general anxiety disorder Archives - Suzanne Wallach

Generalized anxiety disorder (GAD) is listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a mental illness. Mental Health America explains that GAD “is characterized by six months or more of chronic, exaggerated worry and tension that is unfounded or much more severe than the normal anxiety most people experience.” The diagnosis process for GAD typically begins with undergoing a physical exam along with complete medical history. There is currently no laboratory test or scans used to detect or diagnose a generalized anxiety disorder. There are, however, some tests (e.g., blood tests) that could be used in the diagnosis process to check for any other underlying conditions that may be causing symptoms. 

If no signs of physical illness are determined, the process continues with an additional assessment conducted by a mental health professional that specializes in diagnosing and treating mental illnesses (e.g., psychiatrist, psychologist, etc.). The American Family Physician explains that diagnosing GAD “requires a broad differential and caution to identify confounding variables and comorbid conditions.” Generalized anxiety disorder is known as a differential diagnosis. A differential diagnosis implies that there are other possible diagnoses, and requires the diagnostician to differentiate between these possibilities to determine the actual diagnosis and appropriate treatment plan. The mental health professional will ask in-depth questions about one’s reported symptoms (e.g., how long they last, how intense they are, etc.), how the symptoms interfere with one’s daily life, will make observations of one’s attitude and behavior, and may use psychological questionnaires such as the Hamilton test or the GAD-7 screening tool to help determine a diagnosis.

DSM-5 Diagnostic Criteria

The DSM-5 outlines specific criteria to help professionals diagnose a generalized anxiety disorder. When assessing for GAD, clinical professionals are looking for the following, provided by the Anxiety and Depression Association of America:

1. The presence of excessive anxiety and worry about a variety of topics, events, or activities that presents more frequently than not for at least six months.
2. The worry is experienced as very challenging to control. The worry in both adults and children may easily shift from one topic to another.
3. The anxiety and worry are accompanied by at least three of the following physical or cognitive symptoms:
   1. Edginess or restlessness
   2. Tiring easily; more fatigued than usual
   3. Impaired concentration or feeling as though the mind goes blank
   4. Irritability (which may or may not be observable to others)
   5. Increased muscle aches or soreness
   6. Difficulty sleeping (due to trouble falling asleep or staying asleep, restlessness at night, or unsatisfying sleep)

These symptoms must be unrelated to any other medical conditions and cannot be explained by a different mental disorder or by the effect of substance use, including prescription medication, alcohol, or recreational drugs. The diagnostic criteria are somewhat different for adults and children. An adult is diagnosed with a generalized anxiety disorder when at least three of the above symptoms persist for a minimum of six months. In younger people, however, only one symptom is needed for diagnosis, provided it has been exhibited somewhat regularly, spanning over a period of six months. The above criteria differentiate GAD from normal bouts of anxiety and/ or worry that may manifest from a specific set of stressors or for a more limited period.

The information above is provided for the use of informational purposes only. The above content is not to be substituted for professional advice, diagnosis, or treatment, as in no way is it intended as an attempt to practice medicine, give specific medical advice, including, without limitation, advice concerning the topic of mental health. As such, please do not use any material provided above to disregard professional advice or delay seeking treatment.

Generalized anxiety disorder (GAD) is listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a chronic, mental health disorder. GAD is characterized by severe ongoing anxiety and exaggerated worry and tension (even when there is little or nothing to provoke it) that interferes with daily activities. According to the DSM-5 diagnostic criteria, a diagnosis of GAD currently implies chronic, excessive worry lasting at least six months and presenting with three of the possible six somatic or psychological symptoms (restlessness, fatigue, muscle tension, irritability, difficulty concentrating, and sleep disturbance). When posed with the question: What is the most effective antidepressant for an individual diagnosed with GAD? There is no universal answer, as the efficacy of each type of antidepressant medication will depend on each person’s distinct needs. 

Types of Medications for GAD

There are several types of antidepressant medications used to treat GAD, each with respective risks, benefits, and appropriate uses. The Mayo Clinic provides the following breakdown of the various options: 

• Selective serotonin reuptake inhibitors (SSRIs): work by slowing the reabsorption of serotonin (the neurotransmitter known to help with mood regulation and anxiety) in one’s brain. Common examples of SSRIs that may be used to treat GAD include, but are not limited to:
  • Celexa (citalopram)
  • Lexapro (escitalopram)
  • Prozac (fluoxetine)
  • Zoloft (sertraline)
• Selective norepinephrine reuptake inhibitors (SNRIs): work by reducing the reabsorption of serotonin and norepinephrine in one’s brain. They can be prescribed to treat anxiety, depression, and some chronic pain conditions. Common examples of SNRIs that may be used to treat GAD include:
  • Cymbalta (duloxetine)
  • Effexor XR (venlafaxine)
• Tricyclic antidepressants (TCAs): are prescribed less frequently as they are an older class of antidepressants that can cause more side effects than other options. Some examples of TCAs that may be used to treat GAD include:
  • Tofranil (imipramine)
  • Elavil (amitriptyline)
  • Pamelor (nortriptyline) 
• Benzodiazepines: a type of sedative that alleviates muscle tension and can reduce some of the physical symptoms of anxiety. They are often prescribed to help manage symptoms associated with short-term anxiety. Common examples of benzodiazepines that may be used to treat GAD include:
  • Xanax (alprazolam)
  • Valium (diazepam)
  • Librium (chlordiazepoxide)
  • Ativan (lorazepam)

