What is Generalized Anxiety Disorder?
Quite often, people experience anxiety when faced with a difficult situation, and the anxiety ends once the situation is resolved. Occasional anxiety is a common phenomenon that people face especially before undertaking tasks for which they have little confidence in accomplishing. Besides, whenever confronted with the need to make important decisions, people tend to experience anxiety over the possible consequences of such decisions. In general, anxiety occurs when one is facing a difficult situation, has to make a difficult decision, or is about to carry out a task that one has no confidence in accomplishing successfully. In all these instances, the anxiety disappears once the situation causing it is resolved. However, if one displays ongoing excessive anxiety that lasts for months and interferes with one’s day-to-day activities, then one is likely to be suffering from generalized anxiety disorder (GAD).
Symptoms
Constant worry and obsession with concerns about issues that do not warrant the level of worry given to them is a common phenomenon in people with GAD. Other symptoms include restlessness, ability to be fatigued easily, distress in making decisions for fear of their outcome, and not being able to let go of a worry. Furthermore, difficulty in concentering and difficulty falling asleep are often experienced (National institute of mental health (NIMH), 2016, March, signs and symptoms, para. 1; Mayo Clinic, 2014, September 25, symptoms, para. 1). People with generalized anxiety disorder also display some physical signs. Such signs include the following: sweating, headaches, muscle aches, fatigue, and nausea among other signs (Mayo Clinic, 2014, September 25, symptoms, para. 2). GAD affects adults, children, and teenagers (Saxe, et al., 1987). Children and teenagers suffering from the conditions may display the following symptoms in addition to the symptoms stated above: excessive anxiety about performance in sporting events or performance in examinations given at school, low self-esteem, and excessive urge for approval.
Causes and Risk Factors of GAD
GAD has far-reaching consequences on people’s lives. For instance, it can significantly affect one’s performance at work. Besides, people with this disorder can cause accidents when driving. Therefore, on should seek help if one presents with the symptoms associated with the condition. One should see a doctor when one begins to display suicidal thoughts. Besides, signs of depression and constant worrying should be enough reasons for one to seek assistance from specialists. The actual cause of GAD has not yet been established. However, some genetic factors appear to increase chances for the development of the condition. Concerning the environmental factors, stressful or traumatic events are significant contributors to the development of GAD (In Stern, et al., 2016). On the other hand, family history of the condition has also been identified as one of the significant risk factors for the condition. Furthermore, abnormal functioning of the pathways connecting certain parts of the brain that control thinking and emotions has also been associated with GAD.
Studies have found that having a family member with GAD is a significant risk factor for developing the disease. This could mean that there is a gene susceptible to the condition that gets passed from an individual to the offspring. Besides, an experience of a stressful or traumatizing situation increases one’s risk of developing the condition. For instance, people who have made decisions that resulted in severe outcome in the past are more likely to develop this disorder. Obesity has also been found to be one of the major risk factors for most psychiatric disorders. Indeed, some studies have reported a close association between obesity and GAD. For instance, in a study conducted by Petry, Barry, Pietrzak, and Wagner (2008), GAD was found to be significantly associated with overweight and obesity. The aim of the study was to evaluate the association between body mass index (BMI) and psychiatric disorder (Petry, Barry, Pietrzak, and Wagner, 2008). The study involved 41,654 respondents who had participated in the National Epidemiologic Survey on Alcohol and Related Conditions (Petry, Barry, Pietrzak, and Wagner, 2008).
Another study, conducted by Simon and colleagues (2010), found that obesity is highly associated with anxiety disorder. The aim of the study was to establish the association between obesity and substance use disorder, anxiety disorder, and mood disorder (Simon et al., 2010). A total of 9125 respondents took part in this study (Simon et al., 2010). Even though the study found that there is an association between obesity and anxiety disorder, it failed to show the relationship between each type of anxiety disorder and obesity. The study conducted by Scott and colleagues (2008) give similar findings as the study carried out by Simon and colleagues. The aim of the study was to determine the relationship between obesity and mental disorder among the general population across different countries (Scott et al., 2008). However, like Simon and colleagues, Scott and colleagues failed to show the relationship between specific types of anxiety disorders and obesity. However, the fact that they established that obesity is associated with anxiety disorder indicates that obesity and overweight can increase one’s chances of developing GAD. Even though the specific causes of GAD have not been established, many efforts are being made towards that cause.
