Generalized Anxiety Disorder

Figure 1. Worry is a defining feature of generalized anxiety disorder. (credit: Freddie Peña)

What makes a person with generalized anxiety disorder (GAD) worry more than the average person? Research shows that individuals with generalized anxiety disorder (GAD) are more sensitive and vigilant toward possible threats than people who are not anxious (Aikins & Craske, 2001; Barlow, 2002; Bradley, Mogg, White, Groom, & de Bono, 1999). This sensitivity may be related to early stressful experiences, which can lead to a view of the world as an unpredictable, uncontrollable, and even dangerous place. Some have suggested that people with generalized anxiety disorder (GAD) worry as a way to gain some control over these otherwise uncontrollable or unpredictable experiences and against uncertain outcomes (Dugas, Gagnon, Ladouceur, & Freeston, 1998). By repeatedly going through all the possible “what if?” scenarios in their mind, the person might feel less vulnerable to an unexpected outcome, giving them the sense that they have some control over the situation (Wells, 2002).

Others have suggested people with GAD worry as a way to avoid feeling distressed (Borkovec, Alcaine, & Behar, 2004). For example, Borkovec and Hu (1990) found that those who worried when confronted with a stressful situation had less physiological arousal than those who didn’t worry, maybe because the worry distracted them in some way. The problem is, all this “what if?”-ing doesn’t get the person any closer to a solution or an answer and, in fact, might take them away from important things they should be paying attention to in the moment, such as finishing an important project. Many of the catastrophic outcomes people with GAD worry about are very unlikely to happen, so when the catastrophic event doesn’t materialize, the act of worrying gets reinforced (Borkovec, Hazlett-Stevens, & Diaz, 1999). For example, if a mother spends all night worrying about whether her teenage daughter will get home safe from a night out and the daughter returns home without incident, the mother could easily attribute her daughter’s safe return to her successful “vigil.” What the mother hasn’t learned is that her daughter would have returned home just as safe if she had been focusing on the movie she was watching, rather than being preoccupied with worries. In this way, the cycle of worry is perpetuated, and, subsequently, people with GAD often miss out on many otherwise enjoyable events in their lives.

Symptoms of Generalized Anxiety Disorder

People with GAD display excessive anxiety or worry on most days for at least six months about a number of things such as personal health, work, social interactions, and everyday routine life circumstances. The fear and anxiety can cause significant problems in areas of their life, such as social interactions, school, and work.

GAD symptoms include

• feeling restless, wound-up, or on-edge
• being easily fatigued
• having difficulty concentrating; mind going blank
• being irritable
• having muscle tension
• difficulty controlling feelings of worry
• having sleep problems, such as difficulty falling or staying asleep, restlessness, or unsatisfying sleep

Alex suffers from generalized anxiety disorder (GAD): a relatively continuous state of excessive, uncontrollable, and pointless worry and apprehension. People with generalized anxiety disorder often worry about routine, everyday things, even though their concerns are unjustified. For example, an individual may worry about her health and finances, the health of family members, the safety of her children, or minor matters (e.g., being late for an appointment) without having any legitimate reason for doing so (APA, 2013).

Risk Factors for Anxiety

Researchers are finding that both genetic and environmental factors contribute to the risk of developing an anxiety disorder. Although there have been few investigations aimed at determining the heritability of generalized anxiety disorder, a summary of available family and twin studies suggests that genetic factors play a modest role in the disorder (Hettema et al., 2001). The risk factors for each type of anxiety disorder can vary, some general risk factors for all types of anxiety disorders include the following:

• temperamental traits of shyness or behavioral inhibition in childhood
  

  Figure 2. Shyness is a risk factor for some anxiety disorders.

• exposure to stressful and negative life or environmental events in early childhood or adulthood
• a history of anxiety or other mental illnesses in biological relatives
• some physical health conditions, such as thyroid problems or heart arrhythmias, or caffeine or other substances/medications, can produce or aggravate anxiety symptoms; a physical health examination is helpful in the evaluation of a possible anxiety disorder

Diagnosis of Generalized Anxiety Disorder

A diagnosis of GAD requires that the diffuse worrying and apprehension characteristic of this disorder—what Sigmund Freud referred to as free-floating anxiety—is not part of another disorder, occurs more days than not for at least six months, and is accompanied by any three of the following symptoms: restlessness, difficulty concentrating, being easily fatigued, muscle tension, irritability, and sleep difficulties.

About 5.7% of the U.S. population will develop symptoms of GAD during their lifetime (Kessler et al., 2005), and females are twice as likely as males to experience the disorder (APA, 2013). GAD is highly comorbid with mood disorders and other anxiety disorders (Noyes, 2001), and it tends to be chronic. Also, generalized anxiety disorder appears to increase the risk for heart attacks and strokes, especially in people with pre-existing heart conditions (Martens et al., 2010).