Generalized anxiety disorder (GAD) is a mental disorder that is characterized by excessive, irrational, and uncontrollable fear and worry. People diagnosed with GAD tend to have apprehensive expectations about real-life activities and events. According to the Mayo Clinic Staff (2014), psychological symptoms of GAD can vary from one person to another and may include the following:
- Persistent obsession or worrying about different concerns that are blown out of proportion;
- Lack of ability to relax and set worriers aside;
- Inability to concentrate and feeling that the mind “goes blank” (Mayo Clinic Staff, 2014, para. 1);
- Distress and worry about making decisions; in particular, the fear of making the wrong decision;
- Indecisiveness when dealing with uncertainty.
On the other hand, physical symptoms of the condition can include fatigue and irritability, tensions and aches in the muscles, twitching and trembling, issues with sleep, headaches, and sweating, as well as nausea, diarrhea, and irritable bowel syndrome (Mayo Clinic Staff, 2014).
Generalized anxiety disorder is diagnosed when a patient has experienced excessive worry about everyday problems for at least six months (NIH, 2015). The prevalence of the disease is differentiated into the following categories (in the U.S.):
- 12-months prevalence: 3.1% of the U.S. adult population, with 32.2% of them (1% of the U.S. adult population) classified as severe (NIH, 2005);
- Lifetime prevalence: 5.7% of the U.S. adult population (NIH, 2005).
When it comes to the prevalence of generalized anxiety disorder worldwide, it affects between 2% and 5% of the United Kingdom population, 3% of the Australian population, between 3% and 5% of Canadians, and between 2% and 3% of the European people (Roche, 2015).
Conducting a comparison between the occurrence of GAD in different countries is complicated because of the variance in languages, instruments of assessment, as well as political, geographic, and sociodemographic contexts (Hofmann & Hinton, 2014). A more valid estimate of differences between cultural groups can be derived from comparing them within the same multicultural environment. For example, according to the study conducted by Hofmann and Hinton (2014), White Americans endorsed symptoms of GAD (8.6%) more frequently than African Americans (4.9%), Hispanic Americans (5.8%), and Asian Americans (2.4%).
For the sake of argument, the prevalence of GAD in the U.S. and Mexico can be compared. The rate of the disorder’s occurrence in Mexico is 0,4% (Lewis-Fernandez et al., 2010) compared to 5.7% in the U.S. These results are surprising since the quality of healthcare and life, in general, is higher in the U.S. However, the population shows the much greater prevalence of the condition compared to the South American country. This points to the ineffectiveness of comparing the rates of anxiety disorders in different countries since too many factors influence the contrasting results (Lewis-Fernandez et al., 2010).
Age of Onset and Gender Features
While the symptoms of generalized anxiety disorders can occur at any age, the average adult patient is diagnosed with GAD between the ages of twenty and thirty years. The mean age at onset is 32 years in both men and women (Vesga-Lopez et al., 2008). In the majority of cases, the disorder is insidious, with symptoms occurring one by one and then gradually combining and developing into a severe mental health issue. Demographics for lifetime prevalence of GAD among the U.S. adult population are the following:
- 18-29 years: 4.1% of the population;
- 30-44 years: 6.8% of the population;
- 45-59 years: 7.7% of the population;
- 60+ years: 3.6% of the population (NIH, 2005).
Research has shown that different mental disorders can manifest in males and females at different rates severities. If to examine the gender features of generalized anxiety disorder, the lifetime prevalence rates are 2.8% for men and 5.3% for women, whereas the 12-month prevalence of GAD is 1.2% for men and 2.7% for women (Vesga-Lopez et al., 2008). When it comes to co-morbidities that accompany GAD in men and women, men with 12-month and lifetime disorder are more likely to be substance abusers and have an antisocial personality disorder (Vesga-Lopez et al., 2008). On the other hand, they are less likely to have a phobia. Also, men diagnosed with 12-month and lifetime GAD are more likely to be nicotine dependent or drug abusers and significantly less likely to suffer from panic and mood disorders than women (except bipolar) (Vesga-Lopez et al., 2008).
Therefore, the clinical presentation of generalized anxiety disorder significantly differs by gender. Among individuals who have been diagnosed with GAD, men reported the use of addictive medication, alcohol, and drugs at higher rates than women to relieve the adverse symptoms of the disorder. Also, men are more likely to argue and have friction with friends or relatives because of their anxiety. On the other hand, women are much more likely to show the symptoms of fatigue, irritability, and tension in the muscles (Vesga-Lopez et al., 2008). Also, women also reported more complications regarding respiratory, cardiovascular, and gastrointestinal issues compared to men.
It has been identified that environmental factors played a significant role in the development of GAD. On the other hand, genetics may also affect the occurrence of the disorder (however, the role of genetics is much smaller compared to environmental factors). If to speak about the part of the brain that is affected by a generalized anxiety disorder, it has been found that the amygdala, which helps with the processing of emotions, fears, and memory, is involved in anxiety disorders.
The occurrence of one or more negative events in life can significantly increase the likelihood of GAD development than genetic predisposition. For example, abuse in the family or conflicts at school is considered as situations of increased stress that can contribute to the development of generalized anxiety disorder in the future. Among other etiological factors that contribute to the occurrence of GAD, separation at childhood, lack of interactions in social life, low satisfaction with life, and the modeling of a relative (e.g., mother, father, sister, etc.) with anxiety stand out the most. In order to understand the etiology of GAD to the full extent, researchers have used cognitive and behavioral approaches. First, researchers underlined the importance of the function of worry in the development of the disorder. People with GAD usually worry excessively to prevent themselves from experiencing negative feelings. Second, the cognitive variables such as the lack of tolerance for uncertainty, unnecessary and excessive beliefs about worry, as well as the negative orientation on problems have also been included as important etiological factors that play a part in the development and the progression of GAD.
