Generalized Anxiety Disorder: Description
Generalized Anxiety Disorder is characterized by the fact that the affected person is haunted by worries most of the day. For example, they are afraid of illness, accidents, being late or not being able to cope with work. The negative thoughts build up. Those affected replay the feared scenarios in their heads again and again without finding a solution to the problem.
The constant tension also affects the body – physical complaints are therefore part of the appearance of Generalized Anxiety Disorder.
How common is Generalized Anxiety Disorder?
Anxiety disorders in general are among the most common mental illnesses. According to international studies, the risk of developing an anxiety disorder in the course of a lifetime (lifetime prevalence) is between 14 and 29 percent.
The disease usually appears in adulthood. Women are affected more often than men.
Generalized anxiety disorder rarely occurs alone
People with anxiety disorders often also have an increased risk of suicide.
Generalized anxiety disorder: symptoms
Generalized anxiety usually relates to everyday things. Everyone is familiar with worry and fear of negative events that may occur in the future.
Worry about worry
The constant worrying can eventually become so rampant in Generalized Anxiety Disorder that sufferers develop a fear of the worries themselves. They fear that they could harm them, for example in terms of their health. This is then referred to as “meta-worries”.
Physical symptoms
A very characteristic feature of Generalized Anxiety Disorder is the physical symptoms. These can vary greatly. For example, patients often suffer from:
- trembling
- Muscle tension
- gastrointestinal problems such as nausea, diarrhea
- Heart palpitations
- Dizziness
- Sleep disturbances
- Concentration problems
- nervousness
- irritability
Avoidance and reassurance
People with Generalized Anxiety Disorder try to reduce their worries by, for example, contacting family members in heaps to hear that they are okay. They often seek reassurance from others that everything is fine and that they have nothing to worry about. Some sufferers also avoid hearing news to protect themselves from further anxiety.
Generalized Anxiety Disorder: Difference from Depression
People who suffer from depression have similar negative thoughts as patients with Generalized Anxiety Disorder. Unlike depression, however, worries in Generalized Anxiety Disorder are directed toward the future. In depression, thoughts tend to revolve around past events.
Generalized Anxiety Disorder: Causes and Risk Factors
However, experts believe that they are not solely responsible if someone develops a (generalized) anxiety disorder. Rather, it is the interaction of genetic “susceptibility” and other factors or mechanisms that is thought to cause an anxiety disorder to develop. The following possible influences are discussed:
Psychosocial factors
Parenting style
The parenting style of parents may also have an impact on whether offspring develop pathological anxiety. For example, children of overprotective parents show higher levels of anxiety.
Socioeconomic factors
In both cases, however, it is unclear whether the observed relationship is causal in nature – that is, whether unemployment, for example, actually increases the risk for anxiety disorders.
Learning theory explanations
There are also learning theory models as a possible explanation for the development of anxiety disorders. Such models assume that anxiety develops as a faulty learning process:
Other mechanisms may also contribute, such as trying to suppress the worrying thoughts.
Psychodynamic explanations
Some experts believe that conflicts that arose early in life cause the symptoms of an anxiety disorder when they lead to inappropriate (neurotic) attempts at resolution.
Neurobiology
Neurotransmitters are apparently also involved in anxiety disorders. In this respect, anxiety patients show numerous differences compared to healthy controls, as studies have shown.
Generalized Anxiety Disorder: Examinations and Diagnosis
Very often, people with generalized anxiety disorder turn to a general practitioner. However, the reason is usually not the stressful, persistent anxiety – rather, most seek help because of physical complaints that accompany the anxiety disorder (e.g., sleep disturbances, headaches or abdominal pain). Since patients rarely report their anxiety as well, many general practitioners overlook the psychological causes.
Detailed conversation
Your doctor can refer you to a psychosomatic clinic or a psychotherapist. The therapist can talk with you to get to the bottom of your stressful complaints in more detail. Special questionnaires can be helpful in this process. For example, the therapist may ask you the following:
- How often have you felt nervous or tense lately?
- Do you often feel restless and unable to sit still?
- Are you often afraid that something bad might happen?
Diagnosis according to ICD-10
According to the International Classification of Diseases and Related Health Problems (ICD-10), Generalized Anxiety Disorder is present when the following criteria are met:
There has been tension, apprehension, and fear about everyday events and problems for at least six months, with the following findings:
- symptoms in the area of the chest or abdomen (difficulty breathing, feelings of anxiety, pain in the chest, abdominal discomfort)
- psychological symptoms (dizziness, feeling of unreality, fear of losing control, fear of dying)
- general symptoms (hot flushes or cold shivers, paraesthesia)
- symptoms of tension (tense muscles, restlessness, feeling of lump in throat)
In addition, those affected are constantly worried, for example that they themselves or people close to them could suffer an accident or fall ill. If possible, they avoid activities that they perceive as dangerous. In addition, as described above, they worry about their constant worries (“meta-worries”).
