Generalized Anxiety Disorder

Do you feel as if you are excessively stressed, tense or fearful throughout your day? Do these feelings sometimes seem to have no direct cause? Do they keep you from functioning effectively in your daily life? Have you not sought help because you do not have the panic attacks that seem to be a typical symptom of an anxiety disorder?

The above criteria fit with what the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, refers to as generalized anxiety disorder. If you suspect that you suffer from GAD or simply can’t explain the anxiety that disrupts your daily life and happiness, then read on.

What Exactly Is Generalized Anxiety Disorder?

The DSM-5 states that in order for a GAD diagnosis to be present, a person must have the above symptoms for six months or more. In addition, the individual must also have at least three of the following physical or cognitive symptoms:

• Edginess, sometimes called “hyperarousal” or restlessness
• More fatigue than usual or getting fatigued more easily
• Trouble focusing and concentrating or losing track of one’s thoughts
• Irritability, external or internal, that might not be witnessed by others
• Generalized pain with no known cause, such as random muscle aching or soreness
• Sleep disturbances that can include restlessness, trouble falling asleep, trouble staying asleep or a general sense of unsatisfying sleep such as waking up run-down and tired

Anxiety is further defined as excessive fear or worry that is disproportional to a situation or doesn’t have any perceptible cause. To qualify as generalized anxiety disorder, this worry must be significantly disruptive to a person’s life. That is, it must be difficult or impossible for the person to control, and it must interfere with daily productivity.

GAD and the Nature of Worry

Unlike other anxiety or panic disorders, GAD does not feature the acute or sudden episodes that are often called attacks. However, the anxiety present in GAD may start as something small, like a missed phone call or a possible dirty look from a co-worker. From there, the small stressor increases disproportionately until it becomes extreme, disruptive to your day, long-lived or constant, and it invades your other thoughts as you try to concentrate on other things.

Taking a small or simple worry to its extreme is called catastrophization, catastrophic thinking or cognitive distortion. It means that the sufferer fixates on the worst possible consequences of the situation that caused the stress instead of being able to manage it and strategize a solution. In addition, the worry of GAD is different from common stress because it isn’t always about a root cause but is instead about all kinds of different things, hence the term “generalized.” The worry cannot be controlled and is so upsetting on a daily basis that it impedes a person’s daily functioning.

To others, people with GAD may appear to overreact, be extremely pessimistic and have trouble making decisions in stressful situations. But underneath the value judgments of others, there is a very real and thankfully treatable disorder at work.

Anxiety and GAD Statistics

The Anxiety and Depression Association of America, or ADAA, has a wealth of statistics about anxiety in general and GAD in particular. The data in this section is from the organization’s website. The ADAA notes that anxiety and panic disorders are by far the most common form of mental illness in the United States, but they are considered highly treatable. The problem is that only just over a third of people who suffer from an anxiety disorder ever seek treatment.

When untreated, anxiety can lead to physical symptoms. People with anxiety are three to five times more likely to visit their doctors for physical ailments. Ultimately, it is also six times more likely that they will be hospitalized for a psychiatric condition. People with this and other forms of anxiety tend to be diagnosed with depression as well.

Six to eight million adults in the United States suffer from generalized anxiety disorder. That is 3.1% of the U.S. population at large. Approximately 43.2% of people who have GAD are currently getting some form of treatment for it. The ratio of females to males who have GAD is 2:1. The disorder is often comorbid with or accompanies major depressive disorder, also called clinical depression.

While these statistics may seem grim, it is important to remember that despite the low rate of people who seek treatment, professional help is both available and often highly effective.

Other Signs and Symptoms of GAD

The National Health Service in the United Kingdom has created a list of the signs and symptoms of GAD, especially physical ones. These are described below.

People with GAD may have what are called “intrusive thoughts.” These are thoughts that generate worry and tend to enter a person’s thinking without warning or invitation. There may also be dread of the future, no matter how bright one’s prospects are. People with GAD also often have trouble handling uncertainty or unexpected outcomes.

As a result, many sufferers are unable to relax at the end of the day and do not sleep well at night. They may struggle to concentrate and procrastinate often. They may employ avoidance strategies to escape situations known to trigger or worsen anxiety.

Physical signs can include extreme muscle tension, especially in the shoulders, head, neck and upper back. Gastrointestinal issues such as nausea, vomiting and diarrhea may be present. Other symptoms are headaches, dizziness, trembling, sweating and even heart palpitations.

Symptoms in children are often the same but with a handful of variations. Extreme irritability and worry about social situations, friends and performance in school and extracurricular activities are prevalent. Having stomachaches, wanting to cling to family members, refusing to go to school and being easily startled are also common signs.

