Generalised Anxiety Disorder

Generalised Anxiety Disorder (GAD), a neurological anxiety disorder that make people feel anxious and worried most of the time, not just in times of exceptional stress, and these worries interfere with their normal lives. Their worries may relate to any aspect of everyday life, including work, health, family and/or financial issues, even if there's no real reason to worry about them. Even minor matters, such as household chores, can become the focus of anxiety and lead to uncontrollable worries and a feeling that something terrible will happen.

GAD comes on gradually and most often hits people in childhood or adolescence, but

can begin in adulthood, too. It’s more common in women than in men and often occurs in relatives of affected persons. It’s diagnosed when someone spends at least 6 months worried excessively about a number of everyday problems.

Causes

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.

Symptoms

GAD affects the way a person thinks, but the anxiety can lead to physical symptoms, as well. Symptoms of GAD can include:

• Excessive, ongoing worry and tension
• An unrealistic view of problems
• Restlessness or a feeling of being "edgy"
• Irritability
• Muscle tension
• Headaches
• Sweating
• Difficulty concentrating
• Nausea
• The need to go to the bathroom frequently
• Tiredness
• Trouble falling or staying asleep
• Trembling
• Being easily startled

In addition, people with GAD often have other anxiety disorders (such as panic disorder or phobias), obsessive-compulsive disorder, clinical depression, or additional problems with drug or alcohol misuse.

Tests and Diagnosis

To help diagnose generalized anxiety disorder, your health provider may:

Do a physical exam to look for signs that your anxiety might be linked to an underlying medical condition

Order blood or urine tests or other tests, if a medical condition is suspected

Ask detailed questions about your symptoms and medical history

Use psychological questionnaires to help determine a diagnosis

Many experts use the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, to diagnose mental conditions. This manual is also used by insurance companies to reimburse for treatment.

DSM-5 criteria for generalized anxiety disorder include:

• Excessive anxiety and worry about several events or activities most days of the week for at least six months
• Difficulty controlling your feelings of worry
• At least three of the following symptoms in adults and one of the following in children: restlessness, fatigue, trouble concentrating, irritability, muscle tension or sleep problems
• Anxiety or worry that causes you significant distress or interferes with your daily life
• Anxiety that isn't related to another mental health condition, such as panic attacks or post-traumatic stress disorder (PTSD), substance abuse, or a medical condition

Generalized anxiety disorder often occurs along with other mental health problems, which can make diagnosis and treatment more challenging. Some disorders that commonly occur with generalized anxiety disorder include:

• Phobias
• Panic disorder
• Depression
• Substance abuse
• PTSD

Treatment

GAD is generally treated with psychotherapy, medication, or both.

Psychotherapy. A type of psychotherapy called cognitive behavior therapy 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.

It's important to know that although antidepressants can be safe and effective for many people, they may be risky for some, especially children, teens, and young adults. A "black box", the most serious type of warning that a prescription drug can have, has been added to the labels of antidepressant medications. These labels warn people that antidepressants may cause some people to have suicidal thoughts or make suicide attempts. Anyone taking antidepressants should be monitored closely, especially when they first start treatment with medications.

Some people do better with cognitive behavior therapy, while others do better with medication. Still others do best with a combination of the two. Talk with your doctor about the best treatment for you.

Self-Help

There are helpful tips that you can do.

Tip 1: Look at your worries in new ways

The core symptom of generalized anxiety disorder is chronic worrying. It’s important to understand what worrying is, since the beliefs you hold about worrying play a huge role in triggering and maintaining GAD.

Understanding worrying

You may feel like your worries come from the outside, from other people, events that stress you out, or difficult situations you’re facing. But, in fact, worrying is self-generated. The trigger comes from the outside, but an internal running dialogue maintains the anxiety itself.

When you’re worrying, you’re talking to yourself about things you’re afraid of or negative events that might happen. You run over the feared situation in your mind and think about all the ways you might deal with it. In essence, you’re trying to solve problems that haven’t happened yet, or worse, simply obsessing on worst-case scenarios.

All this worrying may give you the impression that you’re protecting yourself by preparing for the worst or avoiding bad situations. But more often than not, worrying is unproductive, sapping your mental and emotional energy without resulting in any concrete problem-solving strategies or actions.

How to distinguish between productive and unproductive worrying? If you’re focusing on “what if” scenarios, your worrying is unproductive.

Once you've given up the idea that your worrying somehow helps you, you can start to deal with your worry and anxiety in more productive ways. This may involve challenging irrational worrisome thoughts, learning how to postpone worrying, and learning to accept uncertainty in your life.

Tip 2: Practice relaxation techniques

Relaxation techniques such as progressive muscle relaxation, deep breathing, and meditation can teach you how to relax.

The key is regular practice. Try to set aside at least 30 minutes a day. As you strengthen your ability to relax, your nervous system will become less reactive and you’ll be less vulnerable to anxiety and stress. Over time, the relaxation response will come easier and easier, until it feels natural.

