Defining Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is characterized by chronic anxiety that is excessive, uncontrollable, often irrational, and disproportionate to the actual object of concern. People with GAD often characterize it as a feeling of "free-floating anxiety"—a term that Sigmund Freud used in his early work. Typically, the anxiety has no definite trigger or starting point, and as soon as the individual resolves one issue or source of worry another worry arises. People with GAD also tend to catastrophize, meaning they may assume the absolute worst in anxiety-inducing situations. Racing thoughts, inability to concentrate, and inability to focus are also characteristic of GAD.

GAD is a particularly difficult disorder to live with; because the individual's anxiety is not tied to a specific situation or event, they experience little relief. This disorder can contribute to problems with sleep, work, and daily responsibilities and often impacts close relationships.

Generalized anxiety disorder

One of the main characteristics of GAD is excessive, constant, often irrational worry that impedes the individual's normal daily functioning.

DSM-5 Diagnostic Criteria

In order for GAD to be diagnosed, a person must experience excessive anxiety and worry—more days than not—for at least 6 months and about a number of events or activities (such as work or school performance). This excessive worry must interfere with some aspect of life, such as social, occupational, or daily functioning, and the person must have trouble controlling the anxiety. The disturbance must not be attributed to the physiological effects of a substance (e.g., a drug or medication) or another medical condition, and must not be better explained by another medical disorder. At least 3 of the following symptoms must be experienced: restlessness or feeling keyed up or on edge; being easily fatigued; difficulty concentrating or mind going blank; irritability; muscle tension; and/or sleep disturbance.

Etiology

In any given year, approximately 2.3% of American adults and 2% of European adults experience GAD. Although there have been few investigations into the disorder's heritability, a summary of available family and twin studies suggests that genetic factors play a moderate role in its development (Hettema et al., 2001). Specifically, about 30% of the variance for generalized anxiety disorder can been attributed to genes. Individuals with a genetic predisposition for GAD are more likely to develop the disorder, especially in response to a life stressor.

Cognitive theories of GAD suggest that worry represents a mental strategy to avoid more powerful negative emotions (Aikins & Craske, 2001), perhaps stemming from earlier unpleasant or traumatic experiences. Indeed, one longitudinal study found that childhood maltreatment was strongly related to the development of this disorder during adulthood (Moffitt et al., 2007). According to these theories, generalized anxiety may serve as a distraction from remembering painful childhood experiences.

Long-term use of benzodiazepines can worsen underlying anxiety, with evidence that reduction in benzodiazepine use can in turn lead to a lessening of anxiety symptoms. Similarly, long-term alcohol use is associated with the development of anxiety disorders, with evidence that prolonged abstinence can in turn result in the remission of anxiety symptoms.

Treatment

GAD is generally chronic, but it can be managed, or even eliminated, with the proper treatment. While there are many options for treating GAD, full recovery is only seen about 50% of the time, which indicates the need for further research into more effective treatment options.

Pharmaceutical treatments for GAD include selective serotonin reuptake inhibitors (SSRIs), which are more commonly used as antidepressants. SSRIs block the reabsorption of serotonin in the brain so that it can keep activating serotonin receptors, improving the individual's mood.

SSRIs as treatment for GAD

SSRIs (selective serotonin reuptake inhibitors) are a type of drug frequently used to treat disorders with symptoms of depression (e.g., major depressive disorder) and anxiety.

Two popular therapeutic programs used for treating GAD are applied relaxation, which focuses on muscle-relaxation techniques, and cognitive behavioral therapy (CBT), which focuses on ways to recognize and reduce worried thoughts. In a study comparing the two, it was found that CBT produced better post-treatment results. Other forms of therapy found to be effective in treating GAD include metacognitive therapy (MCT), which treats the "worrying about worrying" (or "meta-worrying") often found in GAD, and intolerance-of-uncertainty (IUT), which focuses on resolving people's difficulty dealing with uncertain situations. A particular challenge in treating GAD is its high comorbidity with other disorders, such as depression and substance abuse; it can be difficult in therapy to make progress with multiple issues simultaneously.