What is anxiety?
Anxiety is a term most people are familiar with and use in their daily lives. It is common to hear someone refer to him or herself as feeling anxious about an impending, stressful event or something that causes some distress. In fact, most people would identify with having felt anxious at some point in their lives.
The clinical disorder known as generalized anxiety disorder, or GAD, refers to much more than the feelings of anxiousness that most people can relate to. Rather, generalized anxiety disorder is a set of symptoms that together form the disorder, as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR).
Anxiety is a fairly common psychiatric disorder, with an estimated lifetime prevalence of approximately 5 percent. This condition occurs roughly twice as often in women than in men and affects about 40 million people in the United States annually.
Diagnosing generalized anxiety disorder
The DSM-IV-TR is a diagnostic manual for psychiatrists and other mental health professionals outlining the criteria for a diagnosis of generalized anxiety disorder, differentiating the disorder from other conditions such as post traumatic stress disorder, social phobias and obsessive compulsive disorders.
The DSM-IV-TR indicates that those suffering from generalized anxiety disorder experience excessive worrying and anxiety about a number of events. This anxiety occurs for a period of at least six months, occurring on more days than not, causing acute distress in social, workplace and other settings. Individuals experience three or more of the following symptoms, including feeling restless, easily fatigued, tense muscles, irritability, and decreased concentration and sleep disturbances.
Generalized anxiety disorder will not be diagnosed if the anxiety is about having a panic attack, being embarrassed in public or having a flashback, for example. These symptoms would indicate the presence of another disorder such as panic attack, social phobia or post traumatic stress disorder. Generalized anxiety disorder is also not diagnosed when caused by drug or alcohol use, if it is a part of a mood disorder like depression, or if there is a medical reason for its presence, such as hyperthyroid disorder.
Behavioral therapy
The treatment options for anxiety are many. Cognitive behavioral therapies, or CBT, are considered an extremely effective therapy modality for the treatment of generalized anxiety disorder. This short-term therapy model lasts approximately 12 weeks and focuses on changes in thinking and behavioral patterns in order to address the underlying emotional distress. For a person with generalized anxiety disorder, CBT might focus on aiding the individual to identify patterns of thinking and behavior that contribute to increased symptoms. An example of this might be helping an individual determine what prompts “racing thoughts” and to learn techniques to slow thoughts down or focus on one thought at a time. CBT also helps individuals learn techniques to alter their behavior in specific high-stress settings, providing tools to assist them in managing and eventually decreasing their symptoms.
Medications
Medications are commonly prescribed in order to help manage the distressing symptoms of anxiety. It is important to recognize that for an anxiety disorder, medication is symptom relief and not a cure. Therefore, pharmacological interventions should be paired with psychotherapy.
Common medications include antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs) and tricyclics. These medications affect the functioning of neurotransmitters in the brain, such as serotonin, and may help to alleviate symptoms of anxiety. Anti-anxiety medications are also frequently used to treat generalized anxiety disorder. These medications are known as benzodiazepines, such as ativan and clonazepam, and may provide short-term relief of symptoms. This class of medication should be taken with caution due to their potential for addiction. Finally, beta-blockers are sometimes prescribed to minimize the physical distress experienced with anxiety.
The Family Connection
Generalized Anxiety Disorder can be an extremely distressing and painful experience for an individual, as well as their family and friends around them. Family and friends play an important role in helping an individual recognize and manage symptoms, aiding in stress management and supporting techniques applied through therapy.
Family also plays an important role in recognizing when the symptoms of distress become unmanageable, monitoring for signs that a person is having thoughts of suicide and can take responsibility for engaging help when the person is unable to do so themselves. To find a list of crisis resources, contact the local mental health agency or public health offices.
References
Generalized Anxiety Disorder (DSM-IV-TR #300.02)
http://www.brown.edu/Courses/BI_278/Other/Clerkship/Didactics/Readings/gad.pdf
AllPsych Online: Psychiatric Disorders
http://allpsych.com/disorders/dsm.html
Anxiety UK: Diagnostic and Statistical Manual of Mental Disorders
http://www.anxietyuk.org.uk/about-anxiety/diagnostic-and-statistical-manual-of-mental-disorders-dsm/
