The phobias and panic disorder involve periods of anxiety that are acute, usually short-lived, and specific to certain objects or situations.
However, some individuals are anxious all the time, in almost all situations. These individuals may be diagnosed with generalized anxiety disorder (GAD).
Individuals with Generalized Anxiety Disorder worry about their performance on the job, their relationships with family and colleagues, and their health. The focus of their worries may shift frequently, and they tend to worry about many things instead of focusing on only issues of foremost concern. Their worry is accompanied by physiological symptoms, including muscle tension, sleep disturbances, and chronic restlessness. People with GAD feel tired much of the time, probably due to chronic muscle tension and sleep loss.
The disorder most commonly begins in childhood or adolescence.
Over 50 percent of people with GAD also develop another anxiety disorder. Over 70 percent experience a mood disorder, and 33 percent have a substance use disorder (Craske & Waters, 2005; Kessler et al., 2002).
The Diagnostic and Statistical Manual of Mental Disorders, Text Revision-IV (DSM-IV-TR) provides the framework of the criteria of Generalized Anxiety disorder.
- Excessive anxiety and worry (apprehensive expectation) must be persistently present for more days than not for 3 to 6 months, about several events or activities (such as work or school performance etc.).
- The person finds it difficult to control the worry.
- The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 3 to 6 months).
1. Restlessness or feeling keyed up or on edge
2. Muscle tension
3.Difficulty concentrating or mind going blank
5. Being easily fatigued
6. Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)
Due to anxiety and worry about situations, individuals frequently spend inordinate amounts of time and energy preparing for feared situations or avoiding those situations and are immobilized by procrastination, indecision, and seek reassurance from others. These behavioural symptoms of anxiety are very common and lead to significant impairment in an individual`s life.
Understanding the development of Generalized Anxiety Disorder
The cognitions of people with GAD are focused on threat, at both the conscious and unconscious levels. At the conscious level, people with GAD make several maladaptive assumptions, such as “It’s always best to expect the worst” and “I must anticipate and prepare myself at all times for any possible danger.” Many of these assumptions reflect concerns about losing control. People with GAD believe that worrying can help them avoid bad events by motivating them to engage in problem solving. Yet they seldom get to the problem-solving approach. Although they are always anticipating a negative event, they actively avoid visual images of what they worry about, perhaps as a way of avoiding the associated negative emotion. The maladaptive assumptions lead people with GAD to respond to situations with automatic thoughts that stir up anxiety, cause them to be hypervigilant, and lead them to overreact.
When facing an exam, a person with GAD might ruminate, “I do not think I can do this,” “I’ll fall apart if I fail this test,” and “My parents will be furious if I do not get good grades.”
The unconscious cognitions of people with GAD also appear to focus on detecting possible threats in the environment. In the Stroop colour-naming task, participants are presented with words printed in colour on a computer screen. Their role is to say what colour the word is printed in. In general, people are slower in naming the colour of words that have special significance to them (such as disease or failure for people with chronic anxiety) than in naming the colour of nonsignificant words. Presumably they are paying more attention to the content of those words than to the colours (Mathews & MacLeod, 2005).
Why do some individuals become vigilant for signs of threat? Individuals who have experienced stressors or traumas that were uncontrollable or unpredictable develop chronic anxiety and therefore become more watchful for signs of threat.
Treatment for Generalized Anxiety Disorder involves Cognitive-behavioral treatment that focuses on helping individuals with GAD confront the issues they worry about the most; challenge their negative, catastrophizing thoughts; and develop coping strategies.