Generalized Anxiety Disorder

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1. 1. Definisi & Karakteristik

Kecemasan tidak selalu memiliki asosiasi dengan hal-hal spesifik seperti pada diri,
situasi atau peristiwa tertentu, sebagai pusat atau sumber dari gangguan itu sendiri
sedangkan pada generalized anxiety disorder tidak ada sumber yang jelas dari
kecemasannya. Kecemasan digeneralisasi dalam setiap kejadian dalam tiap
harinya.
Penderita generalized anxiety disorder menganggap kekhawatiran mereka sebagai
sesuatu yang tidak dapat dikendalikan (Ruscio, Borkovek, & Ruscio, 2001). Usaha
mereka untuk mengendalikan kecemasan biasanya gagal dan biasanya menderita
sejumlah simptom baik fisik maupun psikologis yang mempengaruhi aspek sosial,
pekerjaan dan fungsi kehidupan secara umum. Mereka mudah merasa sering tidak
berdaya dan sering berada dalam situasi tertekan dan suli berkonsentrasi. Sering
merasakan ketegangan yang sangat besar yang membuat mereka tidak dapat
berfikir, pada mala harinya sulit untuk tidur, atau sulit untuk tetap tidur atau
meskipun tidur, tidak merasakan kepuasan dari tidurnya. Pada siang hari mereka
merasa kelelahan, mudah marah dan tegang. Kekhawatiran seorang
dengan generalized anxiety disorder dapat dialami selama bertahun-tahun. Pada
kenyataannya individu dengan gangguan ini menyatakan mereka tidak pernah tidak
merasakan ketegangan dan kecemasan setiap harinya. Dan orang lain cendrung
melihat mereka sebagai individu yang pesimis.
Kekhawatiran yang paling sering dirasakan adalah mengenai kesehatan mereka dan
masalah sehari-hari, seperti terlambat menghadiri pertemuan atau terlalu banyak
pekerjaan yang harus dikerjakan. Ketikan gangguan ini terjadi pada anak-anak
ketakukan dan kecemasan yang mereka rasakan biasanya berhubungan dengan
prestasi di sekolah. Gangguan ini memengaruhi 8,3% dari populasi dan biasanya
terjadi pada wanita (Kendler.dkk,..2005). pada populasi yang lebih umum. Rasio
jenis kelamin, kira-kira dua pertiganya adalah wanita; pada kondisi klinis, 55 hingga
60 persen klien yang mendapatkan diagnosis dengan kondisi ini adalah wanita (APA,
2000). Sebgianbesar terjadi pada individu yang berusia masih sangat muda, tetapi
peristiwa yang menimbulkan stress ketika individu berada pada masa dewasa dapat
menyebabkan munculnya simptom ini.
Karakteristik Generalized Anxiety Disorder DSM IV TR :

1. a. Mengalami kecemasan yang berlebihan dan perasaan cemas yang sering

muncul selama enam bulan. mempemgaruhi berbagai aktivitas atau situasi
seperti sekolah atau pekerjaan.
2. b. Kekhawatiran, kecemasan dan simptom fisik lainnya yang berhubungan
menyebabkan stress yang signifikan atau ketidakmampuan
3. c. Merasa kesulitan dalam mengendalikan perasaan cemas
4. d. Kecemasan dan kekhawatiran mereka diasumsikan sekurang-kurangnya
dengan tiga hal berikut :
1. i. Gelisah
2. ii. Mudah merasa lelah
3. iii. Sulit berkonsentrasi
4. iv. Mudah marah
5. v. Otot yang tegang
6. vi. Gangguan tidur
5. e. Fokus kecemasan dan kegelisahannya tidak termasuk dalam fokus yang
diutamakan pada pada Axis I; kegelisahan dan kecemasannya bukan
mengenai serangan panik (panic disorder), malu dengan masyarakat
(seperti school phobia), tidak termasuk dalam obsessivec ompulsive disorder,
tidak terfokus pada menjauh dari keluarga atau kerabat lain seperti
pada separation anxiety disorder, tidak terfokus pada berat badan
seperti anorexia nervosa ataubulimia nervosa atau memiliki penyakit serius
seperti pada hypochondriasis, and bukan termasuk dalam posttraumatic
stress disorder (PTSD) .
6. 2. Etiologi
1. a. Perspektif Sosiokultural
Penting untuk dapat memahami peran faktor sosiokultural dalam generalized
anxiety disorder, stress hidup dapat menjadi dasar meningkatkan kecendrungan
individu mengalami kecemasan kronis secara signifikan. Stress hidup tersebut
dapat berupa bermacam-macam dari berbagai hal.
1. b. Perspektif Psikoanalisis
Teori Psikoanalisis berpendapat bahwa sumber gangguan kecemasan menyeluruh
(Generalized Anxiety Disorder) adalah konflik yang tidak disadari antara ego dan
impuls-impuls id. Impuls-impuls tersebut biasanya bersifat seksual atau agresif,

