Generalized Anxiety Disorder

Generalized anxiety disorder is a mental disturbance that interferes with normal life activities and requires medical treatment. It is diagnosed if a person has experienced chronic anxiety and excessive worry for more than six months; has difficulty falling asleep; feels trembly and quivery, especially in the stomach; feels a strange, tight sensation around the forehead; feels keyed up, tearful, angry, self-depreciating; and experiences physical symptoms. These physical symptoms may include palpitations, cold, clammy hands, sweating, belching, sexual dysfunction, flushing, pallor, difficulty swallowing, dry mouth, frequent urination and increased startle-reflex and sleep problems.

In this group of disorders anxiety is either the predominant disturbance, as in Panic Disorder and Generalized Anxiety Disorder, or anxiety is experienced if the individual attempts to master the symptoms, as in confronting the dreaded object or situation in a Phobic Disorder or resisting the obsessions or compulsions in Obsessive Compulsive Disorder. Diagnosis of an Anxiety Disorder is not made if the anxiety is due to another disorder, such as Schizophrenia, an Affective Disorder, or an Organic Mental Disorder.

It has been estimated that from 2% to 4% of the general population has at some time had a disorder that this manual would classify as an Anxiety Disorder.

Panic Disorder, Phobic Disorders and Obsessive Compulsive Disorder are each apparently more common among family members of individuals with each of these disorders than in the general population.

GAD Diagnosis

The essential feature is generalized, persistent anxiety of at least one month’s duration without the specific symptoms that characterize Phobic Disorders (phobias), Panic Disorder (panic attacks), or Obsessive Compulsive Disorder (obsessions or compulsions). The diagnosis is not made if the disturbance is due to another physical or mental disorder, such as hyperthyroidism or Major Depression.

Although the specific manifestations of the anxiety vary from individual to individual, generally there are signs of motor tension, autonomic hyperactivity, apprehensive expectation, and vigilance and scanning.

Motor tension. Shakiness, jitteriness, jumpiness, trembling, tension, muscle aches, fatigability, and inability to relax are common complaints. There may also be eyelid twitch, furrowed brow, strained face, fidgeting, restlessness, easy startle, and sighing respiration.

Autonomic hyperactivity. There may be sweating, heart pounding or racing, cold, clammy hands, dry mouth, dizziness, light-headedness, paresthesias (tingling in hands or feet), upset stomach, hot or cold spells, frequent urination, diarrhea, discomfort in the pit of the stomach, lump in the throat, flushing, pallor, and high resting pulse and respiration rate.

Apprehensive expectation. The individual is generally apprehensive and continually feels anxious, worries, ruminates, and anticipates that something bad will happen to himself or herself (e.g., fear of fainting, losing control, dying) or to others (e.g., family members may become ill or injured in an accident).

Vigilance and scanning. Apprehensive expectation may cause hyperattentiveness so that the individual feels “on edge,” impatient, or irritable. There may be complaints of distractibility, difficulty in concentrating, insomnia, difficulty in falling asleep, interrupted sleep, and fatigue on awakening.

Associated features. Mild depressive symptoms are common.

Impairment. Impairment in social or occupational functioning is rarely more than mild.

Complications. Abuse of alcohol, barbiturates, and antianxiety medications is common.Age at onset, course, predisposing factors, prevalence, sex ratio, and familial pattern.
Differential diagnosis. Physical disorders, such as hyperthyroidism, and Organic Mental Disorders, such as Caffeine Intoxication, must be ruled out.

In Adjustment Disorder with Anxious Mood, the full symptom picture required to meet the criteria for Generalized Anxiety Disorder is generally not present, the duration of the disturbance is usually less than a month, and a psychosocial stressor must be recognized.

In Schizophrenia, Depressive Disorders, Hypochondriasis, Obsessive Compulsive Disorder, and many other mental disorders, generalized and persistent anxiety is often a prominent symptom. The diagnosis of Generalized Anxiety Disorder is not made if the anxiety is judged to be due to another mental disorder.

In Panic Disorder there is often severe chronic anxiety between panic attacks. If the panic attacks are overlooked, an incorrect diagnosis of Generalized Anxiety Disorder may be made.