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Ravi is a 26-year-old software engineer, who recently started his first job, he lives with his wife of one year. He has always been an anxious person and describes himself as being on edge all the time. His wife feels he unnecessarily worries all the time. He has started noticing over the past year that he is unable to control his worries. He constantly worried about his abilities, his responsibilities, criticism from others, ill-health and negative events. This is often associated with physical sensations of uneasiness, abdominal discomfort and constant muscle tension. These thoughts preoccupy him leading to problems with productivity and relationships.
Generalized Anxiety Disorder (GAD) is characterized by persistent and excessive free-floating worry. The worries often cover several aspects of the individual’s life(health, family, work, finances or other issues). Individuals with GAD find it difficult to control their worry and may predict catastrophic outcomes to most events.
A study conducted among Indians revealed an estimated 20% of the population suffers from issues related to anxiety disorders. Not including panic attacks. Out of which around 6% suffer from generalized anxiety and around 4.2% from phobias.
The word anxiety is derived from the Latin anxietas ( which means to choke, throttle, trouble and upset) and encompasses behavioural, affective and cognitive responses to internally anticipated/perceived danger. Anxiety is not the same as fear. Fear is an intense emotional state which is activated in response to an external threat.
Anxiety usually manifests as “what if” thoughts.
- What if the test has only questions I don’t know?
- What if my child falls ill at school?
- What if I get a flat tyre on the way to work?
- What if I get fired from work?
- What if someone burgles my house?
- What if I have a stroke?
Fear and anxiety have strong physiological correlates, palpitations, tremors, lightheadedness, abdominal discomfort and excessive sweating are common physical manifestations of anxiety.
What causes GAD ?
There is no singular cause of GAD. GAD develops secondary to an interplay between several factors that include genetic predisposition, abnormal brain chemistry, environmental and social influences, personality factors and life experiences.
Biologically, the seat of emotion in the human brain lies in the limbic system, a network of interconnected structures responsible for emotion, motivation, memory and learning. The limbic system includes structures like the amygdala, hippocampus and the hypothalamus connecting it to endocrine system and the autonomic nervous system( controls breathing, heart rate and functions that occur without conscious effort). Anxiety is thus associated with autonomic activation such as increased heart rate, tremors, sweating, palpitations and bowel movements.
Anxiety is reinforced by avoidance. Every time one avoids doing things one is anxious about, there is temporary relief from the distressing feelings. For example a person with claustrophobia(closed spaces) avoids going on a lift, at that moment the threat is neutralized and behaviour that neutralized the threat ( avoidance) is reinforced. The only problem is avoidance will reinforce itself and become a pattern of behavior.
How is GAD treated ?
A variety of treatment options are available to effectively manage anxiety disorders. Your health care provider may choose therapy and/or medication. Medications help in addressing underlying neurochemical imbalances. Psychotherapy is aimed at improving your ability to cope with anxiety. Several psychotherapeutic measures such as CBT, relaxation training, mindfulness-based stress reduction are effective in the management of anxiety.
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Ravi was eventually referred to a psychiatrist and based on the history and previously done laboratory investigations, the possibility metabolic, endocrine, cardiac and respiratory contributors to anxiety were ruled out. A diagnosis of generalized anxiety disorder is made and appropriate interventions prescribed. Ravi now understands his illness and its treatment and knows how to effectively deal with anxiety the next time it occurs.