GENERALIZED ANXIETY DISORDER: SYMPTOMS, CAUSES - ECONOMÍA - 2025

The generalized anxiety disorder (GAD) is characterized by indiscriminate concern about anything. Worry can be useful, as it allows you to prepare for vital challenges (pass an exam, do a job well), although in this disorder, worry is unproductive and undesirable.

This excess of concern interferes with functioning in daily life, since the person anticipates disaster in different areas: money, death, family, friends, relationships, work…

Every year 6.8 million Americans and 2% of European adults experience generalized anxiety disorder (GAD). It occurs twice as often in women than in men and is more common in people with a history of substance abuse and in family members with a history of anxiety disorders.

Once GAD develops, it can be chronic, although it can be controlled with correct treatment. In the United States it is the leading cause of disability at work.

Difference between "normal" worry and generalized anxiety disorder

Worries, fears, and doubts are a normal part of life. It's normal to be anxious about a test score or worry about home economics.

The difference between these types of normal concerns and those of the TAG is that the TAG are:

• Excessive
• Intruders
• Persistent
• Weakening.

For example, after seeing a news story about a terrorist attack in another country, the normal person may feel temporarily worried. However, a person with GAD can stay up all night or worry for days about an attack coming.

Normal concerns:

• Worry does not interfere with daily activities and responsibilities
• There is ability to control worry
• Worry is unpleasant even though it doesn't cause significant stress
• Concerns are limited to a small number and are realistic
• Concerns or doubts last for a short period of time.

TAG:

• Worries interfere with work, social or personal life
• Worry is uncontrollable
• Worrying is extremely unpleasant and stressful
• The concern extends to all kinds of topics and the worst is expected
• The concern has been going on daily for at least six months.

Symptoms of generalized anxiety

The TAG can include:

• Persistent worries or obsessions that are disproportionate to the event
• Inability to let go of a worry
• Inability to relax
• Difficult to focus
• Worrying about excessive worry
• Stress about making wrong decisions
• Difficulties managing uncertainty or indecision.

There may be the following physical signs:

• Fatigue
• Irritability
• Muscle tension
• Tremors
• Being easily startled
• Sweat
• Nausea, diarrhea, or irritable bowel syndrome
• Headaches.

Symptoms in children and adolescents

In addition to the above symptoms, children and teens with GAD may have excessive concerns about:

• School or sports performance
• Puntuality
• Earthquakes, wars, catastrophic events.

They may also experience:

• Excessive anxiety to fit in
• Being perfectionist
• Redo tasks because they are not perfect the first time
• Spending too much time doing homework
• Lack of selfesteem
• Approval seeking

Symptoms of autonomic activation

• Palpitations, a pounding heart, or a fast heartbeat.
• Sweating
• Tremors
• Dry mouth (not due to dehydration or medication).

Symptoms concerning chest and abdomen

• Difficulty breathing
• Feeling of suffocation
• Chest pain or discomfort
• Nausea or abdominal discomfort.

Symptoms concerning brain and mind

• Feeling unsteady, dizzy, or weak
• Feelings that objects are unreal (derealization) or that one is distant or not really "here" (depersonalization)
• Fear of losing control going crazy or passing out
• Fear of dying

General symptoms

• Hot flashes or chills
• Homirgueo sensations or numbness.

Symptoms of tension

• Muscle tension or aches and pains
• Restlessness and inability to relax
• Feeling of excitement or mental tension
• A lumpy feeling in the throat or difficulty swallowing

Other non-specific symptoms

• Exaggerated response and surprises or startles
• Difficulty concentrating or a blank mind from worry or anxiety
• Persistent irritability
• Difficulty sleeping from worry.

Causes

As in other mental conditions, the exact cause of GAD is not known, although it can include genetic factors and other risk factors.

Genetics

One third of the variance of the GAD is attributed to genes. People with a genetic predisposition to GAD are more likely to develop it, especially in response to a life stressor.

Substance use

Long-term use of benzodiazepines can make anxiety worse, while reducing benzodiazepines can lessen your symptoms.

Likewise, long-term alcohol consumption is associated with anxiety disorders, with evidence that prolonged abstinence can result in the disappearance of symptoms.