• Progressive muscle relaxation. When anxiety takes hold, progressive muscle relaxation can help you release muscle tension and take a “time out” from your worries. The technique involves systematically tensing and then releasing different muscle groups in your body. As your body relaxes, your mind will follow.
• Deep breathing. When you’re anxious, you breathe faster. This hyperventilation causes symptoms such as dizziness, breathlessness, lightheadedness, and tingly hands and feet. These physical symptoms are frightening, leading to further anxiety and panic. But by breathing deeply from the diaphragm, you can reverse these symptoms and calm yourself down.
• Meditation. Many types of meditation have been shown to reduce anxiety. Mindfulness meditation, in particular, shows promise for anxiety relief. Research shows that mindfulness meditation can actually change your brain. With regular practice, meditation boosts activity on the left side of the prefrontal cortex, the area of the brain responsible for feelings of serenity and joy.

Tip 3: Learn to calm down quickly

The best methods for self-soothing incorporate one or more of the physical senses: vision, hearing, smell, taste, and touch. Try the following sensory-based, self-soothing suggestions when your generalized anxiety disorder symptoms are acting up:

• Sight. Take in a beautiful view. Go to an art museum. Walk around a pretty neighborhood. Look at treasured photos or an interesting picture book.
• Sound. Listen to soothing music. Enjoy the sounds of nature: birds singing, ocean waves crashing on the beach, wind rustling through the trees.
• Smell. Light scented candles. Smell the flowers in a garden. Breathe in the clean, fresh air. Stop by a bakery. Spritz on your favorite perfume.
• Taste. Cook a delicious meal. Slowly eat a favorite treat, savoring each bite. Enjoy a hot cup of coffee or tea.
• Touch. Pet your dog or cat. Take a warm bubble bath. Wrap yourself in a soft blanket. Sit outside in the cool breeze. Get a massage.

Tip 4: Connect with others

For example, anxiety and constant worrying about your close relationships may leave you feeling needy and insecure. Perhaps you tend to read into what people say or assume the worst when a friend or partner doesn’t respond the way you expected or hoped. As a result, you may need lots of reassurance from others or become paranoid and suspicious. These things can put a huge strain on your relationships.

• Identify unhealthy relationship patterns. Think about the ways you tend to act when you’re feeling anxious about a relationship. Do you test your partner? Withdraw? Make accusations? Become clingy? Once you’re aware of any anxiety-driven relationship patterns, you can look for better ways to deal with any fears or insecurities you’re feeling.
• Build a strong support system. Human beings are social creatures. We’re not meant to live in isolation. Connecting to others is vital to your emotional health. A strong support system doesn’t necessarily mean a vast network of friends. Don’t underestimate the benefit of a few people you can trust and count on to be there for you.
• Talk it out when your worries start spiraling. If you start to feel overwhelmed with anxiety, call a trusted family member or friend. Just talking out loud about your worries can make them seem less threatening. It’s helpful to bounce your worries off someone who can give you a balanced, objective perspective.
• Know who to avoid when you’re feeling anxious. Remember that there is a good chance that your anxious take on life is something you learned when you were growing up. If your mother is a chronic worrier, she is not the best person to call when you’re feeling anxious no matter how close you are. When considering who to turn to, ask yourself whether you tend to feel better or worse after talking to that person about a problem.

Tip 5: Change your lifestyle

A healthy, balanced lifestyle plays a big role in keeping the symptoms of GAD at bay. Read on for a number of ways you can stop chronic anxiety and worry by taking care of yourself, and commit to making any necessary anxiety-reducing lifestyle changes.

• Adopt healthy eating habits. Start the day right with breakfast, and continue with frequent small meals throughout the day. Going too long without eating leads to low blood sugar, which can make you feel anxious and irritable. Eat plenty of complex carbohydrates such as whole grains, fruits, and vegetables. Not only do complex carbs stabilize blood sugar, they also boost serotonin, a neurotransmitter with calming effects.
• Limit caffeine and sugar. Stop drinking or cut back on caffeinated beverages, including soda, coffee, and tea. Caffeine can increase anxiety, interfere with sleep, and even provoke panic attacks. Reduce the amount of refined sugar you eat, too. Sugary snacks and desserts cause blood sugar to spike and then crash, leaving you feeling emotionally and physically drained.
• Exercise regularly. Exercise is a natural and effective anti-anxiety treatment. For maximum relief for generalized anxiety disorder (GAD), try to get at least 30 minutes of aerobic activity on most days. Aerobic exercise relieves tension and stress, boosts physical and mental energy, and enhances well-being through the release of endorphins, the brain’s feel-good chemicals.
• Avoid alcohol and nicotine. Alcohol temporarily reduces anxiety and worry, but it actually causes anxiety symptoms as it wears off. Drinking for generalized anxiety disorder relief also starts you on a path that can lead to alcohol abuse and dependence. Lighting up when you’re feeling anxious is also a bad idea. While it may seem like cigarettes are calming, nicotine is actually a powerful stimulant. Smoking leads to higher, not lower, levels of anxiety.
• Get enough sleep. Anxiety and worry can cause insomnia, as anyone whose racing thoughts have kept them up at night can attest. But lack of sleep can also contribute to anxiety. When you’re sleep deprived, your ability to handle stress is compromised. When you’re well rested, it’s much easier to keep your emotional balance, a key factor in coping with anxiety and stopping worry.