“I have terrible sleeping problems. There are times I wake up wired in the middle of the night. I have trouble concentrating, even reading the newspaper or a novel. Sometimes I feel a little lightheaded. My heart races or pounds. And that makes me worry more. I always imagine things are worse than they really are. When I get a stomachache, I think it’s an ulcer.”
“I always thought I was just a worrier. I feel keyed up and unable to relax. At times it comes and goes, and at times it’s constant. It can go on for days. I worry about what I about everything, even everyday things like what I’m going to fix for a dinner party, or what will be a great present for somebody. I just can’t let something go.”
“I worry all the time about everything. It doesn’t matter that there are no signs of problems, I just get upset. I have trouble falling asleep at night, and I can’t keep my mind focused at work. I feel angry at my family all the time.”
Causes
All of us worry about things like health, money, or family problems. But people with generalized anxiety disorder (GAD) are extremely worried about these and many other things, even when there is little or no reason to worry about them. They are very anxious about just getting through the day. They think things will always go badly. At times, worrying keeps people with GAD from doing everyday tasks.
GAD sometimes runs in families, but no one knows for sure why some people have it while others don’t. Researchers have found that several parts of the brain are involved in fear and anxiety. By learning more about fear and anxiety in the brain, scientists may be able to create better treatments. Researchers are also looking for ways in which stress and environmental factors may play a role.
Signs & Symtoms
People with GAD can’t seem to get rid of their concerns, even though they usually realize that their anxiety is more intense than the situation warrants. They can’t relax, startle easily, and have difficulty concentrating. Often they have trouble falling asleep or staying asleep. Physical symptoms that often accompany the anxiety include fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, nausea, lightheadedness, having to go to the bathroom frequently, feeling out of breath, and hot flashes.
GAD develops slowly. It often starts during the teen years or young adulthood. Symptoms may get better or worse at different times, and often are worse during times of stress.
When their anxiety level is mild, people with GAD can function socially and hold down a job. Although they don’t avoid certain situations as a result of their disorder, people with GAD can have difficulty carrying out the simplest daily activities if their anxiety is severe.
Who Is At Risk?
Generalized anxiety disorders affect about 3.1% American adults age 18 years and older (about 18%) in a given year, causing them to be filled with fearfulness and uncertainty.The average age of onset is 31 years old.
GAD affects about 6.8 million American adults, including twice as many women as men. The disorder develops gradually and can begin at any point in the life cycle, although the years of highest risk are between childhood and middle age.
Diagnosis
GAD is diagnosed when a person worries excessively about a variety of everyday problems for at least 6 months.
People with GAD may visit a doctor many times before they find out they have this disorder. They ask their doctors to help them with headaches or trouble falling asleep, which can be symptoms of GAD but they don’t always get the help they need right away. It may take doctors some time to be sure that a person has GAD instead of something else.
First, talk to your doctor about your symptoms. Your doctor should do an exam to make sure that another physical problem isn’t causing the symptoms. The doctor may refer you to a mental health specialist.
Treatments
GAD is generally treated with psychotherapy, medication, or both.
Psychotherapy. A type of psychotherapy called cognitive behavior therapy (CBT) is especially useful for treating GAD. It teaches a person different ways of thinking, behaving, and reacting to situations that help him or her feel less anxious and worried.
Medication. Doctors also may prescribe medication to help treat GAD. Two types of medications are commonly used to treat GAD—anti-anxiety medications and antidepressants. Anti-anxiety medications are powerful and there are different types. Many types begin working right away, but they generally should not be taken for long periods.
Antidepressants are used to treat depression, but they also are helpful for GAD. They may take several weeks to start working. These medications may cause side effects such as headache, nausea, or difficulty sleeping. These side effects are usually not a problem for most people, especially if the dose starts off low and is increased slowly over time. Talk to your doctor about any side effects you may have.
Ways to Make Treatment More Effective
Many people with anxiety disorders benefit from joining a self-help or support group and sharing their problems and achievements with others. Internet chat rooms can also be useful in this regard, but any advice received over the Internet should be used with caution, as Internet acquaintances have usually never seen each other and false identities are common. Talking with a trusted friend or member of the clergy can also provide support, but it is not a substitute for care from a mental health professional.
Stress management techniques and meditation can help people with anxiety disorders calm themselves and may enhance the effects of therapy. There is preliminary evidence that aerobic exercise may have a calming effect.
Since caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders, they should be avoided. Check with your physician or pharmacist before taking any additional medications.
The family is very important in the recovery of a person with an anxiety disorder. Ideally, the family should be supportive but not help perpetuate their loved one’s symptoms. Family members should not trivialize the disorder or demand improvement without treatment.