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A bit of anxiety is common in everyday activities. It is normal to worry about work deadlines, bills, family obligations, and the phone battery running low in the middle of the day. However, the worry should not interfere with the functioning of an individual. Generalized anxiety disorder (GAD) is a psychological condition characterized by extreme worry and tension about daily activities. The apprehension in GAD is so excess that it interferes with the normal functioning of an individual. Individuals with GAD are not able to help with the worry and are in constant anticipation of disaster with every activity of the day. The anxiety is unwarranted and can elicit physiological symptoms such as nausea and vomiting (Locke, Kirst, & Shultz, 2015). GAD is very common among the American population. According to Locke, Kirst and Shultz (2015), about 2.9% of American adults are diagnosed with GAD every year. Among children, GAD is more prevalent in girls and has an early onset of averagely 8.5 years. GAD negatively affects the child’s social, school and emotional wellbeing. Similar to adults, the anxiety can lead to physiological disturbances such as gastrointestinal distress (Keeton, Kolos & Walkup, 2009). GAD cause is not well established but is a well manageable condition with the integration of medical therapy with psychotherapy.
The exact cause of the disorder is not well known. There are several empirical arguments on the probable causes of GAD. The common and recent concept that is embraced is that GAD is caused by deregulation of worry. There is a persistent stimulation of areas of the brain in the event of any worry-inducing stimuli. The emotional memories stored in the brain continue to process stimuli related to worry creating a chronic state of anxiety (Locke et al., 2015). The other significant argument is that genetics play a role in development of GAD. Twin studies have revealed that genetic coding play a significant role in the etiology of GAD (Keeton et al., 2009). Twin studies data also suggest that environmental factors may be involved in the etiology of the disorder (Locke et al., 2015). GAD can occur independently, or can occur along with other psychological comorbidities such as mood disorders (Locke et al., 2015).
There are several anxiety disorders according to the DSM-5 classification. An individual is diagnosed with GAD if there symptoms do not fit in any other category, and meet the criteria for GAD. GAD diagnostic criteria includes the following: unwarranted anxiety and worry about multiple daily activities that the individual is not able to help; the anxiety is associated with at least three of the following symptoms; restlessness, fatigue, concentration deficit, irritability, muscle stiffness and altered sleep pattern; the distress resulting from symptoms interferes with normal functioning: the symptoms cannot be attributed to substance abuse or medication; and the disorder does not meet any other diagnostic criteria (American Psychiatric Association, 2013). The DSM-5 classification helps to distinguish GAD from other anxiety disorders that manifest with some overlapping symptoms. Good history taking and interviewing of the client is essential to correct diagnosis.
Management of GAD
GAD is a treatable disorder. Evidence suggest that use of both medications and therapy yields desirable outcomes (Locke et al., 2015). The recommended first line medication most commonly used for GAD are antidepressants more specifically serotonin reuptake inhibitors. Other medications used are benzodiazepines and anticonvulsants. Therapies used include psychotherapy and relaxation therapy. Psychotherapy includes several approaches within the available varieties. Cognitive behavioral therapy is the most used and beneficial therapy according to exiting evidence (Hoge et al., 2012; Locke et al., 2015). The choice of therapy and medication depends on the situation of the patient and the preferences of the practitioner. Also, beta-blockers are effective in relieving the physiological cardiac symptoms resulting from extreme anxiety. They help calm down the client and decrease the shaking and rapid heart rate (Locke et al., 2015).
Psychotherapy can be used alone or together with medications. Cognitive behavior therapy is effective because it helps the individual to learn how cope with the anxiety, as well as guide towards complete control of behavior. The individual learns how to confront the situations that stimulate anxiety and gradually control how they respond towards the situations (Hoge et al., 2012).
In summary, the exact causes of GAD are not well established but the available management strategies are effective in restoring normal function. Pharmacologic therapy and behavior modification therapies enhance the process of recovery. GAD is fully treatable with adherence to treatment and therapies. Early interventions and proper education to both the family and the individual promote complete recovery. Some individuals may relapse back to anxiety states after discontinuation of treatment. Such cases should be reviewed and put back on treatment to avoid further deterioration into depression.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
- Hoge, E. A., Ivkovic, A., & Fricchione, G. L. (2012). Generalized anxiety disorder: diagnosis and treatment. BMJ, 345(2012), e7500.
- Keeton, C. P., Kolos, A. C., & Walkup, J. T. (2009). Pediatric generalized anxiety disorder: epidemiology, diagnosis, and management. Paediatric Drugs, 11(3), 171-183.
- Locke, A. B., Kirst, N., & Shultz, C. G. (2015). Diagnosis and management of generalized anxiety disorder and panic disorder in adults. American Family Physician, 91(9), 617-624.