generalized anxiety disorder (GAD)

ABOUT/DESCRIPTION
Anxiety Disorders are characterized by chronic, seemingly uncontrollable worry. Generalized Anxiety Disorder, or GAD, is so termed as the pervasive worry experienced by the sufferer lacks a specific reason or target of concern. In other words, there is no clear reason to justify their level of worry and fear. While the GAD sufferer may realize their anxiety and worry is more intense than a particular situation or event warrants, they have difficulty controlling their worry and the worry often interferes with their ability to function normally and comfortably. While not all GAD sufferers are mindful of the source of their anxiety, typical worries for adult GAD sufferers include matters related to health, finances, and family.

Symptoms that often accompany excessive worry include: trembling and inner nervousness, irritability, nausea, muscle tension, sleep disturbances and fatigue. Others symptoms may include strange aches, pains, or numbness in the extremities, difficulty concentrating, and tightness of the throat or choking sensations.

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), a guide used in the US to diagnose mental and mood related disorders, cites the following diagnostic criteria for GAD.

• the anxiety and worry must be present more days that not for at least six months
• the person feels that their worry is difficult to control
• the anxiety and worry is associated with three or more of the physical symptoms listed above with some of the symptoms present for more days than not for six months
• the anxiety and worry lacks a specific reason or target of concern (simplified summary).
• the anxiety, worry, and/or associated symptoms cause 'clinically significant distress or impairment' in normal day-to-day functioning
• the anxiety and worry does not stem from the effects of substance abuse, a general medical or other mental condition (simplified)

Michelle's case history serves as a good example of the typical experience of the GAD sufferer.

"Ever since I was a small child; I have always had this fear which I described to my doctor as "a funny feeling" in my stomach. Needless to say, no one understood what this young girl meant and I had no other way to express what I was feeling. School was especially difficult for me. I would have these 'nervous attacks' in class and I knew everyone was looking at me as I sat there, perspiring. I just kind of held on to my desk, praying the bell would ring so I could get out and get some air. I felt this same way anytime I had to talk in front people, eat out at a restaurant with my family or travel to some place new.

Things really got bad for me when I entered college. My grades were good enough that I received a partial scholarship to a prominent nursing school. But, the more I learned about the various medical maladies and procedures, the more I began to worry that I might be suffering from a serious medical problem myself. I obsessed that I had a heart condition, a brain tumor, leukemia - whatever we were studying, I developed the symptoms.

I saw our family physician on a regular basis, to no avail. Test after test confirmed that physically, I was perfectly fine. I didn't believe it. I thought he just had to be missing something. I was always nervous and jittery. My heart would always be racing. I had strange aches and numbness in my arms and legs. My doctor suggested that it was likely just stress, and prescribed some (prescription drug brand). The pills did help me relax, but I felt like a zombie and only took them if things got really bad."

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QUICK FACTS

Generalized Anxiety Disorder affects approximately 4 million American adults age 18 to 54; while more recent statistics cited by other sources puts this figure closer to 8 million American adults.

The onset of GAD can occur at any age but most commonly occurs between childhood and middle age.

GAD often coexists with other ailments including depression, alcoholism, and other types of substance abuse.

While the exact cause of GAD is unknown, researches have focused their attention on a combination of risk factors including personality characteristics, genetics/biology, and environmental factors.

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GENERAL HELP/TREATMENT TECHNIQUES

Exact treatment will vary from person to person based on severity, and other distinctive factors (such as co-morbid issues like alcoholism), GAD is typically treated with medications, therapy, or a combination of the two.

Both antidepressants and anti-anxiety drugs are prescribed to reduce the symptoms associated with GAD. Specifically, these drugs include benzodiazepines, beta-blockers, tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs) and most recently selective serotonin reuptake inhibitors (SSRIs).

Many forms of therapy are used in the treatment of GAD including psychotherapy, relaxation therapy, and exposure therapy. Perhaps the most researched and clinically proven form of treatment therapy for GAD is cognitive-behavioral therapy (CBT). CBT is simply an integration of the cognitive (thought) restructuring approach of traditional cognitive therapy and the behavior modification techniques of traditional behavioral therapy. CBT is a structured, short-term therapy that that is very goal oriented and conducive to change. It is an action oriented form of therapy based on the premise that bad or faulty thinking patterns cause negative emotions and negative behaviors. This treatment teaches people to understand and change their thinking patterns so that they can change their behavior and emotional state. CBT teaches the individual to think and respond differently in situations that cause anxiety.

While medication and CBT are both effective in reducing the symptoms GAD, CBT generates a greater sense of personal satisfaction in overcoming the disorder. Research has also shown that CBT is more effective than medications at preventing relapse.

There are a number of relatively simple lifestyle changes you can make on your own that may help relieve symptoms of anxiety.

• Avoid products that contain caffeine such as coffee, colas, chocolate, etc.
• Avoid nicotine
• Reduce intake of foods that are high in sugar and fats.
• Get a moderate amount of aerobic exercise daily - consult your physician before beginning any exercise routine.
• Practice some form of relaxation daily (guided imagery, muscle relaxation techniques, meditation, massage, yoga, etc.)
• If you consume alcohol, do so only in moderation

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