Hope in Treatment

Luckily, the Mayo Clinic notes that there is a broad range of treatments for generalized anxiety disorder, including various psychotherapy techniques and medications.

Traditional therapy or “talk therapy” is often the first response to GAD in both children and adults. Cognitive behavioral therapy, or CBT, is an empowering method of understanding the aspects and triggers of a psychological disorder, and it is often the next step in treatment. CBT may involve journaling, learning to recognize situations that cause or worsen episodes and devising ways to divert the patient’s catastrophizing thoughts. CBT is designed to be progressive and short term, so the patient is constantly building new skills to cope with GAD.

The Mayo Clinic also lists medications that may be used, either to replace or in tandem with psychotherapy. The first tier of these includes antidepressants. These are typically divided into two categories. The first are selective serotonin reuptake inhibitors, or SSRIs. They include citalopram as the brand name Celexa, escitalopram as Lexapro, and paroxetine as Paxil or Pexeva. The second class of drugs are the serotonin and norepinephrine reuptake inhibitors, or SNRIs. These include medications like duloxetine as Cymbalta and venlafaxine as Effexor XR. Usually, the SSRI medications are tried before the more powerful SNRIs are employed.

Buspirone or Buspar, a daily anti-anxiety medication, may be recommended as well. Not only is it safe for most age groups, but it is also specifically designed for people with disorders like GAD. It may be taken along with an antidepressant.

In more extreme cases, a doctor may prescribe a class of anti-anxiety drugs known as benzodiazepines, nicknamed “benzos.” The Mayo Clinic classifies these as sedative medications, and they are not recommended for people who have struggled with a substance use disorder or addiction. Benzodiazepines include alprazolam as Xanax, clonazepam as Klonopin and lorazepam as Ativan. These are typically administered on an as-needed basis at the beginning of an episode when the patient first becomes aware of the anxiety. They can also be prescribed in the form of a daily maintenance dose.

Ways to Help Yourself If You Have GAD

It is a national trend that those who need professional mental health care cannot always get it when they need it. What should you do if you have generalized anxiety disorder but do not currently have access to mental health care or medication? There are several safe, effective techniques that can help a person cope with GAD.

The United Kingdom’s National Health Service has published a series of guidelines for self-help and coping for those with GAD. The list of strategies below is based on their recommendations.

1. Try an intellectual distraction, such as a book or online course. The NHS especially recommends books and courses on cognitive behavioral therapy because many of the techniques can be instituted without a therapist present. CBT books and courses will help you better understand the particulars of your condition and how to manage it.

2. Get some exercise and keep doing so regularly. Regular aerobic exercise releases serotonin, a calming neurotransmitter that combats depression and anxiety. Exercise also relieves physical tension, fights stress and elevates your mood. Swimming, biking and fast walking or jogging are prime examples of beneficial exercise.

3. Learn to relax and breathe. Optimizing your breathing and lessening your muscle tightness are tested and true methods for relieving all types of anxiety. Consider some simple breathing exercises, meditation, Pilates or yoga.

4. Avoid caffeine. Caffeine is a stimulant that can add to anxiety even before you are aware of being anxious. Too much caffeine can speed up your heart rate and hinder sleep. At the very least, consider reducing your caffeine and try not to take any in after 1 p.m.

5. Avoid tobacco and alcohol. While both of these are addictive substances, there are also other reasons to avoid them if you have anxiety. Smoking may provide a feeling of relaxation, but that is very temporary. In the long term, smoking raises the heart rate and blood pressure and can lead to severe heart disease. Alcohol may create a relaxed or euphoric feeling and even induce sleep, but these effects are also short lived. Alcohol use does not provide deep and restful sleep, either. Oftentimes, substances like tobacco and alcohol take the place of healthy coping mechanisms while increasing stress in the long run.

6. Find a support group. Being heard helps. Drawing on the experience and wisdom of others also helps. Working together can allow you to discover and build new coping mechanisms for your anxiety. Also, a sense of solidarity and a broader support network can only help you as you navigate GAD. You can find support groups locally in most places as well as online. A good resource to start your search is Mental Health America’s support group network.

If you have or suspect that you have generalized anxiety disorder and also suffer from a substance use disorder or addiction, there is professional help available for you. NFA Behavioral Health, a division of Granite Recovery Centers, offers integrative, comprehensive addiction treatment, along with treatment for comorbid mental disorders. Just because you have a mental illness that complicates your road to recovery, it does not mean there isn’t help out there specifically for you. Take the time to learn more about your options and start your journey toward wellness.