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Generalized Anxiety Disorder
Jacob Yorg
California Southern University
PSY 8701 – Physiological Psychology
Dr. Linda Salvucci
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Generalized Anxiety Disorder
Definition
GAD (Generalized Anxiety Disorder) has been found to be a complex disorder to
diagnose. It has an impact on a person's mental functions. Exaggerated or excessive anxiety and
concern over life events are two of the disorder's main features (i.e., work, finances, or health).
According to the American Psychological Association (APA) (2013), the concern occurs more
frequently than not for at least six months. Panic attacks are not included in GAD. Anxiety and
worrying are common in all groups, but GAD patients have a disproportionate amount of
distressing concerns.
The concept of worry has become ingrained in their everyday routines. Their degree of
dread, for example, is exaggerated in comparison to the scenario they were concerned about at
the time. The customer could recall something that happened in the past or something that has a
slim probability of happening in the future. During this time of worry, a client's perception and
functioning might be affected by fear and dread (Carlson, 2021).
When you are going through this time, people may find it difficult to relate to people,
whether in a high school class, a party at a friend's house, with their spouse or partner, and even
at their place of employment. Individuals diagnosed with GAD are so when they cannot control
their intensity of anxiety. GAD is distinguished from other concerns in that it requires the
identification of specific symptoms over a six-month period to be diagnosed. Many researchers
have been drawn to investigate GAD because of its persistence and high prevalence, covering the
link between the illness gender and different cultures (APA, 2013).
GAD necessitates a high level of feeling anxious and worry about any situation. This
concern happens over more than 50% of the time during a six-month period and can be described
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as excessive. The individual's worry is tough to control, and it does not matter if it switches
between subjects. The symptoms also must include at least three of the following cognitive or
physical examples: (a) Anxiety or sleeplessness; (b) quickly fatigued; feeling more exhausted
than what is expected; (c) reduced focus or sensation; (d) impatience/irritability (may not have
visibility to people around them); (e) increased physical pains or even stiffness; (f) difficulties in
getting a good night sleep (i.e., caused by tossing and turning in bed) (APA, 2013).
Differential Diagnosis
It's critical for a psychologist to initial look at if a diagnosis of Panic Disorder,
Obsessive-Compulsive Disorder, or Social Anxiety Disorder could be made based on
information gathered from the client's intake about their worrying and anxiety. The excessive
concern is a symptom that GAD and other illnesses have in common. The disease, however,
differs from other anxiety disorders in several ways. Excessive worrying in GAD lasts six
months and has a detrimental influence on daily functioning and quality of life. Someone can
have both GAD and a panic condition (APA, 2013).
Furthermore, the two disorders might coexist with other diseases. It may coexist with
social phobia, drug addiction, or severe depressive illness, for example. Many persons with GAD
claim to be nervous all of the time. Although some people may be concerned throughout their
lives, the condition may not emerge until they are in their 30s. The symptoms of GAD remain
constant throughout a person's life after they have been identified. In nervous youngsters, GAD
might be overdiagnosed. As a result, before assuming that GAD is the only anxiety disease,
additional anxiety and mental problems must be investigated (APA, 2013).
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Signs and Symptoms
According to Muris et al. (2017), a psychologist looks at the symptoms displayed and
what distinctions can be made to diagnose GAD. The symptoms presented should differ based on
each client's unique history (age, socioeconomics, causes, etc.). The psychologist could discover
indicators of psychological, mental, or physical in nature. When a person has excessive
worrying, it's critical to evaluate the social and cultural context of what they're worried about.
Worry is not always conveyed in a culturally appropriate manner. GAD can manifest as somatic
or cognitive symptoms, depending on the culture (APA, 2013).
Constant anxiety or worry about certain things or occurrences is the primary indication of
the illness in terms of psychological symptoms. The worry is deemed excessive and outside the
usual range for what an ordinary individual would experience in the same scenario. Worrying
might take the form of a client overthinking strategies and remedies for worst-case
circumstances. For excessive worrying to be deemed GAD, it must interfere with the individual's
life for at least six months (Muris et al., 2017). As a result, another symptom is having anxiety
when they perceive specific responses or events that have no possible danger associated with
them as dangerous. When it comes to making decisions and dealing with uncertainty, there are
other signs of indecisiveness. Individuals suffering from GAD have difficulty getting over a
worry, making it difficult to relax and causing them to become restless. The struggle of getting
over a worry could lead to an inability to focus, which could signify a mental health struggle.