Patients diagnosed with generalized anxiety disorder usually experience the symptoms for at least six months. GAD is less intense compared to panic attacks; however, it lasts much longer, which significantly decreases the quality of life. In many cases, people deal with anxiety their entire life, and depending on the severity of treatment and adherence to it, may not even recover fully.
While adults are more likely to be diagnosed with GAD, children and adolescents are also at risk of experiencing the symptoms of the disorder, which significantly affects their development. A child or adolescent can start worrying more about his or her problems at school, relationships with family and friends, performance in sports, and much more. Children and young people with GAD are usually very strict with themselves since they strive to reach perfection; they always seek approval from other people, even in cases when from the outside they seem to have no worries. This makes their development affected immensely by the disorder; children are unable to become fully-rounded individuals since the majority of their time is occupied with worry about things that should not bother kids that much.
It has been concluded that many people diagnosed with generalized anxiety disorder cannot be cured completely; thus, the symptoms may return from time to time even at the age of seventy. Nevertheless, patients can gain substantial relief from their recurring symptoms with the help of lifestyle changes, medication, and psychotherapy. In some cases, GAD patients will have to take anxiety medication on and off for the rest of their lives to mitigate the severity of the symptoms since they can appear again at any point in time depending on the environmental factors and the chosen lifestyle. With aging, come new problems such as physical health issues or the loss of relatives, so it is instrumental for patients with GAD to keep their anxiety under control to prevent the condition from re-emerging.
Modern strategies for treating generalized anxiety disorder are differentiated into three categories: behavioral therapy, medication, and lifestyle changes. Cognitive-behavioral therapy involves regular sessions with a professional who works in the sphere of mental health. The key objective of such sessions is trying to change the patient’s perceptions, thinking patterns, and behaviors. Therapy has been proven to be a reliable and successful tool for making a long-term change in patients with GAD; because of this, it is now considered the first-line treatment for dealing with anxiety disorders for people that cannot be treated medically (e.g., pregnant women). During therapy sessions, patients learn the ways to recognize, accept, and manage their worries and anxious thoughts. Also, therapists will teach patients how they can calm themselves in emergency situations that contribute to the rise of upsetting thoughts and irrational behaviors.
When designing a medication treatment for GAD, health providers usually create long-term and short-term plans. While short-term programs are designed to ease physical symptoms of anxiety such as muscle tensions (anti-anxiety drugs), long-term plans help manage stress in general (antidepressants). Anti-anxiety medications that patients take for short periods of time to control physical symptoms include Xanax, Ativan, and Klonopin. It is crucial to mention that these drugs should not be taken for extended periods of time since they present higher risks of abuse and dependence. Antidepressants usually need several weeks to start working; moreover, they can have some side effects such as nausea, bowel problems, dry mouth, etc. Some people cannot handle the severity of the side effects and quit medication altogether. The most commonly prescribed antidepressants include Buspar, Prozac, Celexa, Zoloft, Paxil, and Effexor.
Lifestyle changes to help manage GAD include regular exercises, meditations, and yoga, avoiding stimulants (e.g., coffee, over-the-counter drugs), socializing with families and friends. It is also advised to reduce or eliminate the use of alcohol and nicotine since they may encourage irritability and depression. Notably, alcohol can interfere with the effectiveness of the prescribed medication and cause further complications.
Comparing generalized anxiety disorder with similar conditions such as obsessive-compulsive disorder (OCD) is essential for a successful differential diagnosis. Historically, the two disorders have been considered anxiety conditions; however, the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders has separated them into different chapters. The first difference between GAD and OCD refers to behaviors. For example, people with GAD worry a lot, they do not exhibit ritualistic and compulsive behaviors to manage their anxiety while OCD patients use repetitive and unexplained behaviors for relieving the symptoms of their stress. The second difference is associated with thinking. People diagnosed with GAD usually worry about real-life issues such as finances, health, or relationships; on the contrary, mental impulses and thoughts that OCD patients experience extend beyond everyday problems since their obsessive thinking are less realistic in nature. It is important to conclude that the mentioned diagnoses can overlap; there are people who will meet the criteria for both psychiatric disorders. Moreover, treatment strategies for GAD and OCD can be helpful for the two problems, including cognitive behavioral therapy, lifestyle changes, and medication.
Hofmann, S., & Hinton, D. (2014). Cross-cultural aspects of anxiety disorders. Current Psychiatry Reports, 16(6), 450-469.
Lewis-Fernandez, R., Hinton, D., Laria, A., Patterson, E., Hofmann, S., Craske, M.,… Liao, B. (2010). Culture and the anxiety disorders: Recommendations for DSM-V. Depression and Anxiety, 27(2), 212-229.
Mayo Clinic Staff. (2014). Symptoms. Web.
NIH. (2005). Web.
Roche, R. (2015). Web.
Vesga-Lopez, O., Schneier, F., Wang, S., Heimberg, R., Liu, S-M., Hasin, D., & Blanco, C. (2008). Gender differences in generalized anxiety disorder: Results from the National epidemiologic survey on alcohol and related conditions (NESARC). The Journal of Clinical Psychiatry, 69(10), 1606-1616.