Generalized Anxiety Disorder

Definition-cum-Introduction   

          “The term anxiety is usually defined as a diffused, vague, very unpleasant feeling of fear and apprehension” NCERT.

 

         The anxiety disorder is the most common neurotic disorder. Anxiety is anticipation of future threat. The levels of anxiety that are distressing and interfere with day-to-day effective functioning indicate the presence of anxiety disorder. It keeps the individual in a constant state of tension, worry and diffused uneasiness.

 

Major Types of Anxiety Disorders

1.       Generalised Anxiety Disorder

2.       Panic Disorder

3.       Phobias

4.       Obsessive-compulsive Disorder

5.       Post-traumatic Stress Disorder (PTSD)

 

Introduction (GAD)

          GAD is one of the types of anxiety disorders.  It consists of prolonged, vague, unexplained and intense fears that are not attached to any particular object, event or phenomenon. In this condition the individual worries about the quality of their social and nonsocial performance and tends to overestimate the danger in situations.

          The key features of generalized anxiety disorder are persistent and excessive anxiety and worry about various domains, that the individual finds difficult to control. In addition, the individual experiences physical symptoms, including restlessness; being easily fatigued; difficulty concentrating; irritability; muscle tension; and sleep disturbance. Female are at the double the risk of getting into the GAD trap than males.

 

Symptoms

(i)       Increased heart rate & shortness of breath,

(ii)      Difficulty in decision making,

(iii)     Inability to concentrate,

(iv)     Fainting & dizziness,

(v)      Extreme sensitivity,

(vi)     Tremors,

(vii)    Sleeplessness,

(viii)   Loss of appetite,

(ix)     Excessive sweating,

(x)      Frequent urination,

(xi)     Discouragement,

(xii)    Sustained muscular tension, and

(xiii)   Hypervigilance (constantly scanning the environment for dangers).

 

Proteins and Chemicals (Neurotransmitters) Responsible for GAD

1.       Anxiolytic Neurotransmitters GABA, Adenosine, Melatonin and neuroactive steroids.

2.       Anxiogenic Neurotransmitters Glutamate, Serotonin, Acetylcholine, Cholecystokinin and Corticotrophin releasing hormone.

 

Risk and Prognostic Factors

(i)      Temperamental – Behavioral inhibition, negative affectivity (neuroticism), and harm avoidance have been associated with GAD.

(ii)     Environmental – Although childhood adversities and parental overprotection have been associated with GAD, no environmental factors have been identified as specific to GAD or necessary or sufficient for making the diagnosis.

(iii)    Genetic and physiological – One-third of the risk of experiencing GAD is genetic, and these genetic factors overlap with the risk of neuroticism and are shared with other anxiety and mood disorders, particularly major depressive disorders.

 

Diagnostic Criterion

          The individual with chronic anxiety who is eligible for specified GAD criteria and does not meet the criteria for any other anxiety disorder or any other mental disorder should be diagnosed as having generalized anxiety disorder. Before pronouncing an individual with GAD the cultural and gender factors must be taken into account.

(i)       Excessive anxiety and worry occurring more days than not for at least 6 months, about a number of events or activities.

(ii)      The individual finds it difficult to control the worry.

(iii)     The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

(iv)     The anxiety and worry are associated with three or more of the following six symptoms: -

Note: Only one item is required in children.

          (a)      Restlessness.

          (b)      Being easily fatigued.

          (c)      Difficulty concentrating.

          (d)      Irritability.

          (e)      Muscle tension.

          (f)       Sleep disturbance.

          (v)      The disturbance is not due to the physiological effects of a substance   (drug or medication) or another medical condition.

          (vi)     The disturbance is not better explained by another mental disorder.

 

Characteristics of GAD

(i)       Social worries are common in GAD.

(ii)      Excessive and uncontrollable ‘worry’ (apprehensive expectation) is defining symptom of GAD which has shifting nature from one topic to another.

(iii)     It leads to distress and impairment in daily life.

(iv)     The worries typically interfere significantly with psychosocial functioning.

(v)      The worries are more pervasive, pronounced, and distressing; have longer duration; and frequently occur without precipitants.

(vi)     GAD rarely occurs prior to adolescence.

(vii)    The clinical expression of GAD is relatively consistent across the lifespan.

(viii)   GAD manifests more severe symptoms in younger adults than adults.

 

Functional Consequences of GAD

          GAD ensues following psycho-physical consequences in the patient.

(i)       It impairs the individual's capacity to do things quickly and efficiently.

(ii)      The worrying consumes time and energy leading to tiredness, difficulty concentrating, and disturbed sleep.

(iii)     Generalized anxiety disorder is associated with significant disability and distress.

(iv)     Leads to psychological fatigue due to excessive usage of cognitive resources.

 

Treatment

          The appropriate Medication and Behavioural therapy jointly can cure this mental illness.

(i)       Cognitive Behaviour Therapy (modification of maladaptive cognitions).

(ii)      Medications (Such as antidepressants).

(iii)     Yoga (NYU Grossman School of Medicine).

(iv)     Relaxation techniques (breathing exercises, relaxation strategies, and

meditation).

(iv)     Combination of Psychotherapy, medications, and relaxation techniques.

 

References:

1.       Coleman, C. J. (1988). Abnormal psychology and modern life. Bombay, India: D. B. Taraporevala Sons & Co.

2.       Generalized anxiety and generalized anxiety disorder: description and reconceptualization. (1986). American Journal of Psychiatry, 143(1), 40–44. doi:10.1176/ajp.143.1.40

3.       NCERT. (XII). Psychology Book.

4.       DSM V Manual. Published by APA.

5.       Kaur, S.  & Singh, R. (2017). Role of different neurotransmitters in anxiety: a systemic review. IJPSR, 8 (2), 411-421.

 

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