Clinical Corner – Generalized Anxiety Disorder (GAD)

I always thought I was just a worrier. I'd feel keyed up and unable to relax. At times it would come and go, and at times it would be constant. It could go on for days. I'd worry about what I was going to fix for a dinner party, or what would be a great present for somebody. I just couldn't let something go."

"I'd have terrible sleeping problems. There were times I'd wake up wired in the morning or in the middle of the night. I had trouble concentrating, even reading the newspaper or a novel. Sometimes I'd feel a little lightheaded. My heart would race or pound. And that would make me worry more.

Generalized anxiety disorder (GAD) is much more than the normal anxiety people experience day to day. It is chronic and exaggerated worry and tension, even though nothing seems to provoke it. Having this disorder means always anticipating disaster, often worrying excessively about health, money, family, or work. Sometimes, though, the source of the worry is hard to pinpoint. Simply the thought of getting through the day provokes anxiety. People with GAD can't seem to shake their concerns, even though they usually realize that their anxiety is more intense than the situation warrants. People with GAD also seem unable to relax. They often have trouble falling or staying asleep. Their worries are accompanied by physical symptoms, especially trembling, pounding heart, muscle tension, headaches, irritability, sweating, or hot flashes. They may feel lightheaded or out of breath. They may feel nauseated or have to go to the bathroom frequently. Many individuals with GAD startle more easily than other people. They tend to feel tired, have trouble concentrating, and sometimes suffer depression, too.

Depression often accompanies anxiety disorders and, when it does, it needs to be treated as well. The feelings of sadness, apathy, or hopelessness, changes in appetite or sleep, and difficulty concentrating that often characterize depression can be effectively treated with antidepressant medications, and/or psychotherapy. People with more severe symptoms respond best to a combination of medication and psychotherapy. Treatment can help the majority of people with depression.

Usually the impairment associated with GAD is mild and people with the disorder don't feel too restricted in social settings or on the job. Unlike many other anxiety disorders, people with GAD don't characteristically avoid certain situations as a result of their disorder. However, if severe, GAD can be very debilitating, making it difficult to carry out even the most ordinary daily activities. GAD comes on gradually and most often hits people in childhood or adolescence, but can begin in adulthood, too. It's more common in women than in men and often occurs in relatives of affected persons.

General Anxiety Disorder is diagnosed when someone spends at least 6 months worrying excessively about a number of everyday problems. In general, the symptoms of GAD seem to diminish with age. Successful treatment may include medication. Also useful are cognitive-behavioral therapy, relaxation techniques, and biofeedback to control muscle tension.