Anxiety Guide

Learn all about generalized anxiety disorder and the symptoms and treatment for someone who has it.

Anxiety, also called generalized anxiety disorder (GAD), is a mental disorder characterized by persistent excessive or unrealistic fears or worries. The term "anxiety" is commonly used to refer to a general state of unease or apprehension about future events; this is a common feeling experienced by everyone at some point in their lives. GAD describes the condition in which those feelings of fear and worry are persistent¿ -- ¿lasting for weeks or months at a time¿ -- ¿and exaggerated out of proportion to the actual risk or threat, often well beyond what is appropriate for the situation. People with GAD may be overly concerned about their health, finances, family problems, or work and the feelings of nervousness or dread disrupt their everyday lives. These feelings are accompanied by physical symptoms including headaches, fatigue, sleep disturbances, and muscle tension.

GAD affects about7 million American adults, and two thirds of these are women. It can affect people at any age but occurs most frequently between childhood and middle age. Several treatments are available for GAD including medications and psychotherapy as well as coping skills that can help those with anxiety deal with their feelings of dread.

In addition to GAD there are several other anxiety disorders that have anxiety as an integral part of the disorder, including:

-- Panic disorder: in which people experience sudden attacks of terror, usually accompanied by a pounding heart and sweatiness, that give them a sense of unreality, a fear of impending doom, or a fear of losing control.

-- Obsessive-compulsive disorder (OCD): in which people are obsessed with certain fears (e.g. cleanliness, safety) which compels them to perform certain rituals (e.g. cleaning, counting, checking) to relieve the anxiety that these fears produce.

-- Post-traumatic stress disorder (PTSD): a disease that can develop in people who have taken-part in or witnessed a terrifying event that involved physical harm or the threat of physical harm (such as war, rape, or kidnapping) and may cause the person reliving the stressful event over and over.

-- Social anxiety disorder: those with with social anxiety disorder experience overwhelming anxiety in everyday social situations and the fear of that anxiety may pervade their lives.

-- Specific phobias: irrational fears about specific things that pose little or no actual danger, such as heights, water, flying, or spiders.

Symptoms of Anxiety

The main feature of GAD is persistent, excessive, and unrealistic worry about everyday things. These feelings occur on most days for at least six months. People with GAD can't relax and worry constantly and so may have difficulty concentrating. They may also have trouble falling asleep or sleeping through the night. Some of the other physical symptoms that may accompany anxiety include:

-- Fatigue

-- Headaches

-- Muscle tension

-- Muscle aches

-- Difficulty swallowing

-- Trembling or twitching

-- Sweating

-- Nausea

-- Lightheadedness

-- Having to go to the bathroom frequently

-- Feeling out of breath

-- Hot flashes

-- Restlessness

-- Irritability

-- Gastrointestinal discomfort or diarrhea

The anxiety that occurs with GAD can range from mild to severe. Mild anxiety may allow sufferers to maintain a job and function normally in social situations, while severe anxiety can make work and social interaction unbearable and make even simple daily activities very difficult.

Causes of Anxiety

The cause of anxiety disorders, including GAD, is unknown. However, there is evidence that anxiety disorders tend to run in families, suggesting that either genes or family environment (or both) may play a role in their development. There is some evidence to indicate that genes may play a modest role in GAD specifically. However, it is unlikely that anyone inherits an "anxiety" gene; instead, inheriting certain genes makes the development of GAD more likely to occur. Thus, you can inherit a predisposition to developing GAD, but if the right combination of environmental stresses does not occur in your life, you may never experience GAD.

Researchers are also investigating differences in brain function between people who have GAD and those who do not. Some evidence suggests that there may be differences in areas of the brain that control fear responses among the two groups. Researchers also believe that there may be differences in the brain chemistry of people with GAD. The levels of serotonin and norepinephrine, two chemical signals used in the brain (neurotransmitters), are different in people with anxiety disorders than in people without such disorders. While this research provides evidence that the brains of people with GAD may be working differently than the brains of other people, it does not tell us what causes this difference in the first place. It is most likely a combination of factors including genes and the stresses encountered in the environment.

Anxiety Risk Factors

Factors that may increase your risk of developing generalized anxiety disorder include:

-- Female sex: Women are twice as likely as men to suffer from GAD.

-- Childhood trauma: People who experience traumatic events as children are at higher risk for GAD.

-- Serious illness: Having an illness such as cancer can make you feel anxious about the future, treatments, etc.

-- Life stress: Stressful situations in your life, especially when they occur in bunches, can make you feel overwhelmed and lead to anxiety and, potentially, GAD.

