By David Joel Miller.
In Generalized Anxiety Disorder, everything is scary.
The key feature of Generalized Anxiety Disorder (GAD) is that in this disorder the worry-weed just keeps growing. Worry in GAD is all out of proportion. Clients with this problem worry the majority of their time. While you need to have been worrying for at least six months to get this diagnosis, most people with GAD have been worrying far longer. It is common to hear from someone with GAD that they have been worrying all their lives or that they can’t remember a time before they began worrying.
Generalized Anxiety Disorder is a relatively common disorder despite being very disabling for so many. In any given year here in the U. S., it is estimated 3 million people will receive this diagnosis. Cumulatively this amounts to between 27 and 35 million people who are estimated to be living with GAD.
Generalized Anxiety Disorder can begin at any age but many people first realized they were worriers or over-anxious in childhood or adolescence. There used to be a diagnosis for over-anxious children but that one got merged into the GAD diagnosis. While Generalized Anxiety Disorder can strike at any age and often stays with you, your whole life what people will worry about changes as you age.
Common worry themes in GAD are punctuality, natural disasters, being a victim of crime and the need to do things perfectly and be perfect. With all these worries it is common for someone with Generalized Anxiety Disorder to seek reassurance. If they adopt rituals to keep themselves safe it can be a short hop to OCD or a related disorder.
What separates GAD from other anxiety disorders is the length of the list of things you worry about. People with GAD worry about many things most or all the time, not simply a few things occasionally. Someone with Generalized Anxiety Disorder is frequently apprehensive about what might happen and they tend to expect the worse. The anxiety bully whispers in their ear (figuratively) that something bad is about to happen and over time they come to believe these thoughts.
In GAD it is not that they hear these thoughts, as in an auditory hallucination, but the thoughts can take on a life of their own and they start believing that if they think this thought it must be true. One characteristic of GAD is the loss of control over the worry. It happens whether you want or need to worry or not.
Physical symptoms are very common with mental illnesses. This does not mean things are just “in your head.” The increase in stress hormones results in physical signs and symptoms in the body. Adults will have at least three of the six symptoms below. Less than 3 probably mean that one or more of the other anxiety disorders would be a better fit for the problem than GAD. Here are the six physical and emotional problems, 3 of which should be present in GAD.
- Motor racing – Feeling keyed up or restless.
- Tired, worn-out or fatigued for no good reason.
- Mind goes blank, can’t focus or concentrate.
- Grouchy, irritable.
- Muscle tension.
- Poor sleep, reduced, disturbed or otherwise disrupted for no discernible reason.
Note that some of these symptoms are combinations of emotional and physical issues. This is why before giving someone a diagnosis a therapist always wants to be sure that you have recently seen a medical doctor and ruled out a medical condition. We also have to ask about drug and alcohol use, not because we want to pry, but because if you are doing drugs, especially stimulants, this may be causing or aggravating the anxiety.
An important consideration, for this to be Generalized Anxiety Disorder, is that the anxiety needs to be way out of proportion to the actual life risks. A significant part of your thinking brain will be used up on worry leaving less to use in actually living life.
Much of the worry in Generalized Anxiety Disorder can be directed towards what you “should be” doing as opposed to what you are actually doing. People with GAD are likely to have exaggerated startle responses. Most of us will jump if a gun goes off close by, or we probably should. Someone with GAD will jump when a car door slams on the next block.
If you or someone you know has symptoms of GAD, seek professional help. There are treatments that can reduce or eliminate the symptoms of Generalized Anxiety Disorder.
FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.
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