Generalized Anxiety Disorder, better known as GAD, can be characterized by a chronic state of intense worrying and tension. There are certain criteria in the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, that must be met in order to be diagnosed. The main criteria includes excessive anxiety or worry that occurs more days than not for at least six months, as well as being unable to control the worry. The client, if an adult, must also experience 3 or more of the following symptoms, and children must exhibit at least 1 – restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance, and significant distress. The symptoms cannot be due to physiological effects, such as stimulants, such as coffee, or side effects from medication. The symptoms also must fit best under GAD and not any other disorder.
In the United States, approximately 2.7% of adults are diagnosed with GAD in a given year, 1.9% of U.S. men, and 3.4% of U.S. women. Women are more likely to develop GAD because they respond to stress easier, causing increased anxiety. The rate of diagnosis in the U.S. for adults in a lifetime is around 5.7% and this rate is similar worldwide.
There are four factors or dimensions that can interact to cause GAD. These dimensions include biological, psychological, social, and sociocultural. The biological dimension includes genetic influence, such as a family history, overactive fear network in the brain, and lastly abnormalities with GABA receptors which help control anxiety. The psychological dimension includes a lower threshold for uncertainty, or being able to deal with only a small amount of stress, developing anxiety-evoking schemas, use of worrying as coping, and worrying about worrying. Anxiety-evoking schemas are negative thoughts and can be categorized as catastrophizing, overgeneralizing, and personalizing. Catastrophizing is always expecting an unfavorable outcome – Sarah said she failed the quiz, then she received an 85%. Overgeneralizing is making a conclusion based on little evidence – since I failed the first quiz, I am going to fail all the quizzes. Finally, personalizing is believing everything and everyone is working against you and the need to do everything – it was all my fault we failed the group project. The social dimension includes a lack of social network, or little to no friends, separation or loss, anxious or nonresponsive parents, and peer conflicts and victimization, or bullying. The sociocultural dimension includes stressful or poor living conditions, prejudice and discrimination, and low socioeconomic status. All these dimensions play a role in the development of GAD and a diagnosis cannot be reached unless all dimensions are analyzed.
This disorder has a devious onset, meaning it sneaks up on you. For example, it all begins with a normal worry, then it escalates into an excessive worry, then further to planning on how to worry about worrying. The disorder is most commonly developed in early adulthood, as those are typically the years people are under the most stress. Those who do not seek treatment typically do not recover.
Treatment of GAD includes medication for a short-term solution and cognitive behavior therapy for a long-term solution. Medication is used as a short-term solution to GAD stressors that are not encountered daily, such as flying. If a client has a fear of flying, medication may be prescribed to help them relax during the flight. Cognitive behavioral therapy helps clients identify their thoughts and feeling and modify them. Generalized anxiety disorder is one that can become debilitating if not treated, but over half of all patients treated had a significant reduction in symptoms.