-- Personality traits: People with certain personality traits including those with unmet psychological needs or chronic insecurity, and those with some personality disorders, such as borderline personality disorder, may be at increased risk of GAD.

-- Heredity: Some evidence suggests that GAD has a genetic component that causes it to run in families.

GAD tends to occur in tandem with several other disorders. In fact, it rarely occurs on its own. Common co-morbidities or dual-diagnoses include other anxiety disorders, depression, and/or substance abuse. It is important to treat these other disorders as well as the anxiety; otherwise the anxiety symptoms may keep coming back.

If you have anxieties about everyday things and these feelings are affecting your daily life and the feelings seem to go on for months, you may have GAD or another anxiety disorder. If you suspect that you or someone close to you may be dealing with the symptoms of an anxiety disorder, make an appointment with a doctor or therapist. The first step in getting better is seeing a professional who can help.

The first step in diagnosing GAD is usually talking about your symptoms. The doctor may ask detailed questions about your worries and fears or he or she may administer a screening questionnaire to help determine if you have the symptoms of GAD. You may also be given a physical exam to check if some physical condition may be causing your symptoms. In order to be diagnosed with GAD, you must meet the criteria set forth in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) which include:

-- Excessive anxiety and worry about a number of events or activities on most days for at least six months.

-- Difficulty controlling the feelings of worry.

-- Anxiety that is associated with three or more of the following symptoms: restlessness or feeling keyed-up, being easily fatigued, irritability, difficulty concentrating, muscle tension, and sleep disturbances.

-- Anxiety that causes significant distress or impairment in your daily life.

-- Anxiety that isn't related to another disorder, such as panic attacks or substance abuse.

Anxiety Treatments

One type of drug used to treat anxiety is the anti-anxiety medications (anxiolytics). These drugs provide relief from the symptoms of anxiety but do not really address the cause. The majority of these fall under the category of sedatives, fast acting drugs that tend to sedate people and make them less aware of their anxieties. They also tend to make people less aware of everything else as well and they are frequently habit-forming. As a result, these drugs are best used for short-term relief when symptoms are at their worst. The benzodiazepines include alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), and diazepam (Valium) among others. These medications often cause drowsiness and problems with balance and coordination so you should not drive or operate heavy machinery while taking them.

A newer anti-anxiety medication is buspirone (Buspar). This non-sedating medication takes several weeks to begin working but does not cause dependence and so it can be taken for long periods.

Another class of drugs used to treat anxiety is the anti-depressants. Although originally designed to treat symptoms of depression, some anti-depressant drugs can be helpful in treating anxiety symptoms as well. These medications affect the levels of certain brain neurotransmitters including serotonin and norepinephrine. Examples of antidepressants used to treat GAD include fluoxetine (Prozac), paroxetine (Paxil), imipramine (Tofranil), venlafaxine (Effexor), escitalopram (Lexapro), and duloxetine (Cymbalta). Interestingly, anti-depressant drugs that predominantly affect levels of the neurotransmitter dopamine (such as bupropion [Wellbutrin]) are not usually effective at treating anxiety. Like buspirone, these drugs may take several weeks to work.

Psychotherapy, also called "talk therapy" or counseling, can also help improve anxiety symptoms. Psychotherapy involves talking with a trained mental health professional, such as a psychiatrist, psychologist, social worker, or counselor to discover what caused an anxiety disorder and how to deal with its symptoms. Unlike medication, it addresses the root causes of the anxiety and also may help provide coping mechanisms for how to deal with anxiety symptoms when they occur. One type of therapy shown to help with GAD is called cognitive behavior therapy or CBT. CBT helps you recognize when your thoughts and behaviors are unhealthy and provides methods for replacing them with healthy ones. A lot of the feelings of helplessness that accompany mental disorders such as GAD stem from a perceived loss of control. CBT can help you learn to change the way you think and feel even when situations occur that are beyond your control.

Is Anxiety Preventable?

There is no reliable way to prevent anxiety. However, you may be able to reduce your risk of GAD by limiting the one risk factor that is under your control: life stress. It is likely that differences in genetics and personal history determine whether a particular stressful event will cause a given person to experience anxiety. Taking steps to reduce your sources of daily stress may help you better cope with major life events when they do occur.

Should I See a Doctor for Anxiety?

If you are having problems dealing with your fears and worries about everyday things, even when you are giving your best effort to relax or unwind, you may be experiencing GAD. If this anxiety continues for months and interferes with your ability to carry out and enjoy your daily life, you should seek professional help. These symptoms may not go away on their own and the longer you wait before seeking help, the greater the chances that your anxiety symptoms will become severe and affect your ability to work and interact socially.


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