berusaha untuk mengekpresikan diri namun ego tidak membiarkannya, karena

tanpa disadari merasa takut terhadap hukuman yang akan diterima. Sumber
kecemasan yang sebenarnya yaitu hasrat-hasrat yang berhubungan dengan impulsimpuls id yang selalu berusaha untuk mengekpresikan diri. Namun tidak ada
pengalihan dari hasrat-hasrat tersebut melalui suatu objek atau situasi, sehingga
tidak adanya suatu pertahanan dan hal ini menyebabkan seorang yang
menderita generalized anxiety disorder selalu merasa cemas.
1. c. Kognitif Behavioral
Pemikiran utama menurut Kognitif Behavioral tentang generalized anxiety
disorder adalah gangguan tersebut disebabkan oleh proses-proses berpikir yang
menyimpang. Orang-orang yang menderita generalized anxiety disorder seringkali
salah mempersepsikan kejadian-kejadian biasa (seperti menyebrang jalan) sebagai
hal yang mengancam dan kognisi mereka terfokus pada antisipasi berbagai
bencana pada masa mendatang (Beck dkk., 1987; Ingram & Kendall, 1987; Kendall
& Ingram, 1989). Perhatian penderita generalized anxiety disorder mudah terarah
pada stimuli yang mengancam (Mogg, Millar & Bradley 2000; Thayer dkk.,2000).
Terlebih lagi pasien generalized anxiety disorder lebih terpicu untuk mengartikan
suatu stimuli yang tidak jelas sebagai sesuatu yang mengancam dan menilai
berbagai kejadian yang mengancam lebih mungkin terjadi pada mereka (Butler &
Mathews, 1983).
1. d. Perspektif biologis
Beberapa penelitian memperlihatkan bahwa generalized anxiety disorder memiliki
komponen biologis. Generalized anxiety disorder sering ditemukan pada orangorang yang memiliki keluarga dengan penderita gangguan ini. Pada penelitian anak
kembar, ditemukan kemungkinan yang lebih tinggi terjadi pada kembar
identik(Monozygote) dibanding kembar tidak identik (Dyzygote). Model neurobiologi
menjelaskan generalized anxiety disorder dapat disebabkan oleh kerusakan dalam
sistem GABA (gamma-aminobutyric). Sistem GABA
merupakan neurotransmitter penghambat kecemasan, sehingga kerusakan pada
sistem GABA menghasilkan suatu kecemasan yang tidak dapat dikendalikan.
1. e. Perspektif Humanistik
Carl Rogers menjelaskan generalized anxiety disorder sebagai suatu kurangnya
penerimaan terhadap terhadap penghargaan yang tidak positif dari orang lain yang
memilii arti bagi dirinya. Sehingga seorang menjadi terlalu kritis dengan dirinya
sendiri dan perkembangan nilai dirinya.

1. 3. Kasus
Irene adalah seorang mahasiswa berusia 20 tahun dengan kepribadian yang dikenal
baik namun tidak memiliki banyak teman. ia datang ke klinik mengeluhkan
kegelisahannya yang berlebihan dan kesulitan dan mengendalikan dirinya.
segalanya terlihat sebagai suatu bencana bagi Irene. Walaupun ia memiliki prestasi
akademik dengan angka 3,7 ia selalu merasa khawatir bahwa ia akan gagal dalam
ujian. Sehingga sebagai bentuk ketakutannya ia selalu mengulang materi yang
telah ia pelajari berkali-kali, karena ia khawatir suatu saat ia akan lupa dan tidak
mengerti dengan materi tersebut.
Irene tidak hanya khawatir dengan sekolahnya. ia juga khawatir tentang hubungan
nya dengan pasangannya. Dimanapun saat ia berada dengan kekasihnya, ia merasa
cemas dan takut berbuat suatu hal yang bodoh dan membuat ketertarikan
pasangnnya hilang padanya.
irene juga memperhatikan masalah kesehatannya. ia memiliki penyakit hipertensi
minor, mungkin hal ini karena badannya yang agak terlalu gemuk. Hal ini membuat
Irene melihat daging seperti sebagai suatu ancaman kematian yang tidak boleh
dimakan. ia enggan untuk mengukur tekanan darahnya karena ia takut akan
hasilnya yang menurutnya pasti sangat tinggi dan ia tidak menurunkan berat
badannya. Irene membatasi porsi makannya dengan sungguh-sungguh, sehingga ia
juga pernah berperilaku binge eating (dengan sengaja memuntahkan makanan
yang telah dimakan). Irene juga terkadang mengalami serangan panik tiba-tiba,
namun ini bukan hal yag utama yang terlihat dari dirinya. Irene juga sering cemas
akan kemungkinsn terjadinya suatu musibah atau bencana alam.

