Generalised Anxiety Disorder affects approximately 3-5 percent of the population and is one of the most common difficulties, although often it’s often marginalised. A characteristic feature of GAD is worrying and excessive anxiety, which leads to a range of different problems.
In this article, I will discuss what Generalised Anxiety Disorder is and what effective forms of therapy are available.
The Characteristics of Generalised Anxiety Disorder
The diagnostic criteria in the DSM-5 are based on six key points. First and foremost, people who are diagnosed with GAD experience excessive fear or worry about future events, which occurs most of the time for a period of at least six months. This fear relates to everyday activities such as school, college, and work. One of the individuals I asked to describe this state wrote:
"My body was in a constant state of extreme readiness, tense to the limit."
The second point states that the person is unable to cope with the symptoms and is unable to control them. It’s easy to say "don't worry" or "it will be fine," but people with generalised anxiety disorder usually have very entrenched thought patterns that prevent them from redirecting their attention. Worrying is a significant part of their day, causing distress and real suffering.
The heightened level of tension also affects the body and can cause a range of symptoms listed in the third diagnostic category. According to the DSM-5, anxiety and worry are associated with three or more of the following symptoms:
- restlessness, feeling keyed up or on edge,
- easily fatigued,
- difficulty concentrating or mind going blank,
- muscle tension,
- sleep disturbance (difficulty falling asleep, staying asleep, or restless, unsatisfying sleep).
Electroencephalogram (EEG) studies of patients with GAD have shown increased beta wave activity in the frontal lobes, which are responsible for information processing and analytical thinking. Worrying also leads to disrupted sleep as anxious thoughts and tension interfere with sleep.
A separate point mentions the possibility of experiencing nausea, vomiting, and chronic stomach pain. The connection between gastrointestinal symptoms and stress or worrying is very common, even in healthy individuals. Many people experience stomach pain or diarrhea in response to a stressful life event. The gut-brain axis and the person’s microbiota are responsible for this association.
This is how one person described their somatic symptoms to me:
"I had my first attack on the day of my final exam in college. First, there was stomach pain, then diarrhea, nausea, and two to three hours of vomiting. Usually, when the symptoms start, I don't have any thoughts, I don’t get worked up or anything like that. After the symptoms, I notice that something’s subconsciously worrying me. There’s an outburst of emotions when I vomit. I cry out of helplessness. I can't stop it."
The last two guidelines state that other possible causes of anxiety should be excluded. The disorder can’t be attributed to the effects of substances, such as drugs or medications, or the consequences of somatic diseases such as hyperthyroidism.
Although anxiety disorders can coexist, when diagnosing generalised anxiety disorder, it’s important to consider whether the symptoms are more easily explained by the presence of other mental health issues, such as panic disorder (panic attacks), social phobia, isolation from loved ones, weight gain in the course of an eating disorder, somatic symptom disorder, or illness anxiety disorder (hypochondria).
"I worry about worrying."
The essence of GAD is what is known as free-floating anxiety. The name refers to its generalised nature; it’s not coming from a specific cause, and is independent of external circumstances. A person suffering from anxiety disorders can’t control the persistent anxiety that can cause significant discomfort, difficulty in daily tasks, and in relationships with others. It’s also typical to worry about worrying itself.
What are the symptoms of anxiety disorders?
In the conceptualisation of cognitive-behavioural therapy, there are two types of worrying. The first type concerns everyday external events, such as work situations, studies, relationships with partners, and internal experiences, such as alarming pain or pressure in the body.
To some extent, these behaviours are normal and natural for humans — we worry about what’s important to us. Their function is to prepare us for a difficult event or confrontation with someone.
The second type of worrying concerns the nature and occurrence of the thoughts themselves, which are present at the first level. For example, a person worries that they’re worrying, fearing that it will lead to madness or loss of control. Recognising from a meta-level that worrying plays such a significant role in a person's life creates a vicious circle effect and perpetuates the symptoms. One person who described their history with GAD mentioned:
"I worry about getting myself worked up for no reason."
Constant anxiety easily spreads from one thing to another, makes decision-making and problem-solving difficult, and leads to catastrophic thinking because every scenario seems dangerous. Another significant aspect of generalised anxiety is the persistent tension in the body.
When anxiety rules your life...
Generalised anxiety disorder affects how a person perceives themselves and their surroundings. Beliefs about oneself include self-criticism and lack of self-confidence. One person who shared their story with me listed the following thoughts that occur their anxiety: "Something bad will happen to me," "Someone will abduct me, attack me, or harm my loved ones," "I'm not good at anything," "Everyone is better than me," "What if a war breaks out?" They described the feeling as:
"This anxiety often paralysed me to the point where I could only exist," "Everything that happened outside of my room was terrifying," "I had a list in my head of what’s dangerous and threatening."
Another person talked about the beginning of their illness:
"It wasn't just panic attacks once a year anymore, but a continuous feeling of anxiety that lasted for several weeks. I couldn't sleep at night. I felt like someone was squeezing me from the inside. [...] Every morning, I woke up with a feeling that something bad, something unpredictable, would definitely happen today. I was looking for danger everywhere, and of course, I found it in everything."
Through the example of this person's story, it’s clear how worrying functions:
"I always assumed that it's 'better to be pleasantly surprised than disappointed,' so I came up with the darkest scenarios in my head and worried that everything I did would go wrong."
Generalised anxiety disorder affects how individuals perceive themselves.
People with anxiety disorders perceive themselves as objects of threat because they lack sufficient control to increase their sense of security. This was also the case with my interviewee: "It turned out that I unconsciously like to have control over everything, so any change in the plan I came up with would cause weeks of anxiety and worrying about what it would be like now that the plan had changed."
Treating Generalised Anxiety Disorder
In the case of GAD, it’s advisable to consult both a psychiatrist to determine appropriate medication and a psychotherapist to explore thought patterns and sources of anxiety. Another interviewee described their treatment as follows:
"Cognitive-behavioural therapy, acceptance, and learning to love myself have been very helpful. Approaching myself with compassion, acceptance, and love."
It also shows how important mental health education and awareness of one's experiences are in the healing process:
"I’m now much more mindful of my moods, and I don't blame myself for being ill. I give myself more time, I no longer make impulsive decisions, and openly say, 'I have anxiety disorder and need time before we get closer or before I change jobs.' But I used to act in a way that, in the course of one month, I moved house, started a new relationship, and a new job despite the anxiety. I was totally overwhelmed, but I didn't know I had a disorder and how serious it really is."
Cognitive-Behavioural Therapy and Anxiety Disorders
Psychotherapy for anxiety disorders in the cognitive-behavioural approach provides an opportunity to examine behaviour patterns, reframe anxious thoughts and dysfunctional assumptions, as well as reduce anxiety levels through techniques such as breathing or relaxation exercises.
Another person also shared the results of their healing process with me:
"Medication and cognitive-behavioural therapy are very helpful, and I’m able to function better. In therapy, I receive different exercises (such as breathing and relaxation exercises) and materials that help me work with anxiety. It's still the beginning of my journey, but I finally feel there is hope that anxiety won't paralyse me so much. I definitely see improvement."
The quotes come from messages and emails I received after asking on Instagram @psychoedu_ how people experience generalised anxiety disorder. The individuals gave permission to anonymously publish excerpts from their statements.