Generalized Anxiety Disorder
Anxiety disorders are the most common mental illnesses in the US. Here is a review of studies and literature posted on generalized anxiety disorder.
Note: I wrote this paper on generalized anxiety disorder for my PSYC 430 class. I wanted to post it on here, as anxiety affects multitudes of individuals that struggle with addiction.
Aaron Emerson
School of Behavioral Sciences, Liberty University
PSYC 430: Abnormal Psychology
Professor Cindy Bremer
October 11, 2024
Generalized Anxiety Disorder
Anxiety is a mental health disorder that affects people from all walks of life. Anxiety disorders are the most common mental illnesses in the United States, affecting up to 19% of the population (National Alliance on Mental Illness, 2024). In the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5), there are seven distinct anxiety disorders that are defined by the American Psychiatric Association, not including substance induced anxiety disorders or anxiety disorder due to another medical condition. The most common diagnosis is generalized anxiety disorder (GAD). The key features of GAD include excessive and persistent worry about life events such as work or school performance that occurs on a routine basis for at least six months (American Psychiatric Association, 2013). The worry is often associated with symptoms such as restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbances.
GAD is a psychological disorder with a 12-month prevalence of 2.9% among adults in the United States and 0.9% among adolescents, according to the DSM-5. In 2019, data from the National Health Interview Survey showed that over 15% of US adults experienced anxiety symptoms over a two-week period. 9.5% experienced mild symptoms of anxiety, 3.4% experienced moderate symptoms, and 2.7% experienced severe symptoms. Those findings were based on a self-report screen using the GAD-7 scale (Terlizzi & Villarroel, 2020). The survey showed that anxiety symptoms decreased with age, as 19.5% of adults aged 18-29 experienced anxiety symptoms, while 16.6% aged 30-44, and 15.2% aged 45-64 reported anxiety symptoms.
Anxiety is not a new diagnosis or issue, though GAD is a relatively new term. Over the last three centuries, it has been referred to in the medical profession as pantophobia and anxiety neurosis at different times. GAD first appeared as a diagnostic category in 1980 in the third edition of the DSM when anxiety neurosis was split into GAD and panic disorder (Crocq, 2017). They started to distinguish the two disorders due to distinct responses they had to imipramine therapy.
Causes
To evaluate the causes of anxiety, it is important to first break down how anxiety works in the nervous system. Fear and anxiety share similar traits but have separate mechanisms in the brain with distinct neurobiology, existing along a continuum that ranges from typical to pathological and are both influenced by various individual and environmental factors (Jennings, 2023). Both anxiety and fear responses developed through evolution over time and are characterized by how individuals differentiate experiences as being either threatening or non-threatening. The human nervous system is designed to respond to threats to safeguard survival and produces physiological changes that impact perception on an individual level. Commonly referred to as the fight-or-flight response, a stressor sends signals to the amygdala – located in the brain’s limbic system – which then sends a “distress” signal to the hypothalamus (LeWine, 2024). The hypothalamus acts as a command center and communicates with the body’s autonomic nervous system. The autonomic nervous system controls breathing, heart rate, blood pressure, and other bodily functions that contribute to anxiety. That is why anxiety can make someone feel like their heart is beating through their chest, experience sweaty palms, or feel the need to pace a room.
Considering the nervous system’s response to anxiety and fear, the question that looms large is this: if every brain experiences stressors the same way, why are some individuals more prone to developing anxiety disorders that impact their daily lives? One explanation is that repeated childhood stressors or exposure to trauma, abuse, or family instability increases the likelihood of developing a more flawed physiological stress response system (McLaughlin et al., 2010). Genetics can also play a factor in developing an anxiety disorder, and predisposing factors resulting from gene-environment interactions during childhood are thought to be contributors (Steimer, 2002). However, anxiety is one of the most challenging mental health disorders to study from a genetic standpoint due to anxiety being a universal experience. Pinpointing the heritable link that distinguishes typical anxiety from a diagnosable anxiety disorder is complex (Smoller, 2020). One study, though, found that GAD diagnoses are much more common in the children of parents that have been previously diagnosed with GAD. The population-based family study showed a significant odds ratio – ranging from 2.1 to 2.6 odds – for GAD diagnoses in children of parents with GAD (Gottschalk & Domschke, 2017).
Treatment
With GAD being such a widely diagnosed mental disorder, there have been many treatment methods to help address it, such as therapy, mindfulness techniques, and medications. A meta-analysis investigated evidence-based psychotherapies and medications most often used to treat GAD. 79 randomized-controlled trials that included over 11,000 participants with GAD diagnoses were included in the meta-analysis. Psychotherapy showed a medium to large effect size and medication showed a small effect size (g = 0.76 compared to g = 0.38) on outcomes (Carl et al., 2019).
One of the most widely used treatments is cognitive-behavioral treatment (CBT), which helps individuals with GAD confront the worries they struggle with. It seeks to change the thought process that anxiety patients often have, such as negative thinking and catastrophizing thoughts, in hopes of helping them develop better coping strategies and more positive thinking patterns (Jennings, 2023). In a meta-analysis of 65 studies that included 5,048 participants, traditional CBT was measured against third-wave CBT and relaxation therapy and was found to be much more effective long-term (Papola et al., 2023).