1. 4. Prevensi
1. a. Prevensi Sekunder
Dapat digunakan CBT (Cognitive behavioural therapies) (Borkoves dan Ruscos,
2001) yang mengarahkan klien blajar untuk mengendalikan pikiran yang
menimbulkan kecemasan, mencari alternatif bentuk kecemasan lain yang rasional,
dan mengambil tindakan untuk menguji alternatif tersebut. Penekanannya adalah
menghentikan siklus pikiran dan kecemasan negatif. Jika siklus ini telah putus, maka
individu dapat mengembangkan kemampuan untuk mengendalikan prilaku cemas
dan semakin pandai dalam mengatur serta mengurangi pikiran yang menimbulkan
kecemasan. Pada keadaan tertentu, terapi ini dapat dikombinasikan dengan latihan
relaksasi.
1. 5. Terapi
Selain dapat menggunakan CBT, dapat juga menggunakan obat-obatan sebagai
pendkatan biologis. Anxiolytic dapat digunakan untuk generalized anxiety disorder

(juga sering digunakan pada gangguan phobia tau gangguan kecemasan lainnya).
Obat-obatan terutama yang dapat digunakan adalah benzodiazepin,
seperti Valium dan Xanax, juga buspirone (BuSpar), seringkali digunakan karena
pervasivitas gangguan. Setelah diminum, obat tersebut akan bekerja selama
beberapa jam dan dapat menurunkan gejala kecemasan dari penderita. Sejumlah
studi double blind menegaskan bahwa obat-obatan tersebut memberi lebih banyak
manfaat dibandingkan placebo (Apter & Allen, 1999). Beberapa studi menunjukkan
efektivitas beberapa antidepressan tertentu dari jenis tricyclic dan SSRI (Pollack
dkk., 2001; Roy-Byrne & Cowley, 1998).
Terdapat beberapa efek samping dari obat-obatan tersebut mulai dari mengantuk,
kehilangan memori, depresi, hingga ketergantungan fisik serta kerusakan organorgan tubuh. Selain itu jika pasien tidak meminum obat manfaat yang diperoleh
biasanya akan hilang.
Sumber :
1. 1. Abnormal Psychology (Fifth edition) - Gerald C Davidson & John M. Neale.
Halaman 147
2. 2. Abnormal Psychology:Clinical Perspectives on Psychological Disorders
Richard. P Halgin & Susan Krauss Whitbourne. Halaman 211
3. 3. Abnormal Psychology;An Integrative Approach David H. Barlow & V. Mark
Durand. Halaman 127

Generalized anxiety disorder (or GAD) is characterized by excessive,

exaggerated anxiety and worry about everyday life events with no obvious reasons for
worry. People with symptoms of generalized anxiety disorder tend to always expect
disaster and can't stopworrying about health, money, family, work, or school. In people
with GAD, the worry is often unrealistic or out of proportion for the situation. Daily life
becomes a constant state of worry, fear, and dread. Eventually, the anxiety so
dominates the person's thinking that it interferes with daily functioning, including work,
school, social activities, and relationships.
Understanding Phobias, From Types to Treatment

What Are the Symptoms of GAD?

GAD affects the way a person thinks, but the anxiety can lead to physical symptoms, as
well. Symptoms of GAD can include:

Excessive, ongoing worry and tension

An unrealistic view of problems

Restlessness or a feeling of being "edgy"

Irritability

Muscle tension

Headaches

Sweating

Difficulty concentrating

Nausea

The need to go to the bathroom frequently

Tiredness

Trouble falling or staying asleep

Trembling

Being easily startled

In addition, people with GAD often have other anxiety disorders (such as panic disorder
or phobias), obsessive-compulsive disorder, clinicaldepression, or additional problems
with drug or alcohol misuse.

