Generalized anxiety disorder (GAD) is chronic excessive worry about an array of activities or events. The anxiety of GAD is characterized by disproportionate unease, fear, or dread. The anxiety is not limited to one specific worry or concern, and it lasts longer than 6 months. Paying bills or doing laundry might trigger anxious feelings in some, whereas others will feel anxious about duties at work, or will fear that something bad will happen to a loved one. During any given year, about 3% to 5% of the adult population will suffer from GAD; however, few people with the disorder seek treatment.
People with GAD have a sustained “fight or flight” response to stressful situations. Anxiety is a healthy response to a stressful situation. When people are in danger, their brains release hormones that prepare them to fight or run away—commonly called the “fight or flight” response. To prepare the body for action, the heartbeat quickens and the muscles tense up; blood becomes more likely to clot in case of an injury. Normally, this reaction subsides once a person no longer feels threatened. In people with GAD, however, this response is sustained over months, which can cause a host of negative effects for physical health and mental well-being.
A mix of genetic and environmental factors are involved in GAD. Twin studies have shown that genes account for about 37% of the cause of GAD, while environmental factors account for about 62% of the cause.
GAD is thought to occur when certain chemical receptors in the brain do not function properly. The brain chemical gamma-aminobutyric acid (GABA) has an anti-anxiety effect when it binds with certain receptors in the limbic system, the region of the brain that regulates emotions. If these receptors dont allow GABA to bind, a feeling of anxiety results. Abnormalities in other neurotransmitters, such as serotonin, the catecholamines, and cholecystokinin, have also been implicated in GAD.
An underlying psychological conflict, medical problems, or certain drugs can also cause generalized anxiety Table 01. Patients may be highly insecure and self-critical, which can lead to anxiety. Medical problems such as head trauma, brain infections, heartbeat irregularities, thyroid dysfunction, and asthma have also been linked to GAD. Prescription drugs, illegal drugs, alcohol, and caffeine can also produce symptoms of GAD.
Table 1. Medical and Substance-related Causes of Anxiety
Cardiovascular Metabolic Neurologic Respiratory Medications Substances Heart rhythm irregularitiesHeart failure Overactive thyroid glandUnderactive thyroid glandLow blood sugar Brain infectionHead traumaSeizures Allergic reactionAsthmaChronic obstructive pulmonary disease Blood-pressure-lowering medicationsThyroid medicationsInsulin and other diabetes medications AlcoholCaffeineCocaineAmphetamines
Generalized anxiety disorder produces a range of psychological and physical symptoms that can interfere with a persons ability to function. The hallmark of the disorder is excessive concern over at least two different issues that lasts for six months or longer Table 02. The characteristic anxiety of GAD often results in physical complaints such as muscle tension, headaches, and a rapid heartbeat. Patients may find it hard to get a good nights sleep, which may cause irritability and fatigue. Those with GAD are often jumpy or shaky, and say that they feel “on edge.” Some have difficulty concentrating, and become exhausted easily.
Table 2. Symptoms of Generalized Anxiety Disorder
Psychological Physical Worry that is disproportionate to the situation; for example, a feeling of dread or unease when planning a meal or making a phone callWorry that is hard to controlDisturbed sleepRestlessness, irritability, feeling ?on edge?Difficulty concentrating FlushingChillsDizzinessChest pain, palpitations, or tachycardiaHyperventilationChokingRapid heartbeatMuscle tensionHeadachesFatigueDry mouthVomitingDiarrheaNauseaIncreased need to urinate
Although GAD can strike a person at any point in life, its origins are often traced to youth. Many adults with GAD report having had excessive fears as a child, or experiencing social inhibition during their teenage years.
Women are more likely than men to have GAD.
There appears to be a genetic component to GAD. People who have a first-degree relative with GAD are more likely to suffer from GAD themselves.
To determine what is causing your symptoms, your doctor will start with a medical history. Because anxiety is associated with other medical conditions and medications used to treat them, tell your doctor about any illnesses you have and mention the drugs you are taking for them. Your doctor will ask whether anyone in your family suffers from an anxiety disorder or depression.Your doctor will also ask about other possible factors that could be contributing to your anxiety, such as heavy caffeine consumption, alcohol or drug abuse, or any stressful events in your life.
Your doctor will perform a physical examination to help diagnose GAD.
Anxiety can manifest physically. It can increase heart rate and blood pressure, cause muscle tension, and interfere with breathing. In addition to examining these things, your doctor will also look for a furrowed brow, perspiration, dilated pupils, bitten nails, overly washed hands, and a tremor to assess the severity of your anxiety.
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