Anxiety Disorder, Term Paper Example

Introduction

Anxiety disorders, in general, are the most common form of mental illness in the US.

“Generalized anxiety disorder (GAD), the most common type of anxiety disorder, is characterized by excessive and uncontrollable worry. The focus of anxiety may vary (e.g., a real or imagined helath problem, family matters, career challenges), but the inability to control the anxiety is persistent” (Jaffe, et. al., 2011). Generalized anxiety disorder is “most likely to develop in people who are faced with societal conditions that are truly dangerous” (Jaffe, et. al., 2011). Studies have found that people in highly threatening environments are indeed more likely to develop the general feelings of tension, anxiety, and fatigue and the sleep disturbances found in this disorder.

Details

GAD has been called the “basic” anxiety disorder. This implies that many of its features characterize all anxiety disorders, and it is not surprising that singling out clinical features that might be specific for GAD has been difficult. Bearing this in mind, GAD encompasses in various proportions the following “clusters” of clinical features: 1) pathological worry and other cognitive aspects of chronic anxiety, 2) symptoms of tension and consequences of tension and anxiety, and 3) various physical symptoms, most of which reflect automatic hyperactivity.

People with GAD experience excessive anxiety most circumstances and worry about practically anything. In fact, there is sometimes described as free floating anxiety. Like the young carpenter Donaldson, they typically feel restless, keyed up or on easily; have difficulty concentrating; keyed up, or on easily; have difficulty concentrating; suffer from muscle and have sleep problems. The symptoms least six months, nevertheless, most people with the able, with some difficulty, to carry on social relationships activities.

Although the neurobiology of generalized anxiety disorder is among the least investigated in the anxiety disorders, advances are now being made. “Recent work has focused on brain circuits underlying the neurobiology of ear in animal models and in humans, and on how inherited and acquired vulnerabilities in these circuits might underlie a variety of anxiety disorders” (Katzman, et. al., 2011). It is speculated that alterations in the structure and function of the amygdale, which are central to fear related behaviors, may be associated with GAD. This speculation was supported in a magnetic resonance imaging (MRI) volumetric study comparing children and adolescents with GAD with healthy comparison subjects matched for other general characteristics. The study showed those with GAD had larger right and total amygdale volumes, whereas other brain regions were comparable in size between the GAD group and the control group. The frontal cortex and medial temporal lobe are involved in controlling fear and anxiety, and there is evidence for heightened cortical activity and decreased basal ganglia activity in GAD, possibly accounting for the observed arousal and hyper vigilance that occur in the disorder.

Generalized anxiety disorder (GAD) is a highly prevalent and chronic disorder that affects approximately 183 million people worldwide. GAD is one of the most common anxiety disorders seen in primary care, as these patients often use primary care services. “Patients with GAD worry about matters that may seem minor or unrealistic, but they also worry about health of loved ones, marital relationship, and performance at work or in school, and so on” (Jaffe, et.al., 2011.). GAD patients always think negatively and with more apprehensive method and worry that they get sick, lose a job, or have no money, their children might have an accident, etc. They worry themes are not unusual or odd in themselves, as many people without GAD do worry about similar things. Therefore, for the conceptualization of pathological worry, it is more important how people worry rather than what they worry about. Worry process occurs by repeating, long, and meaningless thoughts and activities.

Also, the worry in GAD is almost constant, and it seems to patients that they have been troubled by worries for a very long time. “Patients often realize that they worry excessively but feel that they cannot do anything to stop worrying. There is also a component of intrusiveness in the experience of pathological worry” (Katzman, et. al., 2011). As a result, worries are often described as “unwanted,” but patients are preoccupied with worrying to the extent that they find it difficult to distract themselves, focus on something else, and fully experience or enjoy their lives.