What Causes GAD?

The exact cause of GAD is not fully known, but a number of factors -- including
genetics, brain chemistry, and environmental stresses -- appear to contribute to its
development.

Genetics: Some research suggests that family history plays a part in increasing the
likelihood that a person will develop GAD. This means that the tendency to develop GAD may
be passed on in families.

Brain chemistry: GAD has been associated with abnormal functioning of certain nerve
cell pathways that connect particularbrain regions involved in thinking and emotion. These nerve
cell connections depend on chemicals called neurotransmitters that transmit information from
one nerve cell to the next. If the pathways that connect particular brain regions do not run
efficiently, problems related to mood or anxiety may result. Medicines, psychotherapies, or other
treatments that are thought to "tweak" these neurotransmitters may improve the signaling
between circuits and help to improve symptoms related to anxiety or depression.

Environmental factors: Trauma and stressful events, such as abuse, the death of a
loved one, divorce, changing jobs or schools, may lead to GAD. GAD also may become worse

during periods of stress. The use of and withdrawal from addictive substances, including
alcohol,caffeine, and nicotine, can also worsen anxiety.

How Common Is GAD?

About 4 million adult Americans suffer from GAD during the course of a year. It most
often begins in childhood or adolescence, but can begin in adulthood. It is more
common in women than in men.

How Is GAD Diagnosed?

If symptoms of GAD are present, the doctor will begin an evaluation by asking questions
about your medical and psychiatric history and perform a physical exam. Although there
are no lab tests to specifically diagnose anxiety disorders, the doctor may use various
tests to look for physical illness as the cause of symptoms.
The doctor bases his or her diagnosis of GAD on reports of the intensity and duration of
symptoms -- including any problems with functioning caused by the symptoms. The
doctor then determines if the symptoms and degree of dysfunction indicate a specific
anxiety disorder. GAD is diagnosed if symptoms are present for more days than not
during a period of at least six months. The symptoms also must interfere with daily
living, such as causing you to miss work or school.

How Is GAD Treated?

If no physical illness is found, you may be referred to a psychiatrist
orpsychologist, mental health professionals who are specially trained to diagnose and
treat mental illnesses like GAD. Treatment for GAD most often includes a combination
of medication and cognitive-behavioral therapy.

Medication: Drugs are available to treat GAD and may be especially helpful for people
whose anxiety is interfering with daily functioning. The drugs most often used to treat GAD in
the short-term (since they can be addictive, are sedating, and can interfere with memory and
attention) are from a class of drugs called benzodiazepines. These medications are sometimes
also referred to as sedative-hypnotics or "minor tranquilizers" because they can remove intense
feelings of acute anxiety. They work by decreasing the physical symptoms of anxiety, such as

muscle tension and restlessness. Common benzodiazepines include Xanax, Librium,Valium,

and Ativan. These drugs can cause added sedation effects when combined with many other
medicines, and they are also dangerous if mixed with alcohol. Certain antidepressants, such
asPaxil, Effexor, Prozac, Lexapro, Zoloft, and Cymbalta are also used to treat GAD for longer
periods of time. These antidepressantsmay take a few weeks to start working but they're safer
and more appropriate for long-term treatment of GAD.

Cognitive-behavioral therapy: People suffering from anxiety disorders often participate

in this type of therapy, in which you learn to recognize and change thought patterns and
behaviors that lead to anxious feelings. This type of therapy helps limit distorted thinking by
looking at worries more realistically.

In addition, relaxation techniques, such as deep breathing andbiofeedback, may help

control the muscle tension that often accompanies GAD.

Are There Side Effects of GAD Treatment?

Dependency on sedative-hypnotic medications (benzodiazepines) is a potential
complication of treatment. Side effects of antidepressants vary by specific drug and the
person taking them. Common side effects can include sleepiness, weight gain, and
sexual problems.

What Is the Outlook for People With GAD?

Although many people with GAD cannot be cured and symptoms can return from time
to time, most people gain substantial relief from their symptoms with proper treatment.

Can GAD Be Prevented?

Anxiety disorders like GAD cannot be prevented. However, there are some things that
you can do to control or lessen symptoms, including:

Stop or reduce your consumption of products that containcaffeine, such as coffee, tea,
cola, and chocolate.

Ask your doctor or pharmacist before taking any over-the-counter drugs or herbal
remedies. Many contain chemicals that can increase anxiety symptoms.

Exercise daily and eat a healthy, balanced diet.