Recovery from benzodiazepines tends to take much longer than from alcohol, but previous health can be restored.

Tobacco smoking has also been established as a risk factor for developing anxiety disorders, as has caffeine consumption.

Physiological mechanism

GAD has been associated with a disruption in the function of the amygdala and its processing of fear and anxiety.

Sensory information enters the amygdala through the complex basolateral nucleus. The basolateral complex processes memories related to fear and communicates the importance of threats to other parts of the brain, such as the medial prefrontal cortex and sensory cortices.

Diagnosis

People with GAD can visit a doctor many times before discovering their disorder.

They ask doctors about their headaches and sleep problems, although their true pathology is not always discovered.

In the first place, it is advisable to go to a doctor to make sure that there is no physical problem that is causing the symptoms. The doctor can then refer the patient to a mental health specialist.

Diagnostic Criteria for Generalized Anxiety Disorder - DSM V

The diagnostic criteria for generalized anxiety disorder, defined by DSM V, published by the Association of American Psychologists (APA) is:

A. Excessive anxiety and worry (apprehensive expectation), which occurs on most days during a 6-month period in relation to a number of activities or events.

B. Individual finds it difficult to control worry.

C. Anxiety and worry are associated with three or more of the following six symptoms (with at least some of the symptoms present on most days during a 6-month period).

Note: in children, only one item is enough):

• Restlessness
• Easily fatigued
• Difficulty concentrating or a blank mind
• Irritability
• Muscle tension
• Sleep disorder.

D. Anxiety, worry, or physical symptoms cause significant discomfort or dysfunction in social, occupational, or other important areas of life.

E. The disturbance cannot be attributed to the effects of a substance (eg drug, medication) or another medical condition (eg hyperthyroidism).

F. The disturbance is not better explained by another mental disorder (eg anxiety or worry about having panic attacks, negative evaluations in social phobia, obsessions in obsessive compulsive disorder, separation of attachment figures in separation anxiety disorder, flashbacks of traumatic events in post-traumatic stress, gaining weight in anorexia nervosa, physical complaints in somatic disorder, physical defects in body dysmorphic disorder or wrong beliefs in schizophrenia or delusional disorder).

Criterion according to ICD-10

A. A period of at least 6 months with prominent tension, worry, and feelings of apprehension about daily events and problems.

B. At least four symptoms from the following list of items must be present, with at least one of items 1 through 4.

C. The disorder does not meet the criteria for panic attack disorder, phobias, obsessive compulsive disorder, or hypochondria.

D. Most commonly used exclusion criteria: not supported by a physical disorder such as hyperthyroidism, an organic mental disorder, or a substance use disorder.

When to seek help from a professional?

As previously mentioned, some anxiety is normal, although it is advisable to see a professional if:

• You feel overly worried and interfere with work, personal relationships, or other important areas of life.
• Depressive feelings, problems with alcohol or other drugs
• Other problems related to anxiety
• Suicidal thoughts or behaviors.

Worries don't usually go away on their own and in fact tend to get worse.

Treatment

Cognitive-behavioral therapy (CBT) is more effective in the long term than medication (such as SSRIs), and although both treatments reduce anxiety, CBT is more effective in reducing depression.

Generalized anxiety is a disorder based on psychological components that includes cognitive avoidance, worries, ineffective problem solving and emotional processing, interpersonal problems, intolerance to uncertainty, emotional activation, poor understanding of emotions…

To combat previous cognitive and emotional aspects, psychologists often include some of the following components in the intervention plan: relaxation techniques, cognitive restructuring, progressive stimulus control, self-control, mindfulness, resolution techniques problems, socialization, training in emotional skills, psychoeducation and acceptance exercises.

Cognitive behavioral therapy (CBT)

Cognitive-behavioral therapy (CBT) is a method that requires working with the patient to understand how their thoughts and emotions influence their behavior.

The goal of therapy is to change negative thought patterns that lead to anxiety, replacing them with more positive and realistic thoughts.

Elements of therapy include exposure strategies to allow the patient to confront their anxiety gradually and become more comfortable in the situations that provoke it.