“The thought processes of patients with GAD are often characterized by the escalating pattern of “what if…” style of questioning, whereby one imagined catastrophe leads to another. Many GAD patients have trouble tolerating any ambiguity and uncertainty. They tend to interpret ambiguous situations as implying some hidden danger, which further “justifies” their worrying” (Jaffe, et. al., 2011). They may have nonspecific concerns about some existential and philosophical issues or state that they are anxious “about everything.” They may also experience what has been referred to as “free floating anxiety” – a pervasive anxious feeling, without a clear focus of anxiety.

The relationship between worry and anxiety is not well understood. Many view worry as an aspect of anxiety, especially as its cognitive component. “According to another view, worry is different from anxiety, on grounds that worry can occur in the absence of fear, that worry and anxiety correlate poorly in patients with GAD, and that in comparison with anxiety, worry is more strongly associated with depression, confusion, lack of emotional control, and lack of control over problem solving” (Katzman, et. al., 2011).

Symptoms of Generalized Anxiety Disorder

Patients with GAD are troubled by tension that can be experienced in many different ways. “Thus, patients often state that they are constantly nervous, keyed up, on edge, unable to relax, restless, “cranky” “ready to explode”, unable to tolerate anything, and the like. As a result of the ongoing, excessive perception of threat, GAD patients tend to be hyper vigilant” ((Katzman, et. al., 2011): they are constantly on alert, expect something bad to happen, and get startled easily by ordinary, innocuous, and suddenly occurring stimuli, such as a knock on the door or the telephone ringing. Although poverty and other societal pressures may create a climate in which generalized anxiety disorder is more likely to develop, sociocultural variables are not the only factors at work.

After all, most people in poor, war-torn, politically oppressed, or dangerous environments do not develop this anxiety disorder.

Generalized anxiety disorder is also characterized by various other physical symptoms, which sometimes dominate the clinical presentation. Although the emphasis in the current DSM conceptualization of GAD is on pathological worry and tension, some patients with GAD present mainly with physical symptoms. In such cases, patients are more likely to seek help in primary care of other medical settings. Physical symptoms are not specific for GAD, as they often appear anxiety disorders, particularly panic disorder. Unlike panic disorder, in which physical symptoms are usually severe but appear episodically during panic attacks, physical symptoms in GAD are usually less intense but more chronic.

Many of the common physical symptoms in GAD reflect automatic hyper arousal; tachycardia, palpitations, sweating, dries mouth, and trembling or shaking. Patients with GAD relatively frequently complain of gastrointestinal symptoms, such as nausea, upset stomach, and diarrhea. Other symptoms that may be seen among GAD patients include dizziness, lightheadedness, hot and cold flushes, numbness, and tingling sensations. GAD patients don’t think about their confidence, and they always think about uncertainty in life. They cannot make decision because they cannot take risk and in the decision making process, risk is very important factor. “Intolerance of uncertainty is more specifically related to pathological worry than is intolerance of ambiguity” ((Harvard Medical School, 2011).

Conclusion

Generalized anxiety disorder often occurs in conjunction with other psychiatric disorders. About two thirds of people with generalized anxiety disorder also have major depression. About one quarter have panic disorder. Many have substance use disorders or alcohol dependence. Pathological worry is often accompanied by certain beliefs about worry. It has been demonstrated that “positive” beliefs characterize many if not all worriers, whereas “negative” beliefs are more typical of worriers who also suffer from GAD.

References

Katzman, Martin A, and Dina Tsirgielis. “Treatment Approaches To Generalized Anxiety Disorder.”

Current Medical Literature: Psychiatry 22.2 (2011): 37-56. Academic Search Complete. Web. 13 Dec. 2011.

Jaffe, SE, and T Schub. “Generalized Anxiety Disorder.” (2011): CINAHL Plus with Full Text. Web. 13 Dec. 2011.

“Generalized Anxiety Disorder: People Who Worry About Everything–And Nothing In Particular–Have Several Treatment Options.” Harvard Mental Health Letter 27.12 (2011): 1-3. CINAHL Plus with Full Text. Web. 13 Dec. 2011.