Seek counseling and support after a traumatic or disturbing experience.

Practice stress management techniques like yoga or meditation.

WebMD Medical Reference

View Article Sources
Reviewed by Joseph Goldberg, MD on February 08, 2014
2014 WebMD, LLC. All rights reserved.

Generalized anxiety disorder (GAD)

Definisi
Generalized anxiety disorder (GAD) adalah kebiasaan yang ditandai oleh sebuah pola
kecemasan yang sering dan menetap dan cemas pada banyak aktifitas atau kejadian.
Nama lain
GAD; Anxiety disorder
Penyebab, kejadian, dan faktor resiko
Generalized anxiety disorder (GAD) merupakan kondisi umum yang dikarakterisasikan sebagai
kecemasan yang berlebihan. Contoh, seorang pelajar sering cemas seputar test, yang selalu
selalu cemas akan gagal - meskipun ia mendapat nilai yang baik mempunyai pola tipikal
gangguan kecemasan.
Seseorang akan mengalami kesulitan untuk mengontrol rasa cemasnya. Situasi kehidupan
yang penuh stress, berada di lingkungan stress, bisa menyumbang GAD.
Gangguan ini bisa dimulai kapan saja dalam kehidupan, termasuk saat masih kecil. Banyak
orang melaporkan bahwa mereka mengalaminya sudah lama sejauh yang dapat mereka ingat.
GAD terjadi lebih sering pada wanita daripada pria.
Gejala-gejala (Symptoms)
Kecemasan sering berhubungan dengan symptom berikut:
Kegelisahan
Mudah merasa lelah
Sulit berkonsentrasi
Mudah marah
ketegangan pada otot gemetar, sakit kepala
kesulitan tidur (baca juga kesulitan tidur)
keringat yang berlebihan, palpitasi, sesak nafas, dan variasi symptom gastrointestinal
Treatment
Beberapa treatment yang dapat anda pilih:
pemberian obat.-- Cara ini melibatkan pemberian obat yang memberikan rasa kantuk atau

efek penenang, antidepressant, antihistamines, Benzodiazepines. Sering pemberian obat dalam

jangka lama menjadikan anda ketergantungan dan memiliki efek samping lainya.
Teknik relaksasi.relaksasi yang sistematis pada bagian tubuh
Cognitive behavioral therapy membantu pasien mengenali pikiran yang berkontribusi pada
kecemasan. Cara ini biasanya membutuhkan waktu berbulan-bulan bahkan bertahun-tahun.
Energy psychology memanfaatkan energy dalam tubuh dengan cara menstimulasi pada titiktitik meridian tubuh untuk memperbaiki aliran energy tubuh. Cara ini merupakan cara yang
efektif dan cepat untuk mengatasi tidak hanya kecemasan, tapi juga masalah emosional lainnya
dalam hitungan jam atau hari.
Komplikasi
Orang yang mengalami GAD bisa berkembang menjadi psysical disorder, sepertipanic
disorder atau depresi klinis, atau depresi. Akan menjadi masalah lagi bila seseorang mencoba
mengatasinya dengan narkoba atau alkohol untuk menghilangkan kecemasan.
Mental and health provider
Hubungi Mental and emotional health provider jika anda mendapati symptom kecemasan,
terutama bila hal ini terjadi lebih dari 6 bulan atau lebih lama, atau hal ini telah mengganggu
fungsi keseharian anda.
Note
Informasi di atas diambil dan diterjemahkan dari www.healthline.com

Generalized Anxiety Disorder Symptoms

By Psych Central Staff
~ 2 min read

Generalized anxiety disorder (GAD) is more than the normal anxiety people experience day to
day. Its chronic and exaggerated worry and tension, even though nothing seems to provoke it.
Having this disorder means always anticipating disaster, often worrying excessively about
health, money, family, or work. Sometimes, though, the source of the worry is hard to pinpoint.
Simply the thought of getting through the day provokes anxiety.
People with GAD cant seem to shake their concerns, even though they usually realize that their
anxiety is more intense than the situation warrants that itsirrational. People with GAD also
seem unable to relax. They often have trouble falling or staying asleep. Their worries are
accompanied by physical symptoms, especially trembling, twitching, muscle tension,
headaches, irritability, sweating, or hot flashes. They may feel lightheaded or out of breath. They
may feel nauseated or have to go to the bathroom frequently. Or they might feel as though they
have a lump in the throat.
Many individuals with GAD startle more easily than other people. They tend to feel tired, have
trouble concentrating, and sometimes suffer depression, too.

