Think! You’ve got a huge presentation in front of all your colleagues; you’re nervous, and you’ve got quite a bit of stress leading up to the presentation. That stress is completely normal and really — probably useful in certain situations since it can make you more alert and careful. After the presentations are over you feel the stress start to fade away, right?
Well...for 3% of the population, the
stress doesn’t go away, and maybe that stress isn’t even brought on by a
specific event and is always just sort of always there. Either way, at this
point it’s considered to be anxiety. That anxiety might even get worse over
time and causes things like chest pains or nightmares. Sometimes the anxiety’s
so severe that it causes someone to be anxious about leaving the house or doing
everyday things, like going to work or school. This anxiety may be a sign of Generalized
Anxiety Disorder, sometimes shortened to GAD.
GAD’s characterized by excessive, persistent, and unreasonable anxiety about everyday things, like money, family, work, and relationships; even sometimes the thought of getting through the day causes anxiety. If the anxiety’s persistent, then it doesn’t seem to go away, if it’s excessive, it’s usually more than someone else might feel, and if it’s unreasonable, they probably shouldn’t have a reason to feel anxious about it. People who have GAD might even understand that their anxieties are excessive and unreasonable, but they feel it’s out of their control and doesn’t quite know how to stop it. People with severe GAD might be completely debilitated and have trouble with the simplest daily activities, or they might be only mildly affected and be able to function socially and hold down a job.
Sometimes the feelings might worsen
or improve over time. In addition to having feelings of worries and anxiety,
other symptoms include edginess and restlessness, difficulty concentrating or
feeling like the mind just goes blank, and also irritability. These
psychological symptoms can also lead to physical manifestations of symptoms
like digestive problems from eating more or eating less. They might also have
muscle aches and soreness from carrying tension in their muscles. Finally, difficulty sleeping is a really common symptom that can have a serious impact
on physical well-being, since the body’s not resting and can lead to issues of
chronic fatigue.
Although the decision that someone’s
worry is excessive and unreasonable has a subjective quality, diagnosing GAD is
aided by the diagnostic and statistical manual of mental disorders, or DSM-V,
this manual gives a list of criteria to meet in order to be diagnosed with GAD.
First, the excessive worry and anxiety have to have been present for more
days than not over the course of 6 months. In other words, a person should have
the symptoms of excess or unreasonable worry on 90 or more days out of 180days.
Generally, people can’t quantify or track their feelings in that way, so again,
this is meant to offer a general guideline, right? Okay second—the person
finds it hard to control their anxiety, meaning that they have a hard time
calming themselves or “self-soothing” to help them regain control over their feelings.
Third, an adult must have three or more of the symptoms listed
previously. In children though, typically defined as “school-age”, so between 6
and 18 years old, only one symptom is needed for the diagnosis of GAD. The fourth criteria are that anxiety causes impairment in important daily activities
like school or work. For example, they might miss deadlines or find it
difficult to even go to work because of their symptoms. Fifth, the
symptoms are not attributable to the physiologic effects of drugs or medication,
or due to a medical condition like hyperthyroidism which creates an excess of
thyroid hormone, which can sometimes cause symptoms of anxiety and worry. Finally,
their anxiety isn’t better explained by another mental disorder like social
phobia or panic disorder. Just like a lot of mental disorders, it’s unclear
exactly why some individuals develop a generalized anxiety disorder, but it’s
thought to be a combination of genetic and environmental factors, as it seems
to run in families. It also has been shown to be twice as prevalent in females
as in males.
Treating GAD, like many mental
disorders, may involve psychotherapy, medication, or a combination of the two. If
it’s psychotherapy, cognitive behavior therapy has been effective since it
teaches the patient to think and behave in different ways and react
differently to situations that would usually cause anxiety and worry. Medications
like benzodiazepines or antidepressants might be prescribed as well, benzodiazepines
are a type of psychoactive drug that has a relaxing and calming effect. Antidepressants
might also be prescribed, like selective serotonin reuptake inhibitors, or SSRIs,
which regulate the serotonin levels in the brain and help elevate mood. Even
though both medications and cognitive behavior therapy have similar
effectiveness in the short-term, cognitive behavior therapy has major
advantages over medication in the long term, due to unwanted effects of the
medications like tolerance, dependence, and withdrawal.
Helping current and future clinicians
focus to learn to retain and thrive
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