Generalized anxiety disorder

Everyone experiences anxiety from time to time — usually in response to physical stress (such as nearly being run over by a car) or psychological stress (such as having your boss threaten to fire you). When you are being tested or challenged in some way, normal anxiety warns of potential danger and prepares you to deal with it.

Normal anxiety has its roots in fear—an emotion that serves an important function. When you face a dangerous or stressful situation, fear helps motivate the body to take action by activating the flight or fight response: the heart beats faster, sending more blood to the muscles; breathing becomes heavier; and muscles tense in readiness for movement.

This defensive mechanism provides the body with the necessary energy and strength to cope with threatening situations. When our prehistoric ancestors saw a tiger lying in wait for them, they needed to run. In people with generalized anxiety disorder, the same physical and emotional mechanisms are set in motion, even though there is no physical threat to contend with. For them, feelings of anxiety or apprehension occur for no specific reason.

If you experience a troubling sense of uneasiness for at least 1 month, without other psychological symptoms, the problem may be generalized anxiety disorder.

Abnormalities in a brain neurotransmitter called gamma-aminobutyric acid — which are often inherited — may make a person susceptible to GAD. Life events, both early life traumas and current life experiences, are probably necessary to trigger the episodes of anxiety.

Symptoms

In addition to a troubling and free-floating worry, you may feel restless and irritable. Your heart may beat faster, your breathing may become shallow and rapid, and your hands may tremble. Rapid breathing sometimes sets the stage for hyperventilation (heavy breathing accompanied by a sense of gasping for air, faintness, and numbness). You may perspire more (even without exertion), have trouble swallowing due to dry mouth, and have insomnia.

Physical symptoms such as upset stomach (cramps, nausea, and/or diarrhea), headache, and general aches and pains may be so prominent that sufferers and their doctors focus on the physical symptoms and overlook the underlying anxiety.

Diagnosing generalized anxiety disorder

Several approaches are usually needed to diagnose generalized anxiety disorder:

Medical history. Your answers to questions about how you are feeling, your habits and lifestyle, and your medical history may offer important clues.

Physical exam. Sometimes generalized anxiety disorder is linked to an underlying medical condition such as an overactive thyroid gland.

Psychological evaluation. Your answers to questionnaires can help make the diagnosis.

The standard criteria for generalized anxiety disorder include:

• feeling anxious and worried most days of the week for at least six months
• having trouble controlling feelings of anxiety
• at least three of these symptoms in adults: restlessness, fatigue, trouble concentrating, feeling irritated, muscle tension, or sleep problems
• anxiety or worry that causes distress or interferes with daily life
• anxiety that isn't related to another mental health condition (such as a medical condition, substance abuse, panic attacks, or post-traumatic stress disorder)

Many people with generalized anxiety disorder have another psychiatric disorder, most often depression or dysthymia, a less severe form of depression. They are also more likely to abuse alcohol or other drug. The effects of these drugs or the symptoms of withdrawal from them can raise the level of anxiety.

Treatment options

If you have symptoms of generalized anxiety disorder, talk to your doctor. A combination of medications and psychotherapy can help treat this condition. The most effective drugs for short-term treatment are benzodiazepine drugs, which calm symptoms of anxiety in about half of people with generalized anxiety disorder.

For long-term treatment, antidepressants and the antianxiety drug buspirone may be prescribed to prevent anxiety from coming back.

Like many drugs for mood disorders, buspirone and antidepressants are not effective immediately; it often takes 2 to 3 weeks before the anxiety-reducing effects are apparent. Short-term psychotherapy is more effective than no therapy and at least as effective as antianxiety medicine without psychotherapy.