Usually the impairment associated with GAD is mild and people with the disorder dont feel too
restricted in social settings or on the job. Unlike many other anxiety disorders, people with GAD
dont characteristically avoid certain situations as a result of their disorder. However, if severe,
GAD can be very debilitating, making it difficult to carry out even the most ordinary daily
activities.
GAD comes on gradually and most often hits people in childhood or adolescence, but can begin
in adulthood, too. Its more common in women than in men and often occurs in relatives of
affected persons. Its diagnosed when someone spends at least 6 months worried excessively
about a number of everyday problems.
Specific Symptoms of Generalized Anxiety Disorder
Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at
least 6 months, about a number of events or activities (such as work or school performance).
The person finds it difficult to control the worry.
The anxiety and worry are associated with three (or more) of the following six symptoms (with at
least some symptoms present for more days than not for the past 6 months; children do not
need to meet as many criteriaonly 1 is needed).

Restlessness or feeling keyed up or on edge

Being easily fatigued

Difficulty concentrating or mind going blank

Irritability

Muscle tension

Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)

Additionally, the anxiety or worry is not specifically about having a Panic Attack (though panic
attacks can occur within a person with GAD), being embarrassed in public (as in Social Phobia),
being contaminated (as in Obsessive-Compulsive Disorder), being away from home or close
relatives (as in Separation Anxiety Disorder), gaining weight (as in Anorexia Nervosa), having
multiple physical complaints (as in Somatization Disorder), or having a serious illness (as in
Hypochondriasis), and the anxiety and worry do not occur exclusively during Posttraumatic
Stress Disorder (PTSD).
The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of
abuse, a medication) or a general medical condition (e.g., hyperthyroidism) and does not occur
exclusively during a Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental
Disorder.

Generalized Anxiety Disorder

Extreme, unfounded worry that can interfere with sleep is usually accompanied by body
symptoms ranging from tiredness to headaches to nausea. Treatment with
antidepressants or other medications and psychotherapy, alone or combined, may
alleviate the condition.

Definition
Symptoms
Causes
Treatments

Definition
Generalized anxiety disorder (GAD) is much more than the normal anxiety people
experience day to day. Without provoking, it is chronic and exaggerated worry and
tension. This disorder involves anticipating disaster, often worrying excessively about
health, money, family or work. Sometimes, though, just the thought of getting through
the day brings on anxiety.
People with GAD can't shake their concerns, even though they usually realize that much
of their anxiety is unwarranted. People with GAD also seem unable to relax and often
have trouble falling or staying asleep. Their worries are accompanied by physical
symptoms, especially trembling, twitching, muscle tension, headaches, irritability,
sweating, hot flashes and feeling lightheaded or out of breath.
Many individuals with GAD startle more easily than other people. They tend to feel tired,
have trouble concentrating and may suffer from depression. GAD may involve nausea,
frequent trips to the bathroom or feeling like there is a lump in the throat.
When their anxiety level is mild, people with GAD can function socially and hold down a
job. Although they don't avoid certain situations as a result of their disorder, people with
GAD can have difficulty carrying out the simplest daily activities if their anxiety is severe.
GAD affects about 6.8 million American adults, including twice as many women as men.
The disorder develops gradually and can begin at any point in the life cycle but usually

develops between childhood and middle age. There is evidence that genes play a
modest role in GAD.
Other anxiety disorders, depression, or substance abuse often accompany GAD, which
rarely occurs alone. GAD is commonly treated with medication or cognitive-behavioral
therapy, but co-occurring conditions must also be treated using the appropriate
therapies.

Symptoms
Generalized anxiety disorder (GAD) is characterized by six months or more of chronic,
exaggerated worry and tension that is unfounded or much more severe than the normal
anxiety most people experience. People with this disorder usually:
Expect the worst Worry excessively about money, health, family or work, when there
are no signs of trouble Are unable to relax Are irritable are easily startled can't
control their excessive worrying Suffer from insomnia
Common body symptoms are: feeling tired for no reason; headaches; muscle
tension and aches; having a hard time swallowing; trembling or twitching; sweating;
nausea; feeling lightheaded; feeling out of breath; having to go to the bathroom a
lot; and hot flashes
In children and adolescents with Generalized Anxiety Disorder, their anxieties and
worries are often associated with the quality of performance or competence at school or
sporting events. Additionally, worries may include punctuality, conformity, perfectionism
and are so unsure of themselves that they will redo tasks in order to reach that level of
perfection.