Exclusion of other causes
- Lung diseases such as asthma or COPD
- cardiovascular diseases such as chest tightness (angina pectoris), heart attack or cardiac arrhythmia
- Neurological diseases such as migraine, multiple sclerosis
- hormonal disorders such as hypoglycemia, hyperthyroidism, excess potassium or calcium, or acute intermittent porphyria
- other clinical pictures such as benign paroxysmal positional vertigo (benign paroxysmal positional vertigo)
If necessary, further examinations may be useful, including, for example, a test of the lung function and/or imaging of the skull (by means of magnetic resonance imaging or computer tomography).
Generalized anxiety disorder: treatment
However, when people with generalized anxiety disorder undergo therapy, anxiety symptoms can be identified and reduced. As a result, those affected gain quality of life and are often able to participate in professional and social life again.
Generalized anxiety disorder can be treated with psychotherapy and medication. When planning the therapy, physicians also take into account the wishes of the affected person, if possible.
Generalized anxiety disorder: psychotherapy
Experts primarily recommend cognitive behavioral therapy (CBT) as a form of therapy. To bridge the gap until the start of CBT or as an adjunct, a CBT-based Internet intervention is an option.
A possible alternative to Cognitive Behavioral Therapy is psychodynamic psychotherapy. It is used when KVT does not work, is not available, or the anxiety patient prefers this form of therapy.
Cognitive Behavioral Therapy
The worries reinforce each other and become stronger and stronger. People with generalized anxiety disorder also search for reasons for their worries. An important starting point is therefore to divert attention away from negative stimuli. The patient learns to question these and replace them with realistic thoughts.
KVT-based Internet Intervention
The KVT-based Internet intervention is not suitable as the sole treatment for Generalized Anxiety Disorder. However, it can provide self-help guidance until sufferers can start Cognitive Behavioral Therapy with their therapist. It can also support therapeutic treatment.
Psychodynamic therapy
The duration of outpatient therapy depends on the severity of the generalized anxiety disorder, any concomitant disorders (such as depression, addiction) and psychosocial conditions (e.g. family support, work situation).
Generalized anxiety disorder: medication
The following agents are primarily recommended for medication treatment:
- Selective serotonin-norepinephrine reuptake inhibitors (SNRIs): Venlafaxine and duloxetine are suitable for treatment. They prolong the effect of the neurotransmitters serotonin and norepinephrine.
If necessary, pregabalin can also be used for generalized anxiety disorder. It belongs to the group of drugs called antiepileptics.
Sometimes people with Generalized Anxiety Disorder are also given other medications – for example, opipramol, if SSRIs or SNRIs do not work or are not tolerated.
The effect of the medication does not kick in until a few weeks after the patient starts taking it. As soon as the treatment is effective and the patient’s symptoms improve, the drug treatment should be continued for at least another six to twelve months. This is to prevent relapses.
In some cases, longer use of the medication is necessary – for example, if the generalized anxiety disorder is particularly severe or the anxiety symptoms return after the medication is discontinued.
Generalized anxiety disorder: What you can do yourself
If you have Generalized Anxiety Disorder, there is a lot you can do to support medical treatment and do a lot yourself to better manage the distressing symptoms of anxiety and the circling thoughts.
Relaxation techniques
Treatment with medicinal plants (phytotherapy)
Against symptoms such as tension, nervousness and sleep disorders, herbal medicine (phytotherapy) offers various treatment options. For example, they have a calming, relaxing and sleep-promoting effect:
Ready-made preparations from the pharmacy
Medicinal plants as tea
You can also use medicinal plants such as passionflower, lavender & Co. for tea preparations. Here, too, medicinal teas from the pharmacy offer a controlled amount of active ingredient: They also belong to the phytopharmaceuticals and are available in tea bags or in loose form.
Medicinal tea mixtures such as a calming tea made from passionflower, lemon balm and other medicinal plants are also practical.
If you are taking other medications, discuss the use of herbal preparations with your doctor or pharmacist. He or she can advise you on choosing an appropriate preparation and assess possible interactions between your medications.
Lifestyle
Exercise, by the way, is generally advisable because it reduces stress hormones – in fact, during stress (and anxiety is nothing else for the body), larger amounts of these hormones are released. So be physically active!
Generalized anxiety disorder: course of the disease and prognosis
Generalized anxiety disorder often runs a chronic course. The earlier the disease is treated, the better the chances of recovery. However, the prognosis is worse than for other anxiety disorders.
What can friends and relatives do?
When someone suffers from generalized anxiety disorder, partners, relatives and friends are usually affected and involved in the worries. They often try to reassure the affected person (“No, nothing will happen to me!”). At best, this can help them in the short term, but it does not really take away their worries.
It is better for relatives and friends of people with generalized anxiety disorder to seek help and advice when needed, for example from self-help groups and counseling centers. Information on this is provided by “psychenet – mental health network” at: www.psychenet.de.