In generalized anxiety disorder, a person has frequent or nearly constant, nagging feelings of worry or anxiety. These feelings are either unusually intense or out of proportion to the real troubles and dangers of the person's everyday life.
The disorder is defined as persistent worry for more days than not, for at least several months. In some cases, a person with generalized anxiety disorder feels he or she has always been a worrier, even since childhood or adolescence. In other cases, the anxiety may be triggered by a crisis or a period of stress, such as a job loss, a family illness or the death of a relative. The crisis stress may have ended, but an unexplained feeling of anxiety may last months or years.
In addition to suffering from constant (or non-stop) worries and anxieties, people with generalized anxiety disorder may have low self-esteem or feel insecure because they see people's intentions or events in negative terms, or they experience them as intimidating or critical. Physical symptoms may lead them to seek treatment from a primary care doctor, cardiologist, pulmonary specialist or gastroenterologist. Stress can intensify the anxiety.
Experts believe that some people with this disorder have a genetic (inherited) tendency to develop it. The disorder probably stems from how a variety of brain structures communicate with each other as they manage the fear response. Chemical messengers, gamma aminobutyric acid (GABA) and serotonin, transmit signals along the circuits connecting brain regions. The medications used to treat anxiety affect these circuits.
About 3% to 8% of people in the United States have generalized anxiety disorder. Women have the problem twice as often as men. The average adult patient first seeks professional help between the ages of 20 and 30. However, the illness can occur at any age. Generalized anxiety disorder also has been diagnosed in young children, teenagers and elderly people. The illness is the most common anxiety disorder affecting people age 65 and older.
Of all psychiatric illnesses, generalized anxiety disorder is the least likely to occur alone. Between 50% and 90% of people with the disorder also have at least one other problem, usually panic disorder, a phobia, depression, dysthymia (a less severe form of depression), alcoholism or some other form of substance abuse.
In generalized anxiety disorder, the person has persistent worry or anxiety that lasts for at least several months. This worry or anxiety is excessive, troubling and hard to control. It often interferes with a person's ability to function at home, at work or in social situations.
Here are some of the other defining symptoms or behaviors common in the disorder:
People with generalized anxiety disorder also may have a wide range of anxiety-related physical symptoms that may seem like symptoms of heart disease, respiratory illness, digestive diseases and other medical illnesses.
You may consult a primary care doctor first if you suspect your physical symptoms are part of a medical illness. Your doctor may do tests to check for medical problems. If the results are normal, your doctor may ask about your family history, your history of any mental distress, current anxieties, recent stresses, and daily use of prescription and nonprescription drugs. Some drugs can cause anxiety symptoms. The doctor then may refer you to a psychiatrist for care.
A psychiatrist will diagnose generalized anxiety disorder based on a full psychiatric evaluation that includes:
Although the diagnosis of generalized anxiety disorder may be made after several months of symptoms, the condition can last years, especially without treatment. Many people experience the symptoms as part of a lifelong pattern.
Since stress is a normal part of life, there is usually no way to prevent generalized anxiety disorder in someone who is vulnerable. However, once diagnosed, various treatments can effectively reduce symptoms.
If you have generalized anxiety disorder, the most effective treatment is usually a combination of medications and psychotherapy. Research shows that using both has a more lasting positive effect than either one alone. Your doctor may also offer treatment for other conditions that may be making matters worse, such as a medical problem or depression.
You may need to try more than one approach before you find the right one. Many different kinds of medications can relieve anxiety. Here are the most common categories prescribed:
A number of psychotherapy techniques may be helpful. Here are some examples:
Your therapist may combine any of the above approaches or may discuss others -- for example, meditation, hypnosis or exercise -- with you so that the approach fits your specific problems and needs.
See your doctor if you are troubled by severe worry or anxiety, especially if:
In general, the outlook is good. With appropriate treatment, about 50% of patients improve within 3 weeks of starting treatment, and 77% improve within 9 months.
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