Generalized Anxiety Disorder

Generalized Anxiety Disorder (GAD)

It's normal to feel anxious from time to time, especially if your life is stressful. However, excessive, anxiety and worries that are difficult to control and interfere with day-to-day activities may be a sign of generalized anxiety disorder.

GAD Described

Generalized Anxiety Disorder, or GAD, is also known as  the disorder of the "What ifs?".  That’s because GAD typically involves a chain of runaway worries about future events, such as “what if my car breaks down?”, “what if I don't enjoy my  vacation?”, or “what if my new boss is difficult to deal with?”.   While GAD may initially be about real situations (e.g., a car, a vacation, a job, etc.), GAD worries almost always devolve into a chain of exaggerated fears involving worst case scenarios.  GAD worries typically grow larger and scarier the more we think about them.  Although they are really about remote, unlikely possibilities, GAD worries can feel real, imminent, and terrifying.  

As an example, a GAD worry about a car problem is rarely just about a simple break-down and its inconvenience. Instead, the GAD worry snowballs into “What if my car breaks down?... costs a fortune to fix?... causes me to max out my credit card?... and then causes me to fall into such overwhelming debt that I cannot pay my other bills?”.  The worry starts small but, becomes scarier and more difficult to manage the more we ruminate about it.

Similarly, a GAD worry about a problem on a vacation is never simply about being bored or finding one’s favorite museum or other attraction closed.  Instead, a GAD fear about a vacation is more likely to involve losing one’s wallet, having no funds to get home, getting lost and stumbling into danger,  and then becoming injured or ill while away with no available medical help.      

GAD worries truly are exaggerated “worst case scenarios” that feel real and frighteningly possible.

GAD can be about past events, too.  When GAD involves past events, it is likely to involve exaggerated feelings of guilt about one’s actions pertaining to a recent situation or from the distant past.  GAD worries are often about social interactions we recall with unease.  They usually involve obsessive ruminations about some misstep or verbal faux pas we’ve committed.  However, GAD worries from our past are rarely just about a simple error or slip of the tongue. It’s more likely to be excessive worry about the exaggerated, "unforgiveable" effects of some mistake we’ve made in the past and that mistake's horrible, awful, and almost always purely imagined consequences.

GAD in Childhood and Adulthood

It's possible to develop generalized anxiety disorder as a child or an adult. It’s origins are likely a combination of “nature and nurture”.  That is, the tendency to worry excessively appears to have a biological component (i.e., it is inherited and passed along genetically) as well as a social component (i.e., we may learn the habit of worrying excessively from the people who raise us).

Living with generalized anxiety disorder can be a long-term challenge. In many cases, it occurs along with other anxiety or mood disorders.  For instance, GAD worries may be associated with social anxiety and with agroraphobia as the tendency to worry about "horrible outcomes' often leads to a narrowing of one's lifestyle and social relationships.  GAD may also underlie some people's problems with depressive disorders because of GAD's capacity to give rise to nagging feelings of guilt about the past as well as negative expectations about the future.

Symptoms of GAD

Generalized anxiety disorder symptoms can vary. They may include:

·  Persistent worrying or anxiety about a number of areas that are out of proportion to the impact of the  

   events

·  Overthinking plans and solutions to all possible worst-case outcomes

·  Perceiving situations and events as threatening, even when they aren't

·  Difficulty handling uncertainty

·  Indecisiveness and fear of making the wrong decision

·  Inability to set aside or let go of a worry

·  Inability to relax, feeling restless, and feeling keyed up or on edge

·  Difficulty concentrating, or the feeling that your mind "goes blank"

Physical signs and symptoms may include:

·  Fatigue

·  Trouble sleeping

·  Muscle tension or muscle aches

·  Trembling, feeling twitchy

·  Nervousness or being easily startled

·  Sweating

·  Nausea, diarrhea, or irritable bowel syndrome

·  Irritability

GAD symptoms can cause significant distress in social, professional, or other areas of one’s life.  There may be times when GAD worries don't completely consume a person, but an individual with GAD may still feel anxious even when there's no apparent reason. For example, an individual may feel intense worry about one’s safety or the safety of a loved one or a GAD sufferer may have a general sense of dread that something bad is about to happen.

The Focus of GAD Worries?

Interestingly, GAD worries can shift from one concern to another and typically change with time and age.  The content of one's GAD worries usually depends upon what is important to an individual during a particular phase of his or her life.  For instance, an adolescent’s GAD worries often involve social concerns (e.g., fears of not being popular or suffering rejection) or fears of failure (e.g., not getting into college, failing to make one's parents proud) while an adult’s GAD worries are likely to be more often about financial, professional, or health related concerns.

When to seek help… 

Some anxiety is normal, but it may be time to seek help if:

·  You feel like you're worrying too much, and it's interfering with your work, your relationships, or other aspects of your life.

·  You feel depressed or irritable, have trouble with drinking or drugs, or you have other mental health concerns along with anxiety.

·  You have suicidal thoughts or behaviors — in which case, seek emergency treatment immediately.

Treatment of GAD with Cognitive-Behavioral Therapy

GAD worries are unlikely to go away on their own and they may actually get worse over time. That's because simply rehashing GAD worries over and over again in one's head doesn't seem to resolve them--it usually makes them more entrenched.

Cognitive-behavioral therapy (CBT) has been shown to be a highly effective form of treatment for dealing with GAD worries and reducing the habit of chronic, ruminative anxiety. CBT involves increasing a person's awareness of their worry habits and helping them make important modifications in thinking and in lifestyle to bring about relief.  Cognitive-behavioral therapy is direct and symptom focused.  It emphasizes the development of relaxation and coping skills in place of fear and avoidance.  CBT not only helps individuals decrease their negative thoughts about the past or future, it helps them open up their lives to new possibilities for personal, professional, and social growth.

                                                                                 --M. William Futtersak, Ph.D. Clinical Psychologist