History
Anxiety was first recognized as a medical diagnostic entity in the late 1800s. In the early 1900s, Sigmund Freud recognized anxiety as a central component of mental diseases, and the term "anxiety neurosis" was developed to describe a variety of types of anxiety. It was not until 1980, however, that generalized anxiety disorder (GAD) was first identified as a diagnostic entity in the DSM IV, GAD was changed from a category describing individuals who do not fit other anxiety categories to a well-defined condition with sound diagnostic criteria (Roerig,
Statistics
"About 4: million adult Americans suffer from [Generalized Anxiety Disorder] during the course of a year" (Web Md 2006). The disorder is twice as common in women as in men and ussually has its first onset in adolescence or childhood but can first occur in adults over twenty (Roerig, 2006) Furthermore the University of Ohio presents the following statistics regarding prevalence: ina community sample, the 1-year prevalence rate for Generalized Anxiety Disorder was approximately 3% and the lifetime prevalence rate was 5%. In anxiety disorder clinics, approximately 12% of the individuals present with Generalized Anxiety Disorder (OSU 2006). This does not in itself display an alarming statistic of prevalence, however, it is important to compare this to the DSM III statistics that found generalized anxietydisorder to be a relatively rare current disorder with a currentprevalence of 1.6% (JAMA 1994).
Comparing these statistics would indicate an increase in rates of prevalence-this along with the high number of people aflicted with GAD is of concern because it can become maladaptive because an individual with the disorder may reach a point where the anxiety so dominates their thinking that it interferes with daily functioning, including work, school, social activities and relationships (Canadian Journal of Psychiatry 2006).
Characteristics
We could simply say that GAD is diagnosed when a person worries excessively about a variety of everyday problems for at least 6 months (NIMH 2006), however the DSM IV gives specific criteria for diagnoses. The essential feature of Generalized Anxiety Disorder by the DSM criteria "is excessive anxiety and worry (apprehensive expectation), occurring more days than not for a period of at least 6 months, about a number of events or activities" (OSU 2006). To accurately diagnose Generalized anxiety disorder, the following standard is used. The individual finds it difficult to control the worry; The anxiety and worry are accompanied by at least three additional symptoms from a list that includes restlessness, being easily fatigued, difficulty concentrating, irritability, muscle tension, and disturbed sleep; The focus of the anxiety and worry is not confined to features of another Axis I disorder such as a phobia or panic disorder; The worries are excessive in that they impair the individual's social and occupational functioning; and The intensity, duration, or frequency of the anxiety and worry is far out of proportion to the actual likelihood or impact of the feared event. (OSU 2006).
Axis designation
Generalized anxiety disorder is classified as an axis 1 disorder because it is under the Axis I heading of anxiety didorders, however an individual with GAD may come to the attention of a clinition because of symptoms related to Axis I, II, or III. Because GAD has such far reaching affects, a person may seek help because of cognative issues, physical issues , or family and work related problems that all stem from the disorder.
Treatment
There are numerous forms of treatment for Generalized Anxiety disorder; they include Cognitive-behavioral therapy, psychotherapy, medication, and biofeedback (JAMA 2006). Psychotherapy for GAD is oriented toward combating the patient's low-level, persistent anxiety. Anxiety problems are often accompanied by poor planning skills, high stress levels, and difficulty in relaxing-this is where psychotherapy is beneficial because it allows the therapist to play an effective role in teaching coping skills (Grohol 2004). Cognitive-behavioral therapy is used to aid the patient in recognizing triggers and learning to recognize anxious thoughts as they occur so that the individual will see that the fears are irrational and learn to change their behavior (UMMC 2006).
Several different medications are also used to treat generalized anxiety disorder such as benzodiazepines, buspirone, and extended-release venlafaxine (Roerig, 2006). The most common form of medical treatment is the use of benzodiazepines or "tranquilizers which decreas the physical symptoms of GAD, such as muscle tension and restlessness, but in doing so cause sedation (Web Md 2006).
One option that connects medical and psychotheraputic treatment is biofeedback. Biofeedback allows the patiant to see or hear their bodilly reactions to anxiety such as muscle tension through the use of a machine that picks up electrical signals in the muscles. Feedback of physical responses such as skin temperature and muscle tension provides information to help patients recognize a relaxed state and potentially learn how to relax (Runck 2006).
prognosis
The prognosis for those with generalized anxiety disorder depends on multiple factors. One factor is the severity of the symptoms-some people may have stronger symptoms than others and thus be less receptive to treatment. Also the type of treatment used is important in terms of the outcome; for some people therapy will work best while others will do better with medication, which leads to the other important factor-money. Sometimes it's true in our society that those who are healthy are those who can afford it, and if someone needs medication that they can't afford, the prognosis isn't good. I think though that the most important factor is the person's will to get better, because whatever the treatment, it won't work with a person who won't work with it.
References
Canadian Journal of Psychiatry;
Generalized Anxiety Disorder
Jul2006 Supplement 2, Vol. 51, p51S - 55S, 5p
http://proxy01.ccis.edu:2255/login.aspx?direct=true&db=pbh&AN=
21923482&site=ehost-live
Grohol, John, M. Psy.D.
Psych Central
Generalized Anxiety Disorder Treatment
http://psychcentral.com/disorders/sx24t.htm
Journal of the American Medical Association
Archives of General Psychiatry
DSM-III-R generalized anxiety disorder in the National Comorbidity Survey
Vol. 51 No 5. May 1994
http://archpsyc.ama-assn.org/cgi/content/abstract/51/5/355
National Institute of Mental Health: Anxiety Disorders
http://www.nimh.nih.gov/Publicat/anxiety.cfm#anx7
Ohio State University
Anxiety and Stress Disorders Clinic
DSM IV criteria
http://anxiety.psy.ohio-state.edu/gad-dsm-.htm
Pace, Brian, MA
Journal of the American Medical Association
Generalized Anxiety Disorder
http://jama.ama-assn.org/cgi/reprint/283/23/3156.pdf
Roerig, James L.
Diagnosis and Management of Generalized Anxiety Disorder
Journal of the American Pharmaceutical Association
www.medscape.com/viewarticle/406674
Runck, Bette
National Institute of Mental Health
Biofeedback
http://psychotherapy.com/bio.html
University of Maryland Medical Center
Psychotherapeutic and Other Non-Drug Approaches to Anxiety Disorders
http://www.umm.edu/patiented/articles/what_psychotherapeutic_other_non-
drug_approaches_anxiety_disorder_000028_8.htm
Web MD
http://www.webmd.com/content/article/60/67148
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