Generalized Anxiety Disorder (GAD)

Diagnostic Criteria:
1. Duration/how long it's been a problem
2. Thoughts/cognitions
3. Emotions
4. Behaviors
5. Physiological Symptoms
  1. Muscle tension distinguishes GAD from normal, non-anxious people
DSM Criteria
1. Excessive anxiety and worry occurring more days than not for at least 6 months
  1. About several events/activities
2. Difficulty controlling worry
3. At least 3 of the following:
  1. Difficulty concentrating on other things; blank mind
  2. Muscle tension
  3. Restlessness; keyed up or on edge
  4. Fatigue
  5. Irritability
  6. Difficulty sleeping
4. Significant distress or impairment
5. Not limited to one specific issue
Statistics
1. 3.1% of population in a given year
2. 5.7% meet criteria at some point in their life
3. Similar rates around the world
4. 66% females, 33% males
Course
1. Once developed it takes a chronic course
Onset
1. Onset is in early adulthood
  1. Typically after a stressor
  2. Earlier and more gradual onset than other anxiety disorders
Causes
1. General Biological Vulnerability
  1. Tends to run in families
  2. 30%
  3. Inherited tendency to become anxious, no GAD
    1. Nervousness
    2. Low frustration tolerance
2. Unconscious mental processes
  1. More readily focus attention on threat than non-anxious people
  2. Sensitivity to threat developed in stressful events that seemed dangerous or uncontrollable
3. Chronic worriers
Comorbidity
1. 90% of those with GAD have a second disorder
2. 42% of people with GAD have major depression or dysthymia
3. Also social and specific phobias
Treatment
1. Medications
  1. Benzodiazepines
    1. Minor tranquilizers
    2. Short term relief, modest effects
    3. Not studied longitudinally
    4. Side effects
      1. Impaired motor functioning
      2. Impaired cognitive functioning
  2. Physical and psychological dependence
  3. Antidepressants provide more support
2. Psychological treatment
  1. Behavioral and Cognitive Behavioral
    1. CBT is superior to psychoanalytic treatment
      1. 72% "good outcome" with CBT vs. 31% "good outcome" with psychoanalytic
  2. Same short term benefits as medication
  3. Better long-term, reduces use of meds

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Generalized Anxiety Disorder (GAD)

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