What Causes Generalized Anxiety Disorder?
Generalized Anxiety Disorder (GAD) is diagnosed when a person becomes excessively worried about a variety of everyday concerns, on more days than not, for at least six months, accompanied by three or more specific symptoms. The fear can be so overwhelming that it creates anxiety and distress that interferes with the ability to function in life. What makes generalized anxiety disorder different from other anxiety disorders is that the worry can be about an assortment of issues rather than focused on something specific, like a phobia or a particular perceived threat. Almost 7 million Americans are affected by generalized anxiety disorder, and twice as many women as men suffer from it.
People who suffer from generalized anxiety disorder, or GAD, often feel an anxiousness that is more pronounced than what most people in similar situations experience.
For instance, generalized anxiety disorder sufferers could find themselves worrying excessively about almost anything, like an unspecified impending disaster, that they might be hit by a car or have a heart attack, or be fired from work, or lose their wallet, that a family member may have a serious accident, or other random events.
The excessive worry is difficult to control, even when the fear is unwarranted.
Triggers and Causes of GAD
It is unclear precisely what causes generalized anxiety disorder, but medical and mental health professionals agree it can be triggered by a number of factors. Life experiences that involve environmental influences, genetics, and certain behavioral and developmental issues all play a role.
Environmental factors that can trigger generalized anxiety disorder include:
- Dysfunctional familial relationships
- Death of someone close
- Serious illness or injury
- Substantial trauma such as abuse
- Significantly stressful life experiences.
Behavioral and developmental causes of GAD may be related to extreme negative experiences an individual may have had that lead him or her to associate a specific situation with feelings of fear and anxiousness. In order to prevent the anxiety, steps are taken to avoid those types of situations and triggers in the future. Worrying about the anxiety and possible triggers often leads to further feelings of anxiety and an inability to function in social settings.
There is also evidence to suggest heredity may play a role in the development of generalized anxiety disorder. For instance, a susceptibility to anxiety and familial association have been linked to the occurrence of anxiety disorder. In other words, sensitivity to anxiety is a strong predictor for the development of anxiety. Children who have a close family member with anxiety are more likely to suffer from anxiety as well, although the type of anxiety may be different.
Since an exaggerated fear response is a crucial element in anxiety disorder, recent research into what causes generalized anxiety disorder focuses on looking at the how the brain responds to fear and what happens when that response is inappropriate given the stimuli. Studies have shown a correlation between irregularities in brain circuitry, particularly the way the amygdala affects the fear response process, and anxiety disorder. The amygdala plays an important role in regulating fear and anxiety when stressors present themselves. Dysfunction in the way certain regions of the brain, particularly the amygdala, react to stressors causes an exaggerated fear response that is unwarranted, creating a feeling of intense anxiety. Researchers believe that treating dysfunction in the amygdala may help regulate anxiety and prevent generalized anxiety disorder.
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Am I At Risk?
Women are twice as likely to develop generalized anxiety disorder as men. A person may be at risk for developing GAD if significant trauma has been experienced, there is a close family member who suffers from the condition, he or she has a serious illness, other mental health issues, or abuses alcohol or drugs.
Although it is a separate anxiety disorder, generalized anxiety disorder rarely occurs alone. It usually occurs with other mental health disorders, like phobias and panic disorder, and substance abuse. However, depression is the most commonly co-occurring mental health disorder.
What Are The Symptoms Of Generalized Anxiety Disorder?
Generalized anxiety disorder has both physical and emotional symptoms. Some of the most common emotional symptoms include:
- Excessive worry or fear
- Difficulty controlling worry or fear
- Being easily startled
- An inability to relax
Physical symptoms include:
- body aches
- Difficulty breathing
- Feeling flushed
To be diagnosed with GAD, a person must experience six months or more of chronic acute generalized anxiety or worry that occurs most days, is difficult to control, and causes significant distress or impairment.
Additionally, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) requires a person experience at least three of the following six symptoms; only one is required for children:
- Muscle tension
- Restlessness or feeling on edge
- Difficulty concentrating, or the mind “going blank”
- Sleep disturbances including restlessness, unsatisfying sleep, and/or trouble falling or staying asleep
- Being easily fatigued
Generalized anxiety disorder symptoms must not be attributable to a direct result of substance use, or another medical or mental health issue.
Can Generalized Anxiety Disorder Be Prevented?
Without knowing precisely what causes generalized anxiety disorder, methods of prevention can be problematic. But while there is no way to prevent generalized anxiety disorder for certain, getting treatment early can help manage anxiety and keep it from getting worse. It may be possible to keep symptoms mild or moderate so they do not interfere with daily functions and activities of life. If left untreated, symptoms of generalized anxiety disorder can become increasingly difficult to manage and cause significant impairment. Getting help early can be crucial to help prevent debilitating anxiety and stress from occurring.
Other actions may also help prevent the development of GAD. Avoiding overuse and abuse of substances like alcohol and drugs is important. Drug and alcohol abuse is a significant indicator of generalized anxiety disorder development. Bringing order to life events and responsibilities can also be helpful. Prioritizing time and energy when tackling tasks and issues at work, school, and/or home can reduce feelings of anxiety and being overwhelmed.
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How Is Generalized Anxiety Disorder Treated?
Left untreated, many people who suffer from generalized anxiety disorder are unable to participate in even simple daily activities because their anxiety is too severe. By getting treatment, people with generalized anxiety disorder can be functional, participate in social activities, and hold down a job, rather than avoiding certain situations to prevent anxiety. GAD is generally treated by psychotherapy, medications, or a combination of the two. Mental health professionals have observed improved outcomes when both therapy and medication are used to treat generalized anxiety disorder. Common psychotherapy treatment methods include:
- Cognitive Behavioral Therapy (CBT). CBT can help people who suffer from generalized anxiety disorder identify underlying causes of anxiety and better control symptoms. This treatment method focuses on identifying triggers, changing the way sufferers perceive situations that feel threatening, and creating new behaviors to manage anxiety. The hope is that with new coping skills, avoidance behaviors will stop and improved functioning in social situations can resume.
- Acceptance and Commitment Therapy (ACT). ACT focuses more on accepting unhelpful negative thoughts as they are, rather than trying to replace them with positive thoughts. The aim is to teach people living with generalized anxiety disorder to cope with negative thoughts and feelings better instead of replacing those thoughts and feelings. However, the acceptance must be from a perspective of progressing through those negative thoughts and feelings and a commitment to move toward living life as intended, even when unwanted negative thoughts and feelings are present. Acceptance and Commitment Therapy is about both acceptance and change.
- Relaxation and Mindfulness techniques. Alternative and holistic therapies may also be used to treat generalized anxiety disorder. Most commonly, meditation, yoga, and exercise are employed.
Treatments with medication usually involve antidepressants, particularly Selective Serotonin Reuptake Inhibitors (SSRIs) and anti-anxiety medications called benzodiazepines. SSRIs work on chemical receptors in the brain that regulate fear and anxiety. SSRIs generally take a few weeks to become effective, so it is important to be patient when beginning therapy with these medications.
Benzodiazepines begin working much faster and have fewer side effects than antidepressants, but also can become addictive. They generally are not a good option for people who have co-occurring substance abuse issues.
Coupled with therapy, use of medication can be very effective in treating generalized anxiety disorder.
Residential treatment centers can provide a safe and controlled environment while receiving treatment for generalized anxiety disorder. A residential treatment center is a live-in health care facility that offers individualized treatment in a “home- like” setting 24 hours a day, away from the stressors at home. Combining residential treatment with therapy and medication can further improve positive outcomes for controlling generalized anxiety disorder.