People who suffer from generalized anxiety disorder can be totally overwhelmed with fear and worry. In this lesson, we will explore GAD and learn about the possible causes and treatments of this mental disorder.
Generalized Anxiety Disorder: A Case Study
Tom is a welder at a paper mill where he has worked for over ten years. Every morning, he gets up early before his wife and kids, eats his breakfast, and heads to work. While he eats his breakfast, he tries to distract himself from worrying about the day ahead by reading the morning paper. Tom usually makes a brief stop at Go Nutz Doughnuts to get his only cup of coffee for the day. Today, Tom decides to skip the coffee. He has recently been having trouble sleeping and thinks that skipping the coffee might help his sleep. However, that evening Tom is not able to sleep at all. His wife agrees that he should make an appointment with their physician.
Tom tells his doctor that he has always been a natural worrier. He remembers being anxious as a child and at school. Tom's doctor finds out that his anxiety increased after he bought a house and started a family. Since then, he has been more anxious about his job security and has also found himself worrying about keeping up his house and car, his family's health, and his children's futures. Although he has never had a problem at work, Tom can't stop worrying about his job security and his family's finances. When the doctor asks him if he has tried seeking a better paying job, Tom responds that he couldn't handle the stress of more responsibility.
Tom's doctor finds that Tom has many other symptoms, including a host of physical symptoms. After interviewing Tom, the doctor takes a look at her notes summarizing all of Tom's symptoms.
- Persistent, excessive worry
- Trouble sleeping, difficulty falling or staying asleep, waking early in the morning
- Tense, restless and irritable, feeling on edge
- Difficulty enjoying free time
- Muscle tension and muscle aches
- Gastrointestinal discomfort, diarrhea, nausea
- Frequently feeling out of breath
- Difficulty swallowing
- Frequent urination
- Easily startled
After running a few tests, the doctor believes that Tom has generalized anxiety disorder, or GAD. She knows that generalized anxiety disorder is characterized by excessive anxiety and worry that interferes with normal functioning. Tom has had these symptoms for well over six months, which meets the old DSM-IV-TR criterion for diagnosis. The doctor is aware that the new DSM-V diagnostic criterion requires only three months of symptoms for diagnosis.
Tom's doctor provides him with information on GAD, as well as a referral to a psychiatrist and a psychotherapist. Tom is worried about his new diagnosis and what people will think. He is surprised to learn that the lifetime prevalence of GAD is about six percent. This means that more than one out of every 20 people will experience GAD in their lifetimes.
What Causes GAD?
Why does Tom suffer from generalized anxiety disorder? Why do certain people develop this disorder while others do not? Biologists and psychologists continue to research anxiety disorders like this one to find these answers and develop better treatments. Unfortunately, as with many mental disorders, it is impossible to point to one specific cause of GAD. A mix of factors, including biological, psychological, and social factors, all play a role.
Research has shown that people who have anxiety disorder sufferers in their family are more likely to develop an anxiety disorder, such as GAD. Although we may think of anxiety as a psychological state, anxiety disorders have distinct roots in the nervous system. For example, deficits in GABA, the primary inhibitory neurotransmitter in the central nervous system, have been found to be directly related to anxiety levels and GAD. Drugs that increase the availability of GABA generally have calming effects.
Psychological stressors also have their place in the development of generalized anxiety disorder. Research has found that many people who develop GAD have had a serious trauma in their past, likely involving death, major illness, injury, or abuse. Increased experience of major life hardships can increase the risk of developing anxiety disorders, such as GAD. Often, people with GAD seek treatment after such an event.
GAD is diagnosed nearly twice as often in women as in men and appears to occur more frequently in those of lower socioeconomic status. Scientists have found that people who experienced childhood abuse have a four times greater risk of developing GAD. Psychologists then studied the cognitive (thought) patterns of these individuals and found that the anxiety and worry of GAD may help them avoid more difficult emotions, such as thoughts about their abuse.
Often people turn to drugs and alcohol as a quick relief to the symptoms of stress, but this can be counterproductive. Long-term alcohol abuse, as seen in alcoholism, can lead to substance-induced GAD. The body can quickly become dependent on depressants, such as alcohol and benzodiazepines, simulating GAD during withdrawal. Conversely, abuse of or dependence on stimulants, such as caffeine, can make GAD symptoms worse.
Treatment of GAD
Now, let's see how Tom is doing with his GAD treatment. Tom has been receiving treatment for generalized anxiety disorder for a few months. He sees a psychotherapist who specializes in cognitive-behavioral therapy. This means that the therapist has had specific training in therapy that focuses on correcting maladaptive thought processes and behaviors. The therapist is helping Tom restructure his worrisome thoughts. He has also used relaxation training with Tom to teach him to control and lessen his physical symptoms of anxiety.
Tom has also been given prescriptions by his psychiatrist. Tom was prescribed a benzodiazepine to help keep him calm as well as an antidepressant. Antidepressants are best known for treating depression, but they have been found to be very effective in treating anxiety symptoms as well. Many doctors now prefer to prescribe antidepressants for anxiety disorders because they tend to have fewer side effects than benzodiazepines.
In this lesson, we watched Tom dealing with an anxiety disorder called generalized anxiety disorder, or GAD. His life had become full of fear and worry. Tom had been experiencing tension, irritability, fatigue, and stomach upset for many years, which had recently been getting worse. Tom began to have trouble sleeping, which prompted him to see a doctor.
Research on GAD has helped us understand that it is caused by a number of combined factors. Biological factors include heredity and, commonly, a deficiency in the GABA system. Psychological factors include differences in thought patterns.
GAD sufferers may subconsciously worry about minor things to avoid thinking about past traumas. People who experience life traumas, such as illness, injury, and death, tend to be at an increased risk for GAD. A strong correlation has been found between childhood abuse and the development of GAD. Tom's symptoms have significantly improved through a combination of cognitive-behavioral therapy and the use of antidepressants, and benzodiazepines.
After watching this lesson, you should be able to:
- Define generalized anxiety disorder (GAD)
- Identify and explain causes and treatments for GAD