Causes
Like heart disease and diabetes, anxiety disorders are complex and probably result
from a combination of genetic, behavioral, developmental and other factors.
Using brain imaging technologies and neurochemical techniques, scientists are finding
that a network of interacting structures is responsible for these emotions. Much

research centers on the amygdala, an almond-shaped structure deep within the brain.
The amygdala is believed to serve as a communications hub between the parts of the
brain that process incoming sensory signals and the parts that interpret them. It can
signal that a threat is present, thus triggering a fear response (anxiety). It appears that
emotional memories stored in the central part of the amygdala may play a role in
disorders involving very distinct fears, like phobias, while different parts may be involved
in other forms of anxiety.
By learning more about brain circuitry involved in fear and anxiety, scientists may be
able to devise more specific treatments for anxiety disorders. It someday may be
possible to increase the influence of the thinking parts of the brain on the amygdala,
thus placing the fear and anxiety response under conscious control. In addition, with
new findings about neurogenesis (birth of new brain cells) throughout life, perhaps a
method will be found to stimulate growth of new neurons in the hippocampus in people
with severe anxiety.
Studies of twins and families suggest that genes play a role in the origin of anxiety
disorders. However, experience also plays a part. In PTSD, for example, while trauma
triggers the anxiety disorder, genetic factors may explain why only certain individuals
exposed to similar traumatic events develop full-blown PTSD. Researchers are
attempting to learn how genetics and experience interact in each of the anxiety
disorders -- information they hope will yield clues to prevention and treatment.

Treatments
Medication and specific types of psychotherapy are the recommended treatments for
this disorder. The choice of one or the other, or both, depends on the patient's and the
doctor's preference, and also on the particular anxiety disorder.
Before treatment can begin, the doctor must conduct a careful diagnostic evaluation to
determine whether your symptoms are due to an anxiety disorder, which anxiety
disorder(s) you may have, and what coexisting conditions may be present. Anxiety
disorders are not all treated the same, and it is important to determine the specific
problem before embarking on a course of treatment. Sometimes alcoholism or some
other coexisting condition will have such an impact that it is necessary to treat it at the
same time or before treating the anxiety disorder.

If you have been treated previously for an anxiety disorder, be prepared to tell the
doctor what treatment you tried. If it was a medication, what was the dosage, was it
gradually increased and how long did you take it? If you had psychotherapy, what kind
was it, and how often did you attend sessions? Oftentimes people believe they have
"failed" at treatment, or that the treatment has failed them, when in fact it was never
given an adequate trial.
When you undergo treatment for an anxiety disorder, you and your doctor or therapist
will be working together as a team. Together, you will attempt to find the approach that
is best for you. If one treatment doesn't work, the odds are good that another one will.
And new treatments are continually being developed through research.
Antidepressants
A number of medications that were originally approved for treating depression have
been found to be effective for anxiety disorders. These must be taken for several weeks
before symptoms start to fade, so it is important not to get discouraged and stop taking
these medications before they've had a chance to work.
Some of the newest antidepressants are called selective serotonin reuptake inhibitors,
or SSRIs. These medications act on a chemical messenger in the brain called
serotonin. SSRIs tend to have fewer side effects than older antidepressants. People do
sometimes report feeling slightly nauseated or jittery when they first start taking SSRIs,
but that usually disappears with time. Some people also experience sexual dysfunction
when taking some of these medications. An adjustment in dosage or a switch to another
SSRI will usually correct bothersome problems. It is important to discuss side effects
with your doctor so that he or she will know when there is a need for a change in
medication. Venlafaxine, a drug closely related to the SSRIs, is useful for treating GAD.
Similarly, antidepressant medications called tricyclics are started at low doses and
gradually increased. Tricyclics have been around longer than SSRIs and have been
more widely studied for treating anxiety disorders. For anxiety disorders other than
OCD, they are as effective as the SSRIs, but many physicians and patients prefer the
newer drugs because the tricyclics sometimes cause dizziness, drowsiness, dry mouth,
and weight gain. When these problems persist or are bothersome, a change in dosage
or a switch in medications may be needed. Tricyclics are useful in treating people with