There are a variety of treatment options for individuals diagnosed with generalized anxiety disorder. As is true with taking any type of medication there are associated risks. The specific risks will vary from person to person, as they will depend on several contributing factors (e.g., the individual’s health history, the presence of any additional mental health ailments, substance abuse issues, genetics, etc.). The Food and Drug Administration (FDA) requires antidepressant medications to clearly display a black box warning label indicating the possibility of increased suicidal thoughts and behaviors when taken by some individuals under the age of 25. Not all medications will work for every person, but given the array of options, there is typically at least one antidepressant that can effectively reduce one’s symptoms associated with generalized anxiety disorder.

The information above is provided for the use of informational purposes only. The above content is not to be substituted for professional advice, diagnosis, or treatment, as in no way is it intended as an attempt to practice medicine, give specific medical advice, including, without limitation, advice concerning the topic of mental health. As such, please do not use any material provided above to disregard professional advice or delay seeking treatment.

Generalized anxiety disorder (GAD) is listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a mental illness and is characterized by “chronic anxiety, exaggerated worry, and tension, even when there is little or nothing to provoke it.” Perelman School of Medicine at the University of Pennsylvania asserts that the median age of onset of GAD is 30 years, although “a very broad range exists for the spread of age at the time of onset. Patients reporting a later onset of their GAD typically will say their symptoms developed in response to a significantly stressful event in their lives.” Johns Hopkins Medicine suggests that GAD can be triggered by situational circumstances such as family or environmental stress, chronic illness, or disease. Generalized anxiety disorder is not uncommon, and in any given year, GAD affects 6.8 million adults, which is equal to 3.1% of the U.S. population. The prevalence of GAD in children and adolescents ranges from 2.9% to 4.6%. GAD develops gradually and can begin at any age, but the years of highest risk are between childhood and middle age.

Signs and Symptoms

Generalized anxiety disorder can manifest as psychological symptoms, behavioral symptoms, and physical symptoms. Common examples of GAD symptoms may include any combination of the following:

• Psychological symptoms:
  • Nervousness
  • Irritability
  • Nightmares 
  • A pervasive feeling of apprehension or dread
  • Intrusive thoughts 
  • Feeling edgy, restless, or jumpy
  • An inability to tolerate uncertainty
• Behavioral symptoms:
  • Sleep disturbances
  • Ritualistic behaviors (e.g., repeatedly washing hands)
  • Inability to relax
  • Difficulty concentrating
  • Procrastinating 
  • Avoiding potentially anxiety-ridden situations
• Physical symptoms:
  • Muscle tightness
  • Body aches
  • Fatigue
  • Sweating
  • Heart palpitations
  • Dry mouth
  • Cold or sweaty hands
  • Trembling
  • Shortness of breath
  • Nausea
  • Diarrhea 
  • Chronic headaches

Every individual is different, and the symptoms associated with GAD can vary in severity and duration and will be distinct to each person. 

Causes and Risk Factors

To conclusively understand the precise cause of generalized anxiety disorder, additional research is required, however, clinical findings do point to a combination of biological, environmental, and psychological factors contributing to its development. Risk factors that may increase an individual’s propensity for developing generalized anxiety disorder could include both environmental and genetic factors, such as the following, provided by Healthline: 

• Family history of anxiety disorders
• Recent or prolonged exposure to stressful situations, including personal or family illnesses
• Excessive use of caffeine or tobacco can exacerbate existing anxiety
• Childhood abuse or bullying
• Certain health conditions such as thyroid problems or heart arrhythmias

The University of Rochester Medical Center asserts that an imbalance of two chemicals in the brain (norepinephrine and serotonin) most likely plays a part in the development of GAD. Experts suggest that “those living with GAD may experience certain activation in areas of the brain associated with mental activity and introspective thinking when they encounter situations that could cause worry.” According to Winchester Hospital, it is not uncommon for other anxiety disorders to co-occur in a person with generalized anxiety disorder. 

The information above is provided for the use of informational purposes only. The above content is not to be substituted for professional advice, diagnosis, or treatment, as in no way is it intended as an attempt to practice medicine, give specific medical advice, including, without limitation, advice concerning the topic of mental health. As such, please do not use any material provided above to disregard professional advice or delay seeking treatment.