Living with
Generalised Anxiety Disorder

What is generalised anxiety disorder (GAD)?

To some extent we all worry. It is part of daily life to worry about relationships, deadlines, or arriving on time for an interview. However, some people experience excessive and unrealistic worry that interferes significantly with work or social functioning which may be a sign that they have generalised anxiety disorder (GAD).

How do you know you have GAD?

Symptoms of generalised anxiety disorder may vary but can include:

• Being prone to expecting the worst, even when there is no apparent reason for it.
• The worry is constant and occurs on most days for at least six months.
• Worrying generally concerns health, family, money or work-related issues.
• The excessive worry interferes with all aspects of functioning and everyday living.
• Physical symptoms commonly associated with GAD are restlessness, irritability, muscle tension, fatigue, difficulty sleeping and difficulty concentrating. Trembling, sweating, headaches or migraine, being easily startled and experiencing an upset stomach (diarrhoea or nausea, as commonly related to irritable bowel syndrome, known as IBS) are also common symptoms of GAD.
• Cognitive symptoms include difficulty controlling the worrisome thoughts.

It is possible to develop generalised anxiety disorder as a child or a young adult.
Children and teenagers with GAD may have similar symptoms to adults, but may also experience unique worries, typically about:

• Academic performance at school or their performance in extra-curricular activities like sports. They may require a lot of reassurance to start an activity or to affirm that they are performing well. They will strive for parental approval or praise from their teachers.
• The safety and health of their family members, loved ones and friends.
• Always having to be on time (punctuality).
• Natural disasters or catastrophic events like earthquakes, nuclear war or an asteroid strike.
• That they “don’t fit in”.
• “Perfection” in schoolwork and they may spend more time than they should doing homework or checking redoing their work.
• Additionally, they may experience regular stomach aches, and/or,
• Try to avoid going to school or avoid social situations that are new.

What is the difference between GAD and normal worry, and is there a link to depression?

The distinction between normal worry and GAD rests on the extent of distress and dysfunction associated with the symptoms.
The worries of GAD are more pronounced, more pervasive and more likely associated with physical symptoms than are ordinary worries. Symptoms of GAD last at least six months.

Many people with GAD also have depressed mood. GAD tends to be chronic and a large percentage of these patients go on to develop major depressive disorder.

What causes generalised anxiety disorder?

GAD is a fairly common condition, with as much as 25 % of patients at anxiety clinics presenting with GAD. The condition is present in about 3-8 % of the population an the onset of the disorder is typically around late adolescence or early adulthood.

The risk factors for developing GAD are:

• Gender: Women are twice as likely to develop GAD than men.
• Childhood trauma: There is significant evidence to suggest that children who have suffered abuse or neglect may develop GAD at some point later in life.
• Illness: Living with a chronic or serious illness (like heart disease, cancer or HIV, for example) or other mental health conditions (typically phobias, panic disorder, obsessive compulsive disorder, post-traumatic stress disorder or depression) can lead to excessive worry about the future.
• Stress: People who experience a lot of stress in their lives are also likely to experience excessive worry.
• Personality: People with certain personality types are more prone to anxiety disorders than others. A person who is shy or who thinks less positively about situations is more likely to develop GAD.
• Genetics: Evidence suggests that members of some families may be more prone to developing GAD.
• Substances: Drugs, alcohol, nicotine, caffeine or certain medications may increase the risk of GAD.

How is GAD diagnosed?

If you think you are worrying excessively and feel your worry and anxiety interferes with your daily life, or you depend on alcohol or other substances to reduce your feelings of worry, then contact your doctor or a mental health professional for help as you may have GAD.
The earlier you get help, the easier GAD is to treat and manage, so be open and honest with your doctor or mental health professional.

Your doctor may diagnose you with GAD through one or more of the following ways:

• Physical examination and history taking: Your doctor can look for physical signs of underlying medical conditions that can cause GAD or depression, such as signs of thyroid disease.
  Additionally, they may look for physical symptoms of GAD such as sweating or trembling. While talking and interacting with a patient, a doctor can also observe their behaviour and general mood and ask questions about their general daily-life experience.
• Laboratory tests (blood tests): Your doctor can check for hormone and vitamin levels in the blood. This can show if you have thyroid disease, for example, or vitamin D or B6 deficiencies that are also be linked to anxiety.
• Psychiatric exam: A psychiatrist or psychologist will talk with you about your thoughts, feelings and mood. They may use a questionnaire to help them. They will also determine whether you have any other mental health condition, like depression or post-traumatic stress disorder, that are associated with GAD. They may also want to talk to your family or people you live with to determine your everyday functioning.
• DSM-5: Your doctor or mental health professional may use the criteria for GAD listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association (these are the symptoms listed earlier).

What treatment is available for generalised anxiety syndrome?

Two types of treatment are available for GAD, namely medication and psychotherapy (talk therapy). As with most other disorders, a combination of the two is more beneficial.

Since this is probably a long-term condition which often requires life-long treatment, the prescription of medication should be approached carefully.
Antidepressants, which influence the activity of brain chemicals (neurotransmitters) in the body, are available, while anti-anxiety medication can also be used.
However, sedatives are usually only prescribed on a short-term basis as they have a risk of dependence.

Psychotherapy: People with GAD can be seen as viewing the world through a lens which colours everything with negative predictions. Psychotherapy focuses on attempting to change this perspective.
A type of psychotherapy, cognitive behavioural therapy (CBT) includes self-monitoring and cognitive restructuring.
Self-monitoring involves paying closer attention to one’s thoughts and feelings. This technique is useful in demonstrating to oneself the connection between irrational fearful thoughts about the future and feelings of anxiety.
Cognitive restructuring, on the other hand, involves providing good counter-arguments which dispel the logic of fear and worry found in GAD. Common cognitive distortions in GAD include probability overestimation, catastrophising, and “all or nothing” thinking. Overcoming such distortions requires the help of a mental health professional.

Living and managing

• Keep a journal: This is a useful way to identify the stressors in your life and can be beneficial to your therapy. Identifying what may be worrying can help you feel better.
• Set up schedules and prioritise tasks in your life: This may help to manage your time and energy more efficiently and to help you focus.
• Avoid unhealthy substance use: Keep alcohol consumption in moderation and avoid drug use. Drinking alcohol and using tobacco products make you more anxious, and quitting can reduce this impact.
  Speak to your doctor or mental health professional about ways to quit smoking or drinking alcohol if you think you are addicted.
• See your doctor or find a support group to get more resources to help you cope and to reduce any negative feelings or stigma you may feel about having GAD.
  Find out more about anxiety on Let’s Talk. You can find resources that you may find useful in helping to manage stress and stay positive. You can also find out about where to get help if you are struggling to cope and need someone to talk to

What are the complications associated with GAD?

Other physical health conditions are more common if you have GAD and GAD is more likely to make the symptoms worse for the following:

• Digestive or bowel problems, such as irritable bowel syndrome or gastric ulcers
• Headaches and migraines
• Chronic pain
• Insomnia
• Chronic diseases of lifestyle, especially heart disease, high blood pressure and diabetes.