Generalized Anxiety Disorder

What Is It?

In generalized anxiety disorder, a person has persistent, nagging feelings of worry or anxiety. These feelings are either unusually intense or out of proportion to the real troubles and dangers of the person's everyday life.

The disorder is defined as persistent worry every day or almost every day, for six months or more. In some cases, a person with generalized anxiety disorder feels he or she has always been a worrier, even since childhood or adolescence. In other cases, the anxiety may be triggered by a crisis or a period of stress, such as a job loss, a family illness or the death of a relative. Although the crisis eventually goes away and the stress passes, an unexplained feeing of anxiety may last months or years.

In addition to suffering from nagging worries and anxieties, people with generalized anxiety disorder can have physical and psychological symptoms. The physical symptoms may lead them to seek treatment from a primary care doctor, cardiologist, pulmonary specialist or gastroenterologist. Stress also can intensify the anxiety or lead to a phobia, such as a fear of dogs, driving a car or attending a party. People with generalized anxiety disorder may have low self-esteem or may feel insecure, because they interpret people's intentions or events in negative, intimidating or critical ways.

The exact cause of generalized anxiety disorder remains a mystery, but some people have a genetic (inherited) tendency to develop the problem. The disorder probably stems from a disturbance in brain circuits that control the fear response. One of these structures is the amygdala, a structure deep in the brain that receives information about environmental threats, appraises their significance, and coordinates an effective response. Another part of the brain called the frontal cortex, which is responsible for judgment and planning, is also part of the anxiety response. The chemical messengers, gamma aminobutyric acid and serotonin, transmit signals along those circuits.

About 3% to 8% of people in the United States have generalized anxiety disorder. Women have the problem twice as often as men. The average adult patient first seeks medical attention between the ages of 20 and 30. However, the illness can occur at any age. Generalized anxiety disorder also has been diagnosed in young children, teenagers and elderly people. The illness is the most common anxiety disorder affecting people age 65 and older.

Of all psychiatric illnesses, generalized anxiety disorder is the least likely to occur alone. Between 50% and 90% of people with the disorder also have at least one other problem, usually panic disorder, a phobia, depression, dysthymia (a less severe form of depression), alcoholism or some other form of substance abuse.

Symptoms

In generalized anxiety disorder, the person has persistent worry or anxiety that lasts for at least six months. This worry or anxiety is excessive, troubling and hard to control, and it often interferes with a person's ability to function at home, at work or in social situations.

To be diagnosed with generalized anxiety disorder, a person has to have at least three of the following symptoms:

• Feeling restless or keyed up
• Becoming tired very easily
• Having difficulty concentrating or remembering (your mind goes blank)
• Feeling irritable, crabby or grouchy
• Having tense muscles
• Having trouble falling asleep or staying asleep, or not feeling rested after sleep

People with generalized anxiety disorder also may have a wide range of anxiety-related physical symptoms that may seem like symptoms of heart disease, respiratory illness, digestive diseases and other medical illnesses. These symptoms can include:

• Chest pains, palpitations, abnormally rapid pulse, abnormally rapid breathing, shortness of breath, a smothering sensation
• Abdominal pains, abdominal gas, indigestion, nausea, diarrhea, constipation, frequent urination
• Abnormal or irregular menstrual bleeding
• Problems in sexual function
• Tingling in the arms and legs, chills, sweating, hot flashes, itching skin

Diagnosis

You may consult a primary care doctor first if you suspect your physical symptoms are part of a medical illness. Your doctor may do tests to check for medical problems. If the results are normal, your doctor may ask about your family history, your history of any mental distress, current anxieties, recent stresses, and daily use of prescription and nonprescription drugs. Some drugs can cause anxiety symptoms. The doctor then may refer you to a psychiatrist for care.

Your psychiatrist will diagnose generalized anxiety disorder based on a full psychiatric evaluation that includes:

• Asking you to describe your worries, anxieties and anxiety-related symptoms
• Determining how long you have had these symptoms
• Assessing how worry and anxiety have affected your ability to function normally at home, at work and socially
• Checking for symptoms of other forms of psychiatric illness that might be present at the same time as generalized anxiety disorder

The psychiatrist also may order diagnostic tests, if necessary, to check for a medical illness. These won't be needed if they already have been done by the doctor who referred you to the psychiatrist.