People suffering from GAD are physically exhausted, as evidenced by recurring muscular
pains and tension (Muris et al., 2017). Because they are frequently anxious and easily disturbed,
they have difficulty sleeping. They are also easily agitated, sweating profusely, and trembling
repeatedly. Irritable bowel syndrome and nausea are common symptoms. GAD sufferers
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experience mental stress as a result of the concern that is reflected in the symptoms listed. As a
result, they struggle to maintain a regular social life. As a result, they have shattered relationships
and are increasingly lonely. Notably, even if the source of anxiety moves from one form to
another, the symptoms may persist (Alonso et al., 2018). When a person is concerned about the
safety of a loved one, for example, anxiety may persist even if the loved one's safety improves.
GAD symptoms fluctuate with age, according to Guaiana, Barbui, and Abouhassan
(2018). Adults may have different symptoms than teens and children in this regard. The
variations in symptoms are primarily due to variances in the causes of concern. School
performance, the safety of a family member, catastrophic occurrences, and even timeliness are
all familiar sources of worry for children and teens (Muris et al., 2017). People may experience
various symptoms due to their concerns, like fitting in with specific groups of classmates, having
a perfectionist mindset, losing faith in themselves, struggling with gaining acceptance, evading
situations with large numbers of people, and experiencing recurring stomachaches.
GAD's link between cognitive control and anxiety explains why they can "overthink"
events and feel uncomfortable. According to Makovac et al. (2018), a GAD diagnosis might lead
a person to be anxious about everything. To manage their anxiety, the individual may find it
difficult to distinguish between "worth" worrying about and what situations are part of a healthy
growing process. Worrying can become bothersome over time and lead to a diagnosis.
Underlying Causes
According to Meyer et al. (2018), it is hard to pinpoint an exact cause that brings about
GAD. Although, the condition can be caused by complex interactions between environmental
and biological factors. Some things that could play a role in the interaction are differing genetics,
differences between individual's personality and life development, individual differences in the
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way they perceive danger, and how the chemistry and function of their brain could differ. The
progression, however, is dependent on how an individual's condition progresses.
Incidentally, individuals could find themselves isolated if they desire not to attend social
activities and struggle in managing relationships. Isolated individuals tend to develop GAD more
often than those active socially (Meyer et al., 2018). As a result, significant risk factors for GAD
diagnosis include lack of social activity and poor or short-termed relationships. GAD clients
must understand and know their social history, connections, and interactions. It is possible that a
client might know many people but never hang out with them. Even though it is just a factor, it's
crucial to investigate and understand that social isolation and an excessive desire to worry may
point towards a GAD diagnosis (Ohannessian et al., 2017).
According to Moran (2016), due to their lack of social experience and detachment,
individuals who struggle with GAD tend to misinterpret everyday interactions and social cues.
This might result in twisting a situation as dangerous or feeling rejected when nothing is
observable to support it. With these perceived feelings of risk or danger, an individual might feel
more comfortable interacting with others using other means of communication like social media.
However, they tend not to realize that social media has its own risk of misinterpretation. An
example of GAD worsening without important nonverbal communication cues like an
individual's facial expressions, how they are standing, or even what tone they use in when they
talk is that when a GAD client reads a social media post, they could perceive the message in a
negative or hostile manner, but it was meant as a joke. This could cause a GAD individual to get
anxious or worried that they had offended someone or the other person is mad at them (Moran,
2016). Furthermore, personality differences also play a possible part in developing GAD. For
example, if an individual has a pessimistic, nervous, or avoidant temperament, they are more
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likely to develop the condition than possibly another person. Lastly, an individual's unique life
experiences can also increase the likelihood of developing GAD (Ohannessian et al., 2017).
Developmental
According to Copeland et al. (2018), childhood trauma may increase the risk of
developing GAD. Childhood events such as abuse (either physical or emotional), parental
neglect, the loss of someone close, parental divorce or separation, abandonment, or loneliness
have the risk of elevated anxiety levels. Anxiety may worsen as an adult if these feelings
associated with these events are not handled. With help, this might also lead to distrust of people
both currently in their lives and anyone they would meet.
Threats are difficult for GAD clients to grasp. Uncertainty and anxiety can arise from
everyday encounters. Life experiences that cause emotion Medical and mental health
professionals must collect information about a person's familial and social background to provide
an appropriate diagnosis. For example, individuals who have had severe life problems may be at
a higher risk of developing a generalized anxiety disorder. Furthermore, genetics can have a role
in the progression of sickness in people, particularly those with a family history of the disease
(Carlson, 2021).
