What is Generalised Anxiety Disorder

What is Generalised Anxiety Disorder?

Generalised anxiety disorder (GAD) is one of several anxiety disorders listed in the American Psychiatric Association’s 1994 Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR).

The central symptom that characterises GAD is worry, defined as the cognitive tendency to focus on a problem that one is unable to let go of. Although everyone worries about events in their lives from time to time, the DSM-IV-TR stipulates that the worries of those with generalised anxiety disorder (GAD) are excessive, uncontrollable, long lasting and impairs their day to day functioning.

Other symptoms of anxiety include tiring easily, restlessness, difficulty concentrating, irritability and muscle tension. Symptoms must be present for at least six months in order for an individual to receive a diagnosis of generalised anxiety disorder (GAD).

Comorbidity of Anxiety Disorders

Generalised anxiety disorder (GAD) is often chronic and typically thought to begin in adolescence. However, many sufferers report having had a tendency to worry excessively all their lives. Generalised anxiety disorder (GAD) is frequently comorbid with other anxiety disorders.

Brown and colleagues reported that over half of sufferers will have received a diagnosis of another anxiety disorder. This is thought to be due to two primary reasons. Firstly, many of the symptoms that characterise the different anxiety disorders overlap, and secondly, factors that are thought to contribute to the development of an anxiety disorder may increase the risk to all anxiety disorders.

Furthermore, anxiety disorders are often comorbid with other disorders such as substance abuse disorders, personality disorders and depression. Depression often develops after the onset of an anxiety disorder and is thought to be a result of the feelings of hopelessness and despair produced by anxiety.

Genetic and Neurobiological Factors Related to Anxiety Disorders

Psychologists have identified a number of factors that may increase an individual’s risk of developing an anxiety disorder, such as generalised anxiety disorder (GAD). Twin studies have suggested that genetic factors may play a role in the development of anxiety disorders, with generalised anxiety disorder (GAD) thought to have a heritability of 20-40%.

It is also thought that there may be a neurobiological basis of anxiety disorders. The fear circuit, a set of brain structures that tend to be activated when a person feels anxious or fearful, has been found to show elevated activation in those with anxiety disorders, particularly in regards to the amygdala.

Furthermore, abnormal functioning of the neurotransmitters in the fear circuit has been found in those with anxiety disorders, such as poor functioning of the serotonin system and abnormally high levels of norepinephrine.

Personality and Cognitive Factors Related to Anxiety Disorders

Personality traits that may contribute to the development of an anxiety disorder have also been identified. Some infants show a trait known as behavioural inhibition, which is characterised by agitation and crying when faced with novel stimuli.

A study by Kagan & Snidman in 1999 found that 45% of infants who exhibited signs of behavioural inhibition had begun to show signs of anxiety at age seven. The trait neuroticism has also been associated with anxiety disorders. It has been found that those with high levels of neuroticism are twice as likely to develop an anxiety disorder, and that neuroticism scores are a predictor of the onset of anxiety disorders and depression.

Those with anxiety disorders also show different cognitive behaviours in comparison to those without anxiety disorders. Those who have received a diagnosis of an anxiety disorder have been found to show selective attention to signs of threat. This is thought to happen automatically and very quickly, perhaps before the individual is consciously aware of the stimulus in question.

Lastly, as with depression, negative life events have often been found to precede the onset of anxiety. In 1989, Finlay-Jones estimated that 70% of people with an anxiety disorder had reported a negative life event before receiving a diagnosis of an anxiety disorder.

Generalized Anxiety Disorder Causes

Generalized Anxiety Disorder Causes: The Origins and Causes of GAD

The causes of generalized anxiety disorder remain a matter of debate. Genetics, imbalances in brain chemistry and environmental factors have all been suggested as possible causes of anxiety attacks, but exactly what causes anxiety disorders is often unclear.

Family and Anxiety Disorder Causes

Anxiety disorders seem to run in families. People whose first-degree relatives suffer from generalized anxiety disorder have a higher than normal risk of also developing GAD. A family history of severe anxiety disorders suggests genetic or environmental causes of anxiety attacks.

Twin studies support the theory that genetics contribute to generalized anxiety disorder. Results from studies of twins suggest genetic anxiety disorder causes are responsible for up to 37 percent of GAD cases.

