Generalised Anxiety Disorder

INTRODUCTION

If you find “worry’ uncontrollable, you may be suffering Generalized Anxiety Disorder (GAD). The defining features of GAD are excessive anxiety occurring more days than not that is difficult to control. The worry is time consuming and a significant impairment in occupational and social functioning occurs. Often, it is related to several topics or circumstances in the remote future, the perceived outcome is often negative or disastrous. Common worry themes are listed in Table 1. These themes are common to all at sometime, however, in non-sufferers control over the worry occurs and there is an absence of impairment.

OTHER SYMPTOMS OF GAD

Symptoms of chronic worry in GAD are associated with a number of somatic or bodily symptoms, (see Table 2). For the diagnosis of GAD, three or more of these symptoms must occur. Irritability, insomnia, fatigue and restlessness are the most common. Symptoms of autonomic arousal, such as palpitations, sweating and trembling are often experienced. Chest pain, nausea and breathing difficulties also occur. Some experience depersonalisation, the feeling of being detached from oneself or derealisation, the feeling of being detached from the external world.

Course, gender and onset

Chronicity is the norm for GAD with studies reporting that only 18-25% obtain a remission. Symptoms typically wax and wane with an exacerbation occurring in times of stress. GAD occurs approximately twice more often in females than in males with onset most commonly occurring between 18 – 25 years of age. The precise time of onset is often difficult to ascertain as many with GAD report an early susceptibility to worry and up to 50% have a prior anxiety disorder. Onset is often insidious although in later life, when GAD is a common presentation, onset may occur in response to a major life change.

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