General Anxiety Disorder (GAD)

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Overview

Everyone experiences anxiety as a normal reaction to threatening, dangerous, uncertain, or important situations. Psychiatric medicine classifies anxiety as normal or pathological. Normal anxiety can enhance some people's function, motivation, and productivity, such as the person who works well under pressure. People with generalized anxiety disorder (GAD) experience pathological anxiety, which is excessive, chronic, and typically interferes with their ability to function in normal daily activities. Generalized or "free-floating" anxiety is distinguished from phobia because it is not triggered by a specific object or situation.

Incidence and Prevalence
GAD affects more than 6 million people in the United States. The chance that any given person in the United States will develop it over a lifetime is estimated at 8% to 9%. More than 10% of people seen in anxiety treatment clinics are diagnosed with GAD, which affects more women (60%) than men (40%).

Because perceptions and descriptions of anxiety differ among cultures, it is hard to assess the global prevalence of anxiety disorders. Many people in the United States who are diagnosed with GAD claim to have been nervous or anxious their whole lives. Eastern societies, on the other hand, perceive and treat anxiety differently, as something associated with pain.

Causes

GAD is associated with irregular levels of neurotransmitters in the brain. Neurotransmitters are chemicals that carry signals across nerve endings. Neurotransmitters that seem to involve anxiety include norepinephrine, GABA (gamma-aminobutyric acid), and serotonin.

Norepinephrine is concentrated in the locus ceruleus (nerve cluster that lies near the brain's fourth ventricle). Increased activity in the locus ceruleus is associated with anxiety, and decreased activity in the locus ceruleus diminishes anxiety. Increased levels of GABA and serotonin seem to reduce anxiety. All of these neurotransmitters interact during heightened anxiety.

The psychodynamic theory of psychology sees anxiety as an alerting mechanism that arises when our unconscious motivations clash with the constraints of our conscious mind. This conflict is intensified in people with GAD. Behavioral theory holds that anxiety results from not knowing how to behave in a given situation. The possibility of suffering negative consequences because of inappropriate behavior may result in hesitation and inaction. The anxiety may be generalized to similar situations. For example, anxiety over taking a particular test may be generalized to taking all tests in the future.

Risk Factors

There are biological and environmental risk factors for GAD, which include the following:

• Environmental stressors (e.g., work, school, relationships)
• Genetics
• Sleep deprivation, sleep inconsistency

Stressful situations in the following areas can intensify symptoms:

• Financial concerns
• Health
• Relationships
• School problems
• Work problems

Research has shown a 20% risk for GAD in blood relatives of people with the disorder and a 10% risk among relatives of people with depression. There also seems to be a correlation between GAD and other psychiatric disorders, including depression, phobia disorder, and panic disorder. Anxiety is a risk factor for sleep disorders such as insomnia.

General Anxiety Disorder (GAD) Resources

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