Expected Duration

By definition, symptoms of generalized anxiety disorder last for at least six months. If untreated, the condition can last longer, with symptoms occurring over many years.

Prevention

There is no way to prevent generalized anxiety disorder. However, if you have already been diagnosed, you may be able to decrease your anxiety level by cutting down on caffeine, alcohol or other substances that might be triggering your symptoms.

Treatment

If you have generalized anxiety disorder, your doctor probably will treat you with a combination of medications and psychotherapy.

Three classes of medications typically are prescribed to treat generalized anxiety disorder:

• Benzodiazepines Examples are clonazepam (Klonopin), lorazepam (Ativan), diazepam (Valium) and alprazolam (Xanax). They are very safe and often bring quick relief from the symptoms of anxiety. They may be used only during the first weeks of treatment while waiting for other medications, such as antidepressants, to start working. In some people, the medication eventually stops working because the body becomes accustomed to it. This is called tolerance. If you need to stop taking these drugs, it should be done gradually under a doctor's direction, because withdrawal reactions can occur.
• Antidepressants These are the main treatment, especially when anxiety is long lasting or when of the person also has depression. The drugs used to treat generalized anxiety disorder include the popular selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), sertraline (Zoloft) and paroxetine (Paxil), and the tricyclic antidepressants, such as nortriptyline (Aventyl, Pamelor) and imipramine (Tofranil). They take several weeks to work, so a benzodiazepine often is prescribed to give relief during that time.
• Buspirone (BuSpar) Buspirone is an antianxiety drug that can be effective for generalized anxiety disorder. However, it is used much less frequently than the drugs listed above. Like antidepressants, it usually takes two to three weeks to begin working.

Psychotherapy

A number of psychotherapy techniques may be helpful. Cognitive behavioral therapy helps you recognize the unreasonableness of fearful thinking and teaches you techniques for controlling your symptoms. Psychodynamic, insight-oriented or interpersonal psychotherapy can help you sort out conflicts in important relationships or explore the history behind the symptoms.

Two specialized approaches for the treatment of anxiety are:

• Applied relaxation This method teaches people with generalized anxiety disorder to control their symptoms by using imagination and muscle control. Relaxation techniques, such as diaphragmatic breathing, meditation and visualization, can relieve some of the more bothersome physical symptoms.
• Biofeedback This form of therapy uses special sensors attached to the skin to teach people with generalized anxiety disorder to recognize anxiety-related changes in their physiological functions, such as pulse, skin temperature and muscle tone. With time and practice, they learn to modify these anxiety-related changes and to control the effect of anxiety on the entire body.

When To Call A Professional

See your doctor if you are troubled by severe worry or anxiety, especially if:

• Your anxious feelings have lasted for several months.
• You feel that you can no longer control your anxious feelings, and this makes you feel helpless or frightened.
• Your constant anxiety is interfering with your personal relationships or with your ability to function normally at home, at school or at work.
• You are having difficulty concentrating or remembering.
• You are having trouble sleeping.
• You have unexplained physical symptoms that may be anxiety-related.

Prognosis

In general, the outlook is good. With appropriate treatment, about 50% of patients improve within 3 weeks of starting treatment, and 77% improve within 9 months.

Additional Info

American Psychiatric Association

1000 Wilson Blvd.

Suite 1825

Arlington, VA 22209-3901

Phone: (703) 907-7300

Toll-Free: (888) 357-7924

E-Mail: apa@psych.org

http://www.psych.org/

National Institute of Mental Health

Office of Communications

6001 Executive Blvd.

Room 8184, MSC 9663

Bethesda, MD 20892-9663

Phone: (301) 443-4513

Toll-Free: (866) 615-6464

TTY: (301) 443-8431

Fax: (301) 443-4279

E-Mail: nimhinfo@nih.gov

http://www.nimh.nih.gov/

Anxiety Disorders Association of America

8730 Georgia Ave.

Suite 600

Silver Spring, MD 20910

Phone: (240) 485-1001

Fax: (240) 485-1035

http://www.adaa.org/