Experiencing some degree of anxiety is a normal aspect of life. If those transient feelings become excessive, chronic, or interfere with a person’s ability to function effectively, a generalized anxiety disorder may be present. Patients with GAD tend to fret about almost anything that might happen in the future. They may even worry about being worried. They can become preoccupied with their physical health or just feel tired all the time for no reason.
A GAD patient’s perceived trigger of the anxiety can also vary from time to time and is often susceptible to daily events, such as world news, personal losses, or any kind of change—both positive and negative. Children and adolescents may focus on school performance, nuclear war, need for approval, or perfectionism, while older adults may become apprehensive about memory slips and physical decline.
DO YOU HAVE GAD GENERALIZED ANXIETY DISORDER?
Ask yourself if you have any of the following symptoms. If you find yourself checking off several of the boxes, GAD may be the source of your unease.
- easily startled
- chronic fatigue
- trouble concentrating
- persistent rumination
- muscle tension
Bruce knew me from when I treated his father for Alzheimer’s disease, and when he absolutely couldn’t stand his symptoms anymore, he sought me out and made an appointment. As I listened to him describe his anxiety symptoms, a diagnosis of generalized anxiety disorder seemed like a no-brainer, but there were other possible contributing factors to rule out first. Bruce’s attempt at meditation failed because he was too easily distracted whenever he tried it, which could have indicated an attention deficit disorder. His shortness of breath and episodic nature of his symptoms suggested possible panic attacks.
DIAGNOSTIC FEATURES OF GENERALIZED ANXIETY DISORDER
- excessive anxiety and worry
- difficulty controlling worry
- three or more of the following:
- feeling restless, edgy, or keyed up
- often tired
- trouble concentrating or mind going blank
- muscle tension
- sleep problems
- cause significant stress or interfere with social or occupational functioning and
- can’t be explained by another physical or mental problem.
However, after getting a more detailed history of what he’d been experiencing, GAD was the most likely diagnosis. Bruce’s free-floating anxiety drifted from one concern to the next, and that had become his standard mental state. He had gotten used to it, and it seemed like no matter what he did in life, in the back of his mind, there was always a concern that things could go wrong at any moment. We reviewed the diagnostic criteria for a GAD diagnosis, and Bruce met almost every one.
Symptoms of generalized anxiety disorder vary among individuals, and sometimes patients have features of several anxiety disorders simultaneously. Bruce had trouble controlling his anxiety throughout the day, and even when he enjoyed a momentary reprieve from worry, he would fret about when the next bad thing would occur. This anticipatory quality of worry differentiates it from fear, which is a distressing emotion triggered by impending danger rather concern about some future hypothetical event.
IS IT REALLY GAD (GENERALIZED ANXIETY DISORDER) OR SOMETHING ELSE?
Although Bruce’s symptoms were typical of a generalized anxiety disorder, sometimes another psychiatric disorder or medical illness may be causing the symptom cluster or syndrome. Many patients who have major depression also experience anxiety symptoms. They too suffer from irritability, insomnia, anxiety, and fatigue, and this may be why Bruce’s internist thought it was depression. Also, many GAD symptoms overlap with other anxiety disorders, such as social anxiety and panic disorder.
Bruce did not appear depressed to me, and he didn’t have other features typical of major depression like appetite loss or feelings of guilt. Also, his insomnia was more representative of an anxiety disorder than depression—he had trouble falling asleep at bedtime, whereas depressed people complain of awakening in the middle of the night or too early in the morning and being unable to fall back to sleep.
When I questioned Bruce about panic attacks, it didn’t seem like a big issue for him. Social anxiety didn’t appear to be the problem either—Bruce felt comfortable with friends and family and even meeting new people occasionally, despite his natural distrust of strangers.
Physical symptoms, including intermittent shortness of breath, fatigue, dizziness, and upset stomach, are common in generalized anxiety disorder, and Bruce had several physical complaints. Sometimes physical illnesses can trigger anxiety symptoms and can be the underlying cause of many anxiety disorder symptoms. I conferred with Bruce’s internist, and we made sure that his laboratory tests were up to date. In older or middle-aged individuals like Bruce, I am particularly concerned about physical or mental symptoms being a clue to an underlying medical condition because age increases a person’s risk of medical illnesses such as cancer, diabetes, and heart disease. We ran some blood tests, checked his cardiogram, and determined that no physical illnesses could explain Bruce’s symptoms.
PHYSICAL SYMPTOMS OF GENERALIZED ANXIETY
- muscular pain, tension
- tightness of muscles
- ringing in the ears
- chest pain
- trembling and shaking
- shortness of breath
- numbness and tingling
- rapid heart rate
- upset stomach
In Bruce’s case, his attempts at self-help strategies seemed to backfire. After trying both mindfulness and transcendental meditation on his own, he gave up on meditation because it just made him feel more anxious and left him feeling like a failure. When I suggested an anxiety medicine, Bruce was afraid to try it because of the bad reaction he had to the antidepressant. He wanted to try everything else before turning to meds.