Diagnostic Criteria
The diagnostic criteria for GAD include the following (American Psychiatric Association, 2013, p. 222):
Excessive anxiety about several events and activities (for example work) that occurs for more days than not for a period not less than six months
The affected individual has difficulty controlling the worry
The disturbance cannot be attributed to the physiological effect of a substance (for example, medication)
The anxiety leads to a distress or impairment of occupational or social functioning that is clinically significant.
The anxiety is characterized by three of the six symptoms listed below:
Difficulty concentrating
Irritability
Restlessness or feeling on edge, of feeling keyed up
Muscle tension
Being easily fatigued
Sleep disturbance
The excessive anxiety and worry about several events is the essential feature about generalized anxiety (American Psychiatric Association, 2013, p. 222). In this case, the intensity, duration, and frequency of the anxiety, or worry, are not proportional to the actual likelihood or impact of the event that is anticipated (American Psychiatric Association, 2013, p. 222). Adults suffering from this condition often find themselves worrying about nearly all day-to-day activities (American Psychiatric Association, 2013, p. 222). Some of these activities do not warrant the anxiety these people experience about them. Furthermore, the affected person has difficulty controlling the worry (American Psychiatric Association, 2013, p. 222). Hence, they can’t stop worrisome thoughts from interfering with their efforts to concentrate on their day-to-day activities. One of the features that distinguish GAD from non-pathological disorder is that it is associated with worry that excessive that occurs for more duration and frequency than not.
GAD Epidemiology
GAD is a highly comorbid psychiatric condition. As a matter fact, it is one of the most comorbid anxiety disorders. People diagnosed with GAD are also likely to display the symptoms of other anxiety disorder. For instance, people with GAD are also likely to show symptoms of panic disorder (Cicchetti & Cohen, 2006). Furthermore, major depressive disorder (MDD) also co-occurs with GAD quite often (Muse & Moore, 2012). The high comorbidity of GAD makes it one of the most costly psychiatric conditions to treat and to manage. Besides, people with GAD and other comorbid conditions are likely to experience increased deterioration of health. Consequently, they are more likely to develop depression and suicidal thoughts. Many studies have found that GAD is closely associated with depression. Some studies also show that the risk factors for anxiety disorders are similar to those of depressive disorders. For instance, in the study conducted by Moffitt and colleagues (2007) to test whether MDD has similar risk factors to the risk factors associated with GAD, GAD and MDD were found to share some risk factors. However, not all risk factors are shared between the two conditions. Indeed, the study concluded that the development of the two conditions possibly takes different pathways (Moffitt and colleagues, 2007). There is the need for further research to establish the risk factors that clearly define GAD.
A high prevalence of anxiety disorders has been reported in Australia. According to the findings of the survey of mental health and wellbeing conducted in 2007 over a period of twelve months in Australia, the prevalence of GAD was found to be 2.7 percent (Australian Bureau of Statistics, 2008,). The survey targeted people aged from 16 to 85 years (Australian Bureau of Statistics, 2008). The female population recorded a higher prevalence than their male counterparts (Australian Bureau of Statistics, 2008, p.10). The survey also found that nearly 2.3 million of the Australian population aged from 16 to 85 years reported anxiety disorder (Australian Bureau of Statistics, 2008).
Mental disorders are associated with the highest prevalence of suicide cases. Indeed, suicide accounts for the largest proportion of premature death among the people suffering from mental illnesses. Anxiety disorders account for most suicide cases in all types of mental disorders. Indeed, many studies have reported a close association between suicide attempts and anxiety disorders. For instance, in the study carried out by Nepon, Belik, Bolton, and Sareen (2010) to determine how anxiety disorders are related to suicide attempts, anxiety disorder, especially post-traumatic stress disorder (PTSD) and panic disorder, “were found to be independently associated with suicide attempts” (Nepon, Belik, Bolton, and Sareen, 2010). The study used data obtained from the “National Epidemiologic Survey on Alcohol and Related Conditions Wave 2” (Nepon, Belik, Bolton, and Sareen, 2010). Even though the study did not explain the level of association between GAD and suicide attempts, the findings for PTSD and panic disorder could apply to GAD since they share many symptoms. Consequently, people suffering from GAD are at a higher risk of attempted suicide than their counterparts who are not affected by any mental condition.
