Generalized Anxiety Disorder (GAD): Signs, Symptoms, and DSM-5 Criteria

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Dr. Alexander Sidawi

Dr. Sidawi is an Orlando based, UF trained physician who is happy to be serving the community he grew up in by offering a combination of psychiatric medication management and psychodynamic psychotherapy.

What is Generalized Anxiety Disorder (GAD)?

Generalized Anxiety Disorder (GAD) is a psychological condition where a person experiences extensive and overwhelming worry about everyday life events. Unlike the typical anxiety that comes and goes with stress, GAD entails a deep-rooted and excessive nervousness, influencing one’s everyday functioning both from a physical and mental standpoint. This article examines the defining features and symptoms of GAD, reviews the diagnostic standards as per the DSM-5, and shares some knowledge on the epidemiology of GAD.

Persistent Concern

Generalized Anxiety Disorder (GAD) is typified by a pattern of relentless, heightened worry that dominates a person’s mindset for most days during a span of at least six months. Those living with GAD find themselves in a perpetual state of concern, often overestimating dangers and anticipating worst-case scenarios, even in the absence of clear reasons for worry. This condition can be all-consuming, infiltrating numerous facets of daily life.

Common causes for concern in those with GAD include:

  1. Worrying about making mistakes or not being good enough in personal or professional settings.
  2. Concerns over health and fears of undiagnosed illnesses.
  3. Anxiety about finances, such as going into debt or not having enough money for future needs.
  4. Fear of negative evaluation or disapproval by others.
  5. Apprehension about the well-being of loved ones or fear of something bad happening to them.
  6. Concerns about global issues or catastrophes, such as natural disasters or political unrest.
  7. Anxiety about routine daily activities and responsibilities becoming overwhelming.
  8. Worrying excessively about punctuality or time management.
  9. Fear of losing control or the inability to cope with potential challenges.
  10. Concerns about the future and uncertainty about what it holds.

Emotional and Bodily Reactions – A Vicious Cycle

Generalized Anxiety Disorder (GAD) is not solely a condition of the mind; it has a profound physical component as well. The psychological turmoil experienced by those with GAD often gives rise to a host of physical symptoms that can be as debilitating as the anxiety itself. A pervasive sense of restlessness can take hold, leaving individuals feeling unable to stay calm or stationary. They might be prone to agitation, with an ever-present sensation of being on edge, as if bracing for some imminent but undefined threat.

This heightened state of alertness can drain the body’s reserves, leading to pronounced fatigue. Despite feeling exhausted, individuals with GAD may find themselves unable to engage in the kind of deep, restorative sleep necessary for physical and mental recovery. Instead, their sleep may be fitful and unsatisfying, plagued by restlessness and frequent awakenings, often due to racing thoughts or worries that invade their dreams.

The physiological impact of GAD extends to muscle tension, which can be chronic and pervasive, leading to pain and discomfort that further compounds the individual’s distress. Some may experience tremors or an unsettling shakiness, which can interfere with daily activities and exacerbate feelings of vulnerability. Excessive sweating can occur, even in the absence of high temperatures or physical exertion, as the body remains in a state of hyperarousal. Gastrointestinal disturbances are also common, including nausea, diarrhea, and a churning sensation in the stomach, which can be distressing and may deter individuals from eating or participating in social meals.

These physical manifestations of GAD underscore the disorder’s capacity to affect the entire body. It can result in a vicious cycle where physical symptoms amplify anxiety, which in turn, exacerbates the physical symptoms, creating a challenging pattern that can significantly impair one’s quality of life and overall functioning.

DSM-5 Criteria for Generalized Anxiety Disorder

Generalized Anxiety Disorder (GAD) is diagnosed when the following conditions are met, according to the DSM-5:

  1. Excessive anxiety and worry about various events or activities, occurring more days than not for at least six months.

  2. Difficulty controlling the worry.

  3. The anxiety and worry are associated with at least three of the following symptoms (only one is required for children):

    1. Restlessness or feeling on edge.

    2. Fatigue.

    3. Difficulty concentrating or mind going blank.

    4. Irritability.

    5. Muscle tension.

    6. Sleep disturbances.

  4. The anxiety, worry, or physical symptoms cause significant distress or impairment in daily life.

Epidemiology of Generalized Anxiety Disorder

  1. Lifetime Prevalence: Generalized Anxiety Disorder affects a considerable portion of the population. Studies estimate the lifetime prevalence of GAD to be between 6 to 9%, making it one of the most prevalent anxiety disorders.

  2. Age Distribution: GAD shows a bimodal distribution in terms of age prevalence. The first peak occurs in young adulthood, with prevalence rates rising around age 20. The second peak emerges later in life, around age 40. This suggests that GAD may affect individuals at different life stages, with unique stressors and challenges influencing the disorder’s onset.

  3. Age of Onset: The median age of onset for GAD is around 30 years old, making it a condition that often begins in early adulthood. However, GAD can develop at any age, and the age of onset may vary based on individual factors and life circumstances.

Treatment for Generalized Anxiety Disorder

Treatment for Generalized Anxiety Disorder usually includes medications and/or talk therapy. When it comes to pharmacological treatments, a range of medications are available, each medication’s use considered on a case by case basis depending on the patient. Antidepressants, a primary therapeutic option, encompass well-known drugs like Prozac (fluoxetine), Zoloft (sertraline), Lexapro (escitalopram), Cymbalta (duloxetine), and Effexor (venlafaxine). 

These medications often help by modulating neurotransmitters associated with anxiety and mood regulation. Buspar (buspirone) offers another avenue of treatment, particularly for those who may not respond to or tolerate the direct serotonergic agents. In situations where rapid symptom relief is necessary, benzodiazepines such as Ativan (lorazepam), Valium (diazepam), and Klonopin (clonazepam) may be employed. However, these are typically reserved for short-term usage due to risks associated with long-term use, such as tolerance and dependency.

Beyond medication, psychotherapy provides a robust framework for addressing GAD. Cognitive Behavioral Therapy (CBT) is often the first-line psychotherapeutic approach, helping individuals to identify and reframe anxiety-provoking thoughts, fostering more adaptive coping mechanisms. Acceptance and Commitment Therapy (ACT) encourages patients to embrace their thoughts and feelings rather than fighting or feeling guilty for them. Mindfulness therapy, which can include practices such as meditation and breathing exercises, aims to center individuals in the present moment, reducing the tendency to ruminate on past or future worries.

In addressing the treatment of Generalized Anxiety Disorder (GAD), it is crucial to consider differential diagnoses due to symptom overlap with other psychiatric conditions. Social Anxiety Disorder, for instance, shares GAD’s pervasive worry but is specific to social situations. Obsessive-Compulsive Disorder (OCD) can mimic GAD’s persistent concerns, yet it’s characterized by compulsions and obsessions. Avoidant Personality Disorder also features anxiety, particularly about rejection, leading to avoidance behaviors. Each overlapping condition necessitates a tailored treatment approach, often involving a combination of medication and psychotherapy. 

Accurate diagnosis is essential, as it informs the direction of treatment, whether it’s the exposure therapy commonly used in Social Anxiety Disorder, the targeted behavioral interventions in OCD, or the self-esteem enhancing techniques in Avoidant Personality Disorder. Consulting with a mental health professional skilled in differentiating these disorders is a critical step towards effective management and improved quality of life for those affected.