Generalized Anxiety Disorder
Generalized Anxiety Disorder or GAD is one of the most common anxiety disorders but can be difficult to diagnose. Studies suggest it affects somewhere between three and 10 percent of people and is twice as common in women. It is also the most commonly found anxiety disorder in older adults, often triggered by traumatic events such as a fall or acute illness in this group. It may present differently in older adults, however, who may have during their working life, managed it by working or keeping busy. However, when they retire, they no longer have anything to distract them and may not develop new coping strategies so become over-focused on health issues or family concerns. Indeed frequent visits to the doctor presenting with unsubstantiated health concerns can be a key indicator of the presence of GAD.
Causes of GAD
While the exact cause of GAD is still not clear, several factors seem to contribute to its development.
Genetic factors: Family history may increase the likelihood of being diagnosed with GAD.
Brain chemistry: GAD has been associated with certain nerve cell pathways dysfunction; if the pathways that connect particular brain regions do not function efficiently then problems related to mood or anxiety may result. For example, it may affect the regulation of the emotional reaction to potentially threatening stimuli.
Environmental factors: Traumatic life events may contribute to GAD; GAD also may also worsen at times of stress. The use of and withdrawal from addictive substances can also exacerbate anxiety.
The risk of GAD is increased by:
- Biological sex - female
- Family history
- High levels of current stress
- History of trauma
- History of other anxiety disorder
- Chronic pain or physical illness
- History of substance use
- Repeated visits with the same physical symptoms which do not respond to treatment (for example stomach-aches or unexplained fatigue)
- Medications that can cause anxiety as a side-effect (including some herbal medicines)
Signs and symptoms
GAD is difficult to diagnose - apart from it having none of the distinct features of other disorders, anxiety symptoms are also associated with several health issues, including other mental health issues (other anxiety disorders and depression). For example, cardiac issues, hyperthyroidism, respiratory problems, can all produce symptoms you might associate with anxiety.
Conversely, anxiety symptoms can also manifest themselves physically (known as somatizing). Therefore someone may present with symptoms of a severe stomach complaint but after investigations it can become clear that there is nothing pathological (disease-process) occurring but that it is caused by psychological factors.
Anxiety-like symptoms can also be caused by medications, including anti-hypertensives (blood pressure medication), hormones, steroids, antidepressants and over-the-counter medications that contain caffeine or pseudo-ephedrine, such as are often found in cold and flu remedies.
General anxiety syndrome is a condition characterized by persistent and excessive worry, even when there’s nothing specific to worry about. People with GAD ruminate and focus on “what-if” scenarios to excess such that the worry “spirals” out of control. Mental health professionals are likely to suspect the presence of GAD in someone reporting long-standing, excessive worry not connected to particular circumstances, alongside symptoms of physiological arousal such as restlessness, insomnia, and muscle tension.
What Are the Symptoms of GAD?
GAD shapes the way a person thinks, but physical symptoms are associated as well. Symptoms may include:
Disproportionate and persistent worry
An unrealistic view of problems
Restlessness or a feeling of unease
Tension in the muscles
The urge to urinate/defecate frequently
Dyskinesia (shaking or trembling)
Being easily startled
Mental health professionals will use a combination of interview and psychometrics (scales, measures, questionnaires) alongside the criteria of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) to diagnose GAD.
A commonly used measure, The Generalized Anxiety Disorder Assessment (GAD-7) may be used as part of the diagnostic process. It is a seven-item self-report measure that assesses the severity of generalized anxiety disorder (GAD). The individual is asked to score the severity of their symptoms over the past fortnight. Responses range from “not at all”, “several days”, “more than half the days” to “nearly every day”.
As stated earlier, people with GAD often present primarily with physical complaints (headaches, muscle tension, gastrointestinal symptoms, back pain, and insomnia), and may not declare worry or distress of any kind. GAD is, therefore, a potential diagnosis in people with such symptoms, as well as individuals who are frequent attendees to health services with the following issues:
- Chronic physical health complaints
- Those frequently seeking reassurance about Somatic (physical) symptoms
- Tachycardia (increased heart rate)
- Unexplained shortness of breath
- An exaggerated startle response
Treatment is recommended on the basis of individual diagnoses: that is, the number, severity, and duration of symptoms alongside the extent of distress and impact on daily life.
Recommended treatment will also be based upon the individual's circumstances such as any physical health complaints, environmental stressors, pre-existing/co-morbid mental health or substance use issues and previous responses to treatment.
Treatment may consist of the following approaches and typically in this order:
Psycho-education including lifestyle advice - increasing exercise, monitoring intake of anxiety-increasing substances such as caffeine, diet and sleep hygiene
Self-help both independent and guided/facilitated (such as guided relaxation, for example)
Intensive intervention such as Cognitive-behavioural Therapy or mindfulness-based approaches
Pharmacotherapy (drug treatments), typically using SSRI and SNRI-based antidepressants in the first instance.