Evidenced-based Treatment in Seattle

Generalized Anxiety Disorder

Do you often worry about things that are unlikely to happen? If so, you might meet criteria for Generalized Anxiety Disorder (GAD).

Generalized anxiety disorder is a common psychiatric condition. Population studies have found a lifetime prevalence of generalized anxiety disorder of 5.0%-5.7%.  Generalized anxiety disorder is more common in women and it is a common psychiatric disorder in the elderly.

People who have generalized anxiety disorder often have personality traits of chronic worry, difficulty recovering from emotional distress, emotional hyperactivity and intensity, hypersensitivity, and hypervigilance.

There are numerous symptoms of GAD that can be exhibited by individuals. However, these are the most common problems:

  • You worry to the point you stress out frequently
  • You worry to the point you disrupt your lifestyle
  • You have panic attacks when you worry about certain things
  • You feel that worrying is out of your hands and there’s no way of stopping it
  • You are very anxious to know what’s going to happen in the future, you have little to no patience
  • You have difficulty sleeping
  • You may experience sweating or nausea
  • You are easily irritated

Generalized anxiety disorder is typically a chronic disease and most patients experience fluctuations in the severity of symptoms. Complete and lasting remission can occur but the incidence of lasting remission is not high and for many patients who do have remission, some levels of anxiety remain.

Unfortunately, many patients who have generalized anxiety disorder do not respond to therapy. The consequences of generalized anxiety disorder can be serious. It is associated with significant functional impairment.  It is also associated with an increased risk for depression and cardiovascular disease. It also has been associated with an increased incidence of suicidal ideation and suicide attempts and has a significant negative effect on a person’s quality of life.

Medications such as SSRIs, SNRIs, Mirtazapine, Buspar, and benzodiazepines as needed are often helpful for anxiety symptoms.

Psychotherapy, also referred to as talk therapy, consists of finding the root of what’s causing you to exhibit symptoms of GAD. A common type of psychotherapy is cognitive behavioral therapy, which teaches you how to change specific thoughts patterns and behaviors that perpetuate your symptoms. This therapy helps you get rid of negative thoughts that may trigger symptoms of GAD.

Causes of Generalized Anxiety Disorder

The cause of generalized anxiety disorder is complex and not completely understood. Risk factors for generalized anxiety disorder are

Depression
Family history of psychiatric disorders
Financial strain
Female gender
Poor parenting
Negative life events
Physical ailments/disabilities

Genetic
Twin studies and other genetic research indicate that generalized anxiety disorder is moderately heritable, but the genetic influences have not been clearly identified.

Biological
There is data and research that suggest that brain function and brain metabolism are significantly different in patients who have generalized anxiety disorder.

Environmental
Environmental influences are clearly associated with the development of generalized anxiety disorder, i.e., stressful life events, poor parenting, and physical ailments and disabilities.

Diagnostic Criteria

The American Psychiatric Association’s diagnostic criteria for Generalized Anxiety Disorder, located in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5):
A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

  1.  Restlessness, feeling keyed up or on edge.
  2. Being easily fatigued.
  3. Difficulty concentrating or mind going blank.
  4. Irritability.
  5. Muscle tension.
  6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder [social phobia], contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder)

Anxiety Medications

Selective Serotonin Re-Uptake Inhibitors (SSRIs)
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Fluvoxamine (Luvox)
Paroxetine (Paxil)
Sertraline (Zoloft)
Vilazodone (Viibryd)

Serotonin-Norepinephrine Re-Uptake Inhibitors (SNRIs)
Desvenlafaxine (Pristiq)
Duloxetine (Cymbalta)
Milnacipran (Ixel)
Venlafaxine (Effexor)

Anxiolytics
Buspirone (Buspar)
Mirtazapine (Remeron)

Benzodiazepines

Books for Anxiety