Suicidal attempts tend to be high in adolescents suffering from anxiety disorder. This has been reported in several studies. For instance, in a study conducted by Boden, Fergusson, and Horwood (2007) to determine the level of contribution of anxiety to suicidal behaviors in adolescence and young adulthood, anxiety disorders were found to be strongly associated with suicidal attempts and suicidal thoughts. The data used in this study were obtained from the Christchurch Health and Development Study (CHDS), a longitudinal study in which 100 participants had taken part (Boden, Fergusson, and Horwood, 2007). According to National survey of mental health and wellbeing conducted in 2007 in Australia, suicide was found to be the leading cause of premature death among the people diagnosed with mental illnesses (Australian Bureau of Statistics, 2008, p. 19). Since many studies have linked GAD to suicide attempts, the condition could have accounted for most cases of the attempts in the survey.
Intervention for GAD
The interventions for GAD are mainly classified into two categories: pharmacotherapy and psychotherapy. Psychotherapy mainly involves psychological counseling in which the patient should work with the counselor closely. One of the most common forms of psychotherapy for GAD is cognitive behavioral therapy (CBT). Other forms of psychotherapy for the condition include the following: supportive psychotherapy, psychoanalysis, interpersonal therapy, and attention intervention. Supportive psychotherapy mainly aims at helping patients to deal with emotional distress. In this case, comforting, encouraging, and ensuring are some of the main techniques used. Psychoanalysis, on the other hand, is a relatively longer process aimed at helping individuals to understand the factors contributing to their emotional distress. Psychoanalysis is a theory as well as being a form of the technique for psychotherapy. Interpersonal therapy is based on the effects of relationships on an individual’s mental status.
Various medications are available for the treatment and prevention of the reoccurrence of GAD. The goals of different forms of pharmacotherapy for GAD vary slightly. Some of the forms of pharmacotherapy used in treating GAD are the following: serotonin-norepinephrine reuptake inhibitors (SNRI), benzodiazepines, selective serotonin reuptake inhibitors (SSRIs), hydroxyzine, and buspirone. The effectiveness in treating GAD varies from one form of pharmacotherapy to the other depending on the aim of each. The medications for GAD also vary regarding their modes of action. For instance, SSRIs functions by increasing the level of serotonin in the brain. SNRI, on the other hand, work by blocking the absorption of norepinephrine and serotonin in the brain.
The effectiveness of the various forms of pharmacotherapy and psychotherapy in treating GAD vary. The two types of interventions also vary in terms of their goals. For instance, while SSRIs therapy is aimed at treating the symptoms of the condition; CBT seeks to deal with the root cause of the condition. Various studies have also reported a variation in the effectiveness of the two forms of treatment for the condition. However, some studies show no change. The review conducted by James, James, Cowdrey, Soler, Choke, (2015) found no clear evidence indicating that CBT is more efficacious than other forms of therapy. The meta-analysis conducted by Hofmann and colleagues to determine the efficacy of CBT found that the therapy is efficacious in treating anxiety disorders (2012). In another meta-analysis, carried out by Olatunji, Cisler, and Deacon (2010) to review the efficacy of CBT versus placebo in treating adult GAD, CBT was found to be more efficacious in treating the condition than the placebo.
Some studies have also attempted to establish whether CBT is superior to other forms of psychotherapy in treating psychiatric disorders. For instance, the review conducted by Tolin (2010) to determine whether CBT is superior to other forms of psychotherapy to treat psychiatric conditions found that CBT is superior to psychodynamic therapy. However, the therapy was not found to be superior to supportive and interpersonal therapy (Tolin, 2010). In another study, carried out by Seidler and Wagner (2006) to compare the efficacy of EMDR and trauma-focused CBT in treating PTSD, none of the two forms of therapy was found to be more efficacious than the other.
Conclusion
GAD remains one of the mental disorders of great concern to the society. People are increasingly exposed to stressors from various sources. For example, exposure to environmental stressors is on the increase in different parts of the world. For instance, more challenges in daily life continue to emerge, and these challenges lead to increased cases of depression. As more challenges continue to emerge, the prevalence of GAD is likely to increase since the exposure to social and economic challenges lead to greater risk of developing the condition. Therefore, there is the need to increase efforts towards reducing and preventing cases of GAD and other conditions. Presently, GAD remains the one of the anxiety disorders with a serious burden to the Australian population. There is the need for more effective interventions to deal with the problem.
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