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Mental Health Information Centre - Southern Africa

Generalized Anxiety disorder

What is generalized anxiety disorder?

The term “generalized anxiety disorder” (GAD) refers to a condition characterised by excessive worry. In some ways, the term “tension disorder” is a better one because both mental tension (e.g. worry, irritability) and physical tension (e.g. muscle tension, insomnia) are experienced.

People with GAD worry about everyday life circumstances (e.g. job responsibilities, finances, the health of family members) or about more minor matters (e.g. household chores, keeping appointments). The worries are experienced as difficult to control, and they are clearly distressing or interfere significantly with work or with social functioning.

The worrying is accompanied by one or more of a range of physical symptoms, such as restlessness, getting tired easily, difficulty concentrating, irritability, muscle tension, and disturbed sleep.

The particular symptoms of generalized anxiety disorder may differ somewhat from person to person. For example, some people may experience mostly cognitive symptoms (i.e. worry), while in other people the bodily symptoms (e.g. aches and pains) are experienced as the main problem.

Worries are not always GAD

The worries of generalized anxiety disorder need to be distinguished from the depressed thoughts of depression and the obsessions of obsessive-compulsive disorder (OCD).

The disorder that most closely overlaps with GAD is in fact depression; many people with GAD also have depressed mood, and many people with depression also have significant worries. The obsessions of OCD tend to be relatively senseless in comparison to the more understandable worries of GAD.

A number of different general medical disorders may present with symptoms of anxiety; it is important not to misdiagnose GAD in these cases. Certain foods (e.g. caffeine), medications (e.g. stimulants), and substances (e.g. alcohol) may also contribute to increased anxiety.

GAD should be differentiated from normal anxiety. The distinction between normal anxiety and a clinical disorder such as GAD rests on the extent of distress and dysfunction associated with symptoms. The worries of GAD are of course more pronounced, more pervasive, and more likely associated with physical symptoms than are ordinary worries.

Who gets GAD?

Around 3% to 8% of the general population will suffer from GAD at some point in their lives. The prevalence of the disorder is higher, however, in people who are already visiting a general practitioner. GAD is also more common in people with another psychiatric disorder, including another anxiety disorder. Finally, GAD is somewhat more common in women than in men.

Most people with GAD say that they have suffered from excessive worrying all their lives; the condition may start at a young age and may continue for many years. Symptoms often worsen during stressful times.

What to do and where to go for help?

There are several different medications that can be used for the treatment of generalized anxiety disorder. These include benzodiazepines (tranquillisers), buspirone (Buspar), and antidepressants such as the tricyclic antidepressants, venlafaxine, and selective serotonin reuptake inhibitors (SSRIs).

People with GAD can be seen as viewing the world through a lens which colors everything with negative predictions. Psychotherapy (talk therapy) focuses on attempting to change this lens (technically, this is the “cognitive” part of “cognitive-behavioural therapy”).

Steps in the cognitive-behavioural therapy of GAD can include self-monitoring and cognitive restructuring. Self-monitoring involves paying closer attention to one’s thoughts and feelings. In some ways this is an exposure (“face the fear”) technique, but the technique is also useful in demonstrating to oneself the connection between fearful thoughts about the future and feelings of anxiety.

Cognitive restructuring involves providing good counter-arguments which dispel the logic of worry and fear found in GAD. Common cognitive distortions in GAD include probability overestimation, catastrophising, and all or nothing thinking. Overcoming such distortions may well require the help of a professional.

Further resources/ references

SA Depression & Anxiety Group

Internet: www.sadag.org.za

Download pdf for more information : Anxiety disorders 

Books

Chronic Anxiety: Generalized Anxiety Disorder and Mixed-Depression. Ronald M. Rapee and David H. Barlow (Eds). Guilford Press, 1991.
Generalized Anxiety Disorder: Diagnosis, Treatment and Its Relationship to Other Anxiety Disorders. David Nutt, Spilios Argyropoulos and Sam Forshall. Bladwell Science Inc., 1999.
Overcoming Generalized Anxiety Disorder: Client Manual. John White. New Harbinger Publications, 1999.

 



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