and to use coping strategies.
• 5. Try to provide the person reassurance about unrealistic fears.

THE DO’S

Encourage the person to seek professional help. This may be difficult as the person with GAD may deny having an anxiety disorder. However, you can encourage the person to seek help to manage their physical symptoms of distress.

THE DONT’S

Use language such as “you shouldn’t feel that way” or “you must stop worrying”. This type of communication will only serve to increase the anxiety in the person.