Medication is often used to treat GAD and is typically recommended to be combined with psychotherapy. Some of the most common medications used to treat anxiety include benzodiazepines, antidepressants, buspirone, and hydroxyzine. Benzodiazepines such as Xanax, Librium, and Valium provide short-term relief but are associated with addictiveness and abuse risks (Longo & Johnson, 2000). Antidepressants commonly used to treat GAD include SSRIs and SNRIs such as Lexapro, Cymbalta, and Effexor. Authors of a literature review posted in a pharmacotherapy journal suggested that SSRIs and SNRIs represent first-line treatment for adults with GAD, while buspirone, benzodiazepines, SGAs, and pregabalin should be used when SSRI’s and SNRI’s have not worked (Strawn et al., 2018).
Sociocultural Factors
Biological, cultural, and environmental factors can influence how an individual experiences emotions. GAD is more commonly diagnosed among women, with prevalence rates among women and adolescent girls at least twice as likely as men and adolescent boys. Individuals of European descent are more likely to exhibit GAD diagnostic criteria than individuals of Asian and African descent, while people from high-income countries are more likely to report GAD symptoms (American Psychiatric Association, 2013). One study assessed prevalence rates of anxiety disorders in the United States and found that Asian Americans consistently expressed symptoms of anxiety disorders less frequently than all other racial groups (Hofmann & Hinton, 2014). It also found that White Americans were significantly more likely to mark symptoms of anxiety than the three studied minority groups. 8.6% of White Americans (N = 6,870) endorsed GAD symptoms compared to 4.9% of African Americans (N = 4,598), 5.8% of Hispanic Americans (N = 3,615), and 2.4% of Asian Americans (N = 1,628).
Conclusion
Anxiety affects just about every individual in some way, whether it is a diagnosable disorder that cripples an individual’s ability to function or just a passing moment of worry that throws off someone’s presentation at work. Everyone can identify with the feeling of being anxious and sometimes a person can struggle with it and not even know they have a mental health disorder. As an evolving world becomes more conscious of the effects of untreated mental health, it is likely that GAD treatment will become even more common. Thankfully, treatment for GAD is advancing and so is our knowledge of how our body responds to fear and anxiety. It is also likely that studies of how anxiety impacted multitudes of school students and individuals in the workplace during the Covid-19 pandemic will bring more awareness to how GAD can develop from chronic stress. It will be vital to examine future trends in research and treatment to continue expanding our knowledge of GAD.
References
-American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
-Carl, E., Witcraft, S. M., Kauffman, B. Y., Gillespie, E. M., Becker, E. S., Cuijpers, P., Van Ameringen, M., Smits, J. A., & Powers, M. B. (2019). Psychological and pharmacological treatments for generalized anxiety disorder (GAD): A meta-analysis of randomized controlled trials. Cognitive Behaviour Therapy, 49(1), 1–21. https://doi.org/10.1080/16506073.2018.1560358
-Crocq, M.-A. (2017). The history of generalized anxiety disorder as a diagnostic category. Dialogues in Clinical Neuroscience, 19(2), 107–116. https://doi.org/10.31887/dcns.2017.19.2/macrocq
-Gottschalk, M. G., & Domschke, K. (2017). Genetics of generalized anxiety disorder and related traits. Dialogues in Clinical Neuroscience, 19(2), 159–168. https://doi.org/10.31887/dcns.2017.19.2/kdomschke
-Hofmann, S. G., & Hinton, D. E. (2014). Cross-cultural aspects of anxiety disorders. Current Psychiatry Reports, 16(6). https://doi.org/10.1007/s11920-014-0450-3
-Jennings, H. (2023). Nolen-Hoeksema’s abnormal psychology (9th ed.) McGraw Hill.
-LeWine, H. E. (2024, April 3). Understanding the stress response. Harvard Health. https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response
-Longo, L., & Johnson, B. (2000, April 1). Addiction: Part I. Benzodiazepines—Side Effects, Abuse Risk and Alternatives. American Family Physician. https://www.aafp.org/pubs/afp/issues/2000/0401/p2121.html
-McLaughlin, K. A., Kubzansky, L. D., Dunn, E. C., Waldinger, R., Vaillant, G., & Koenen, K. C. (2010). Childhood social environment, emotional reactivity to stress, and mood and anxiety disorders across the life course. Depression and Anxiety, 27(12), 1087–1094. https://doi.org/10.1002/da.20762
-National Alliance on Mental Illness. (2024, August 9). Anxiety disorders. NAMI. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Anxiety-Disorders/
-Papola, D., Miguel, C., & Mazzaglia, M. (2023). Psychotherapies for Generalized Anxiety Disorder in Adults. JAMA Psychiatry. https://doi.org/ https://doi:10.1001/jamapsychiatry.2023.3971
-Smoller, J. W. (2020). Anxiety genetics goes genomic. American Journal of Psychiatry, 177(3), 190–194. https://doi.org/10.1176/appi.ajp.2020.20010038
-Steimer, T. (2002). The biology of fear- and anxiety-related behaviors. Dialogues in Clinical Neuroscience, 4(3), 231–249. https://doi.org/10.31887/dcns.2002.4.3/tsteimer
-Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2018). Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: An evidence-based treatment review. Expert Opinion on Pharmacotherapy, 19(10), 1057–1070. https://doi.org/10.1080/14656566.2018.1491966
-Terlizzi, E. P., & Villarroel, M. A. (2020). Symptoms of generalized anxiety disorder among adults: United States, 2019. National Center for Health Statistics, 378. https://doi.org/https://www.cdc.gov/nchs/products/databriefs/db378.htm