People with generalized anxiety disorder (GAD) are the worry experts. It’s not uncommon for people with the disorder to assume that they are locked into daily uncontrollable worry. Untreated, these individuals learn to compensate in other ways, often settling for a lower quality of life; resigning themselves to physical and emotional discomfort.
Everyone worries to some degree at some point about something in their lives. However, the worry experienced by individuals with generalized anxiety disorder is clearly out of proportion to the actual likelihood or impact of the feared event. The worry is longstanding.
Themes of worry may include health, finances, job responsibilities, safety of one’s children or even being late for appointments. The worry is difficult to control and interferes with the task at hand. For example, students may find it difficult to get their schoolwork done and parents often describe difficulty letting their child get on the school bus. These feelings of worry and dread are accompanied by physical symptoms such as pain from muscle tension, headache, frequent urination, difficulty swallowing, “lump in the throat” or exaggerated startle response.
For some people this chronic anxiety and worry have become the standard approach taken to all situations, no matter how little the worry is based in actual situations. While the exact cause for GAD is uncertain, experts feel that it’s a combination of biological factors and life events. It’s not uncommon for some people with GAD to also have other medical disorders such as depression and/or panic disorder. These may be influenced by the activity certain chemicals systems in the brain.
This silent suffering can make diagnosing GAD difficult. It’s also further complicated because a certain amount of anxiety and worry are normal and other medical disorders can be involved as well.
If someone suspects they have GAD, it’s very important for them to reflect on what situations cause anxious feelings, how long they have experienced these feelings and if the worry is reasonable. For example, someone in their 30s with no medical problems who has had two normal physical examinations in the past six months but spends the day worrying about their health may be experiencing GAD.
Most people with GAD describe themselves as constant worriers and acknowledge that this approach to situations is something they have done their entire lives. Often others describe them as “high strung,” “nervous” or “tense.”
But it’s helpful to recognize this constant anxiety as a treatable disorder, not a quirk or an inherent character weakness. Remember that heightened anxiety or worry has a purpose, but for people with GAD, routine activities are perceived as risky and this perception is strong and steadfast.
While always present to a degree, GAD usually has a waxing and waning course. Regardless of the ups and downs, however, some GAD sufferers will become so consumed with worry that they can’t function.
Their worlds shrink down until they can’t work at all; or, if they can be employed, it can only be jobs that have few demands and responsibilities. In addition, they need to recruit people into their lives who can compensate for their excessive worry. For example, the marriage partner with GAD might relinquish all the financial responsibilities, creating an unequal distribution of responsibilities in the relationship.
Focus of Worry Changes with Age
Excessive worry may change though the lifecycle in patients with generalized anxiety disorder. For example, as children/students, the focus of distress might be grades, clothing or getting into the “right” school. These objects of concern can become so intense that studying becomes impossible.
In adulthood, different themes emerge. For example, concern over the health of the family might intensify to the point that it’s impossible to allow a child to walk from the front door to a school bus without fearing for their safety. Anxiety over job security and/or promotion can reach the point that it actually interferes with performance because the worry interferes with the ability to concentrate on anything else.
For older people, end of life issues become the focus. Themes of catastrophic thinking may include who will take care of them if they become ill or what should they do with their money?
While the themes may vary with age and from person to person, the common thread is the same: chronic and exaggerated worry over situations and topics that can’t be turned off at will. Whether it’s an uncommon dread of missing appointments, worry about routine tasks, such as needing to change the car oil, or daily concern about finances despite being financially secure, the thoughts can interfere with daily life functions.
GAD Includes Physical Symptoms Too
Generalized anxiety disorder, however, is not limited to affecting emotions. Individuals with GAD describe equally distressing physical symptoms. Excessive muscle tension can result in muscle spasms and chronic joint and muscle pain. Too much acid produced in the stomach can lead to digestive problems.
Because of this, GAD sufferers feel miserable and actively seek relief from these physical symptoms. It’s estimated that as many as 10 percent of the people who repeatedly make visits to health-care providers have GAD.
Despite many visits to a medical professional, people with GAD are often not diagnosed with the disorder until a secondary illness manifests, such as depression. Perhaps this occurs from becoming overwhelmed with, in addition to constant daily worry, new job or school responsibilities.
Or, perhaps there’s a problem of substance abuse due to self-medication. Maybe associated physical symptoms, such as severe abdominal pain, become unresponsive to medication prescribed by a primary care physician.
Regardless of the reason, once diagnosed, GAD is very treatable. Treatment methods include medication and cognitive-behavior therapy. Having a diagnosis by a medical professional helps the person accept that this is a real disorder and treatment can be refocused on the underlying cause for physical and emotional pain.