CBT can be used alone or in conjunction with medication.

Components of CBT to treat GAD include: psychoeducation, self-observation, stimulus control techniques, relaxation techniques, self-control techniques, cognitive restructuring, exposure to worry (systematic desensitization), and problem solving.

• The first step in treatment is psychoeducation, which requires giving the patient information about the disorder and its treatment. The purpose of education is to unequalize the disease, build motivation for treatment, and give realistic expectations about treatment.
• Self-observation requires monitoring levels of anxiety and the events that triggered it. Your goal is to identify the signs that cause anxiety.
• Stimulus control aims to minimize the stimulus conditions in which worries occur.
• Relaxation techniques reduce stress.
• With cognitive restructuring, the aim is to build a more functional and adaptive vision about the world, the future and the patient himself.
• Problem solving focuses on solving current problems.

Acceptance and Commitment Therapy (TAC)

CT is a behavioral treatment designed to achieve three goals: 1) reduce avoidance strategies of thoughts, memories, feelings and sensations, 2) reduce the person's response to their thoughts, and 3) increase the person's ability to maintain your commitment to change your behavior.

This therapy teaches attention to purpose, the present - in a non-judicious way (mindfulness) - and acceptance skills to respond to uncontrollable events.

It works best in combination with drug treatments.

Uncertainty intolerance therapy

This therapy focuses on helping patients develop skills to tolerate and accept uncertainty in life to reduce anxiety.

It is based on the psychological components of psychoeducation, awareness of worry, training in problem solving, exposure in imagination and real, and recognition of uncertainty.

Motivational interview

A new approach to improve recovery rates in GAD is to combine CBT with motivational interviewing (ME).

It focuses on increasing the intrinsic motivation of the patient and works, among other personal resources, empathy and self-efficacy.

It relies on open-ended questions and listening to promote change.

Medication

Different types of medication are used to treat GAD and should always be prescribed and supervised by a psychiatrist.

Although antidepressants can be safe and effective for many people, there can be risks for children, teens, and young adults.

• SSRIs (selective serotonin reuptake inhibitors): These are usually the first line of treatment. Its side effects can be diarrhea, headaches, sexual dysfunctions, increased risk of suicide, serotonin syndrome…
• Benzodiazepines: They are also prescribed and can be effective in the short term. They carry some risks such as physical and psychological dependence on the drug. They can also reduce attention and have been associated with falls in older people. They are optimal to be consumed in the short term. Some benzodiazepines are alprazolam, chlordiazepoxide, diazepam, and lorazepam.
• Other drugs: atypical serotonergic antidepressants (vilazodone, vortioxetine, agomelatine), tricyclic antidepressants (imipramine, clomipramine), serotonin-norepinephrine reuptake inhibitors (SNRIs) (venlafaxine, duloxetine)…

Risk factor's

These factors could increase the risk of developing GAD:

• Genetics: You are more likely to develop it in a family with a history of anxiety disorders.
• Personality: a shy, negative or avoidant temperament may be more prone to develop it.
• Sex: women are more frequently diagnosed.

Complications

Having GAD can influence:

• Problems falling asleep and staying asleep (insomnia).
• Concentration problems.
• Depression.
• Substance abuse.
• Digestive problems.
• Headaches.
• Heart problems.

Comorbidity

In a 2005 US survey, 58% of people diagnosed with major depression also had anxiety disorders. Among these patients, the comorbidity rate with GAD was 17.2%.

Patients with comorbid depression and anxiety tend to have greater severity and greater difficulty in recovering than those with a single illness.

On the other hand, people with GAD have a comorbidity with substance abuse of 30-35% and with drug abuse of 25-30%.

Finally, people with GAD can also have illnesses associated with stress, such as irritable bowel syndrome, insomnia, headaches, and interpersonal problems.

Prevention

Most people with GAD need psychological treatment or medication, although making lifestyle changes can also help a lot.

• Stay physically active.
• Avoid tobacco and coffee.
• Avoid alcohol and other substances.
• Get enough sleep.
• Learn relaxation techniques.
• Eat healthy.

References

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