Generalized Anxiety Disorder (GAD)

Generalized anxiety disorder (GAD) is an anxiety disorder characterized by excessive, uncontrollable and often irrational worry about events or activities. This excessive worry often interferes with daily functioning, and sufferers are overly concerned about everyday matters such as health issues, money, death, family problems, friendship problems, interpersonal relationship problems, or work difficulties.

Individuals may exhibit a variety of physical symptoms, including:

Feeling tired
Fidgeting
Headaches
Numbness in hands and feet
Muscle tension
Difficulty swallowing
Upset stomach, vomiting or diarrhea
Breathing difficulty
Difficulty concentrating
Trembling
Irritability and restlessness
Sleeping difficulties
Hot flashes and sweating
Rashes
These symptoms must be consistent and ongoing, persisting at least six months, for a formal diagnosis of GAD.

Standardized rating scales such as GAD-7 can be used to assess severity of GAD symptoms.

Prevalence
Globally
4% are affected at some point in their life.

GAD is seen in women twice as much as men.

USA
GAD is the most common cause of disability in the workplace in the United States.

United States: approx. 3.1 percent of people age 18 and over in a given year (9.5 million)

UK
5.9 percent of adults were affected by GAD in 2019.

Other
Australia: 3 percent of adults
Canada: 2.5 percent
Italy: 2.9 percent
Taiwan: 0.4 percent
The usual age of onset is variable, from childhood to late adulthood, with the median age of onset being approximately 31 and mean age of onset is 32.7. Most studies find that GAD is associated with an earlier and more gradual onset than the other anxiety disorders. The prevalence of GAD in children is approximately 3%; the prevalence in adolescents is reported as high as 10.8%. When GAD appears in children and adolescents, it typically begins around 8 to 9 years of age.

Risk Factors
Genetics
Genes are attributed to about a third of general anxiety disorder’s variance. Individuals with a genetic predisposition for GAD are more likely to develop GAD, especially in response to a life stressor.

Substance-induced
Long-term use of benzodiazepines can worsen underlying anxiety, with evidence that reduction of benzodiazepines can lead to a diminishment of anxiety symptoms. Similarly, long-term alcohol use is associated with anxiety disorders, with evidence that prolonged abstinence can result in a disappearance of anxiety symptoms. However, it can take up to two years for anxiety symptoms to return to baseline in about a quarter of people recovering from alcoholism.

In one study in 1988–90, illness in approximately half of patients attending mental health services at British hospital psychiatric clinic, for conditions such as panic disorder or social phobia, was determined to be the result of alcohol or benzodiazepine dependence. In these patients, anxiety symptoms, while worsening initially during the withdrawal phase, disappeared with abstinence from benzodiazepines or alcohol. Sometimes anxiety pre-existed alcohol or benzodiazepine dependence, but the dependence was acting to keep the anxiety disorders going and could progressively make them worse. Recovery from benzodiazepines tends to take a lot longer than recovery from alcohol, but people can regain their previous good health.

Tobacco smoking has been established as a risk factor for developing anxiety disorders. Neurotransmitter systems, inflammation, oxidative stress, mitochondria dysfunction and neurogenesis are affected by exposure to cigarette smoke which are all pathways thought to be associated with GAD.

Excessive caffeine use has also been linked to aggravating and maintaining anxiety. This is due to overactivation of the sympathetic nervous system

Gender
Women are twice as likely to develop GAD as men. This is primarily because women are more likely than men to live in poverty, be subject to discrimination, and be sexually and physically abused.

Oppression
Populations with a higher rate of diagnosis of GAD are individuals that are traditionally oppressed. This includes individuals with low and middle socio-economic status, separated, divorced, low levels of education, unemployed and widowed individuals.

African Americans have significantly higher odds of enduring GAD and the disorder often manifests itself in different patterns.

GAD is also common in the elderly population.

Low self esteem, disrupted family environments and sexual abuse also increase the risk of GAD.

Pathophysiology
Generalized anxiety disorder has been linked to disrupted functional connectivity of the amygdala and its processing of fear and anxiety. Sensory information enters the amygdala through the nuclei of the basolateral complex (consisting of lateral, basal and accessory basal nuclei). The basolateral complex processes the sensory-related fear memories and communicates their threat importance to memory and sensory processing elsewhere in the brain, such as the medial prefrontal cortex and sensory cortices.

Another area, the adjacent central nucleus of the amygdala, controls species-specific fear responses in its connections to the brainstem, hypothalamus and cerebellum areas. In those with generalized anxiety disorder, these connections seem less functionally distinct, and there is greater gray matter in the central nucleus. Another difference is that the amygdala areas have decreased connectivity with the insula and cingulate areas that control general stimulus salience, while having greater connectivity with the parietal cortex and prefrontal cortex circuits that underlie executive functions. The latter suggests a compensation strategy for dysfunctional amygdala processing of anxiety. This is consistent with cognitive theories that suggest the use in this disorder of attempts to reduce the involvement of emotions with compensatory cognitive strategies.

Prevention
Mental disorders are difficult to prevent, but many techniques are available to help relieve and manage anxiety.

Physical Activity
Physical activity promotes the production of endorphins, triggering positive feelings including euphoria and feelings of pleasure.

Increased core temperature can help to relax muscles.

Meditation
Many sufferers have found ease by relaxation exercises, deep breathing practice, and meditation. Meditation has been found to increase attention and awareness.

Diet
Foods high in Omega-3 including Oily Fish such as Salmon and Mackerel reduce the inflammatory response and so helps to increase serotonin availability.

Foods containing Vitamin B-12 and Folate have been shown to increase levels of neurotransmitters which are lacking in patients with GAD e.g. Epinephrine, Serotonin and Dopamine. Food containing high levels of Vitamin B12 include dairy products and fortified cereals. High folate levels can be found in leafy green vegetables including broccoli and peas.

Other
Additionally, avoidance of caffeine may prevent GAD.

Avoiding nicotine also can decrease the risk for the development of anxiety disorders including generalized anxiety disorder.

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