Social Influences
Anxiety is taught, according to Burstein M & Ginsburg G (2010). If a parent or caregiver
shows nervous tendencies, for example, children will imitate similar behaviors. If the concern is
the chosen coping technique, this model may produce excessive anxiety. Caretakers and others in
our social circles, according to social theorists, may educate us on how to deal with stress. As a
result, this early learning might lead to long-term excessive anxiety and stress. Understanding the
family of origin in a social setting is critical when working with an anxious client. Understanding
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a person's social influences may aid a mental health practitioner to identify where and how
anxious thoughts emerge. If GAD is caused by learned behavior, knowing how to treat it requires
knowledge of the source.
As mentioned previously, social media has similar challenges as regular social
interaction with people, such as rejection, humiliation, loneliness, or even abandonment. People
diagnosed with GAD struggle with accurately perceiving social interactions and their cues. This
leaves them open to possibly interpreting things as unfavorable, threatening, or even as rejection.
Most often, during this time, there is no present perceivable threat. Social media interactions lend
themselves to perceiving comments or actions inaccurately. There is a possibility they have a
higher risk of misinterpretation as key non-verbal cues like reading expressions in the face, body
position, or even tone (Makovac et al., 2018).
The Brain
According to Bandelow et al. (2019), the amygdala plays a crucial role in our ability to
recognize and feel fear. As a result, imaging studies of GAD patients with more significant
amygdala activity during the processing of unpleasant emotions may not come as a surprise.
Patients with GAD may feel incorrect social cues and excessive anxiety due to this activity in the
amygdala.
The centromedial amygdala is located near the top of the amygdala. It helps control
alertness, heart rate, respiration, and the production of neurotransmitters such as serotonin and
dopamine (Makovac et al., 2018). People with GAD exhibited various behaviors; thus, their
neurotransmitters in these two regions, which communicate with different targets, demonstrate
confusing pathways. It is also found that their amygdala is less linked to the part of the brain that
regulates fear responses. This has shown that people suffering from GAD may struggle with
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controlling their fear and anxiety during certain times. On the other hand, in GAD individuals,
the amygdala is found to have a more vital link to cortical prefrontal executive-control networks.
This cognitive control link helps regulate emotions through an individual thought (Makovac et
al., 2018).
Treatment
GAD therapy is initiated after determining that another illness does not cause the
observed warning signs and indicators. People suffering from GAD are frequently referred to
individuals who have specific training to help individuals suffering from GAD. Typically,
therapy for GAD will utilize Cognitive Behavior Therapy (CBT) and possible pharmacotherapy.
Cognitive-behavioral therapy is frequently used to treat GAD. CBT includes an education
component in which the client learns why they are worried and anxious and how it affects them.
The client is working on identifying and changing unhelpful thought patterns and beliefs. Instead
of worrying all the time, they learn how to schedule appropriate times to worry. Finally, they are
gradually placed in situations that make them anxious to learn how to face and cope with those
situations rather than avoid or try to escape them (Murrough et al., 2015).
Acceptance and Commitment Therapy is another approach that therapists can use with
clients suffering from GAD. ACT is a relatively new treatment for GAD. There has been little
research on ACT and GAD, but the studies that have been conducted so far are encouraging.
ACT's overarching goal is to assist people in identifying what they value most in their lives, such
as family, work, social relationships, and community, and to assist them in taking action to
support living following these values. Unlike CBT, the goal of ACT is not to reduce the
frequency or intensity of unpleasant thoughts and feelings; instead, the ACT therapist teaches
people cognitive defusion techniques to reduce their struggle to get rid of or control their
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thoughts. Cognitive defusion refers to observing thoughts as they are rather than becoming
engrossed in them. Although we can't change the thoughts that pop into our heads, we can
change how we respond to them, leading to less time having these unpleasant thoughts and
worries, which leads to less anxiety. Mindfulness is also used in ACT to help people learn
cognitive defusion. Lastly, accepting one's anxious thoughts and feelings can cause anxiety to
lessen and feel less threatening. People can be liberated to do more things in their lives that are
meaningful and important to them. A standard CBT for GAD therapy course can be relatively
short—10 or 20 sessions—with the client practicing learned skills (Ruiz et al., 2020).
Alonso et al. (2018) believe the pharmaceutical strategy for treating GAD should only
use medications for a limited time. When taken over an extended time, drugs intended to treat
GAG can become addictive or cause drowsiness. When taken incorrectly, benzodiazepines, a
family of medicines, can harm memory and attention. Benzodiazepines work by decreasing
physical symptoms of anxiety such as restlessness and muscular tightness. They don't have the
same negative consequences. Ativan, Valium, Librium, and Xanax are some of the most often
used benzodiazepines for GAD therapy (Health Quality Ontario, 2017). These medicines can be
used independently without mixing with other prescriptions. However, they should not be taken
with alcohol. Long-term usage of antidepressants is advised. When determining whether or not to
treat GAD with medication, it's critical to consider a client's addiction history.
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