co-occurring anxiety disorders and depression. Imipramine, prescribed for panic

disorder and GAD, is an example of such a tricyclic.
Anti-anxiety Medications
High-potency benzodiazepines relieve symptoms quickly and have few side effects,
although drowsiness can be a problem. Because people can develop a tolerance to
them -- and would have to continue increasing the dosage to get the same effect -benzodiazepines are generally prescribed for short periods of time. People who have
had problems with drug or alcohol abuse are not usually good candidates for these
medications because they may become dependent.
Some people experience withdrawal symptoms when they stop taking benzodiazepines
abruptly instead of tapering off, and anxiety can return once the medication is stopped.
Potential problems with benzodiazepines have led some physicians to shy away from
using them, or to use them in inadequate doses, even when they are of potential benefit
to the patient. Alprazolam is a benzodiazepine that is helpful for panic disorder and
GAD. Clonazepam (Klonopin) is used for social phobia and GAD.
Some people experience withdrawal symptoms if they stop taking benzodiazepines
These potential problems have led some physicians to shy away from using these drugs
or to use them in inadequate doses.
Buspirone, a member of a class of drugs called azipirones, is a newer antianxiety
medication that is used to treat GAD. Possible side effects include dizziness,
headaches and nausea. Unlike the benzodiazepines, buspirone must be taken
consistently for at least two weeks to achieve an antianxiety effect.
Other Medications
Beta-blockers, such as propanolol, are often used to treat heart conditions but have also
been found to be helpful in certain anxiety disorders, particularly in social phobia. When
a feared situation, such as giving an oral presentation, can be predicted in advance,
your doctor may prescribe a beta-blocker to keep your heart from pounding, your hands
from shaking and other physical symptoms under control.
Psychotherapy

Psychotherapy involves talking with a trained mental health professional, such as a

psychiatrist, psychologist, social worker or counselor to learn how to deal with problems
like anxiety disorders.
Cognitive-Behavioral and Behavioral Therapy
Cognitive-behavioral therapy (CBT) is very useful in treating anxiety disorders. The
cognitive part helps people change the thinking patterns that support their fears, and the
behavioral part helps people change the way they react to anxiety-provoking situations.
For example, CBT can help people with panic disorder learn that their panic attacks are
not really heart attacks and help people with social phobia learn how to overcome the
belief that others are always watching and judging them. When people are ready to
confront their fears, they are shown how to use exposure techniques to desensitize
themselves to situations that trigger their anxieties.
The behavioral component of CBT seeks to change people's reactions to anxietyprovoking situations. A key element of this component is exposure, in which people
confront the things they fear. Another behavioral technique is to teach the patient deep
breathing as a relaxation aid.
Exposure-based behavioral therapy has been used for many years to treat specific
phobias. The person gradually encounters the object or situation that is feared, perhaps
at first only through pictures or tapes, then later face-to-face. Often the therapist will
accompany the person to a feared situation to provide support and guidance.
If you undergo CBT or behavioral therapy, exposure will be carried out only when you
are ready; it will be done gradually and only with your permission, and you will work with
the therapist to determine how much you can handle and at what pace you can
proceed. To be effective, the therapy must be directed at the person's specific anxieties
and must be tailored to his or her needs. There are no side effects other than the
discomfort of temporarily increased anxiety.
A major aim of CBT and behavioral therapy is to reduce anxiety by eliminating beliefs or
behaviors that help to maintain the disorder. For example, avoidance of a feared object
or situation prevents a person from learning that it is harmless. Similarly, performance of

compulsive rituals in OCD gives some relief from anxiety and prevents the person from
testing rational thoughts about danger, contamination, and so forth.
CBT or behavioral therapy generally lasts about 12 weeks. It may be conducted in a
group, provided the people in the group have sufficiently similar problems. Group
therapy is particularly effective for people with social phobia. Often "homework" is
assigned for participants to complete between sessions. There is some evidence that,
after treatment is terminated, the beneficial effects of CBT last longer than those of
medications for people with panic disorder; the same may be true for OCD, PTSD and
social phobia. If you have recovered from an anxiety disorder, and at a later date it
recurs, don't consider yourself a treatment failure. Recurrences can be treated
effectively, just like an initial episode. The skills you learned in dealing with the initial
episode can be helpful in coping with a setback.
For many people, the best approach to treatment is medication combined with therapy.
As stated earlier, it is important to give any treatment a fair trial. And if one approach
doesn't work, the odds are that another one will.

Sources

Archives of General Psychiatry

Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition - TR
National Institute of Mental Health - Anxiety Disorders
National Institute of Mental Health (Genetics Workgroup) - Gentics and Mental
Disorders
British Journal of Psychiatry Supplement
Psychiatric disorders in America: the Epidemiologic Catchment Area Study