Environmental Causes of Anxiety

Family history influences more than determine a person’s genetic makeup. Families have a profound effect on a person’s environment. How a family handles stress, conflict and anxiety-producing situations has an enormous influence on how individual’s deal with anxiety. Families who model unhealthy responses to anxiety can pass negative behavioral patterns from one generation to another, increasing the risk anxiety disorders.

Family dynamics and attitudes certainly increase the risk of severe anxiety problems, but cannot be considered true causes of GAD. A family that is prone to anxiety can include individuals who handle anxiety and stress in positive ways. Likewise, while stressful or traumatic life events can trigger generalized anxiety disorders, not everyone who experiences a traumatic event requires help for severe anxiety. Such events may be triggers for GAD, but are not causes.

Brain Chemistry and Severe Anxiety

Imbalances in brain chemistry may cause chronic anxiety. Neurotransmitters are chemical messengers vital for the transmission of messages from one brain cell to another. Low levels of neurotransmitters affect how well the brain transmits information, and changes how the brain reacts to certain stimuli.

Low levels of the neurotransmitters serotonin and norepinephrine are associated with severe anxiety. Treatment for generalized anxiety disorder includes SSRI and SNRI antidepressants, which regulate levels of serotonin and norepinephrine. Whether imbalances in brain chemistry cause anxiety, or are the result of anxiety disorders, is open to debate.

While the causes of anxiety may be open to debate, GAD responds well to treatment. Generalized anxiety disorder symptoms may be treated with antidepressants and anti-anxiety medication. talk therapy for anxiety is also effective, especially when combined with medication.

GAD and disorder

Generalized Anxiety Disorder Complications: Insomnia, Clinical Depression and Teeth Grinding Due to GAD

Generalized anxiety disorder can cause secondary physical or mental disorders and aggravate symptoms of existing conditions. Certain mental disorders such as clinical depression and bipolar disorder often occur in combination with GAD. Physical complications include bruxism (teeth grinding), headaches, digestive problems and an increased risk of cardiovascular events.

Clinical Depression, Bipolar Disorder, and GAD

GAD is often co-morbid with other mental disorders (meaning the two disorders are present at the same time). Often the two disorders interact, with each disorder worsening the symptoms of the other. Cases of generalized anxiety disorder in combination with bipolar disorder or different types of depression are common.

Differentiating between clinical depression and generalized anxiety disorder is complicated, as the disorders share a cluster of symptoms, including:

  • Anxiety
  • Insomnia
  • Agitation
  • Difficulty concentrating.

GAD and Substance Abuse

People with substance abuse problems have high rates of generalized anxiety problems. The risk of drug abuse, alcoholism, and cigarette smoking is higher than normal in people with GAD, but it’s not always clear which condition developed first.

Some people who live with generalized anxiety disorder turn to substance abuse in attempts to self-medicate symptoms of GAD. Certain types of substance abuse, in contrast, are known to trigger anxiety disorders.

GAD and Cardiovascular Disease

While the connection is not fully understood, anxiety disorders increase the risk of several cardiovascular conditions. People with generalized anxiety disorder have a higher than normal risk of the following:

  • High cholesterol levels
  • Hypertension (high blood pressure)
  • Thickened blood vessels (atherosclerosis).

Heart surgery outcomes may be adversely affected by generalized anxiety disorder, and both anxiety and clinical depression lower the chance of favorable heart surgery outcomes.

Physical Complications of GAD

Anxiety disorders and clinical depression both aggravate serious chronic health conditions, worsening reported symptoms and reducing quality of life. GAD is seen in combination with many different physical conditions, including:

  • Allergic disorders
  • Asthma
  • Bruxism (teeth grinding during sleep)
  • Chronic bronchitis
  • Emphysema
  • GERD
  • Insomnia and other sleep disorders
  • Irritable bowel syndrome
  • Migraines
  • Tension headaches.

Suicide and Generalized Anxiety Disorders

Suicide rates are higher amongst people with anxiety disorders than amongst the general population. Suicide rates are even higher when anxiety disorders accompany clinical depression. Substance abuse can also increase a person with GAD’s risk for suicidal behavior.