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Anxiety disorder with manifestations of generalized anxiety. Generalized anxiety disorder: symptoms, treatment

Generalized anxiety disorder or generalized anxiety disorder is a disorder characterized by diffuse and chronic worry. Unlike people with phobias or PTSD, people with generalized anxiety disorder do not have anxiety caused by specific triggers; they may be disturbed by something related to ordinary life. Patients diagnosed with generalized anxiety disorder often shift the focus of their anxiety from one problem to another as their daily circumstances change.

What is a generalized disorder characterized by?

Generalized anxiety disorder is characterized by constant worry and fear that is excessive and difficult to control. Common problems associated with generalized anxiety disorder include work, money, health, safety, and household chores. The anxiety typical of this condition often depends on a large number of problems and is related to the person's environment.

A patient diagnosed with generalized anxiety disorder usually recognizes that their anxiety is disproportionate in duration or intensity to the actual likelihood or impact of a dangerous situation or event. Anxiety levels in people with this condition may rise and fall over a period of weeks or months, but tend to become a chronic problem. The disorder usually worsens during stressful periods.

What are the symptoms of generalized anxiety disorder

Work, family life, social activities, or other areas of a person's functioning are the main criteria for the manifestation of symptoms of generalized anxiety disorder. Diagnostic manuals for psychiatrists mention physical symptoms such as insomnia, muscle pain, headaches, indigestion, etc. Common symptoms in an adult include anxiety, fatigue, difficulty concentrating, irritability, high muscle tension and sleep disturbances.

Patients diagnosed with generalized anxiety disorder have a high incidence of concurrent (accompanying) psychiatric symptoms, especially those associated with depression, other anxiety disorders, or substance abuse. They also often have or develop stress-related physical illnesses and conditions such as headaches, irritable bowel syndrome, temporomandibular joint dysfunction, bruxism, and hypertension. In addition, the discomfort or complications associated with arthritis, diabetes, and other chronic diseases are often exacerbated by the generalized disorder. Such people are more likely to seek help from their physician than from a psychiatrist, and are also more likely than patients with other disorders to visit health care facilities, undergo extensive or repeated diagnostic testing, describe their health as very poor, and smoke or drink alcohol heavily. Additionally, patients with anxiety disorders have higher mortality rates.

Why is generalized disorder so difficult to recognize?

In many cases it is difficult for the physician to determine whether anxiety precedes or follows the physical condition of his patient; Sometimes a person develops generalized anxiety disorder after being diagnosed with a physical chronic illness. In other cases, stress caused by constant and repeated worry leads to physical illnesses and disorders. There is a general concept of a “vicious circle” in the relationship between generalized anxiety disorder and other disorders.

Generalized anxiety disorder in children

Children diagnosed with generalized anxiety disorder have the same symptoms as adults. They worry about issues that are not typical for children, such as whether the family has enough money for emergency needs, how safe it is to play on the playground, whether there is enough gas in the tank of the family car before a trip, and similar problems. Concerns also arise among children from stable and happy families who do not have serious financial or other problems.

Generalized anxiety disorder often has an insidious onset that begins relatively early, although it can be precipitated by a sudden crisis at any age. Doctors say the disease most often begins in childhood, although symptoms may not appear until adolescence or early adulthood. About half of all patients diagnosed with this disorder report that their anxiety began in childhood or adolescence. This type of constant anxiety can be considered as part of a person's temperament, or as an innate predisposition, and sometimes as an anxious feeling. However, it is not unusual for people to become anxious during their adult years in response to chronically stressful or anxiety-producing situations.

The specific experiences of a person with generalized anxiety disorder may depend on their ethnic background or culture. Some people experience dissociative symptoms when their perception of reality is temporarily altered - they may feel as if they are in a trance, or as if they are observing the activities around them but not participating in them.

What are the causes of generalized disorder

The causes of generalized anxiety disorder are a mixture of genetic and environmental factors. It is known that the disease is familial. Recent studies of the human genome point to a genetic factor in the development of generalized anxiety disorder. This has identified a gene associated with panic disorder, raising the possibility that there is a gene or genes that determine susceptibility to generalized anxiety. The role of the family environment (social modeling) in a person's susceptibility to this mental disorder is uncertain. Social modeling, the process of learning patterns of behavior and emotional response from observing parents or other adults, appears to be a more important factor for women than for men.

Social and gender factors of anxiety disorders

Another factor in the development of generalized anxiety disorder is social expectations associated with gender roles. Previous findings that women have higher levels of emotional stress and lower quality of life than men have recently been confirmed. The higher prevalence of the disease in women is associated with diffuse but pervasive expectations. Many women take on responsibility for the well-being and safety of other family members in addition to work or vocational school. The global nature of these responsibilities, as well as their inexorable nature, is described as a mirror image of the persistent but nonspecific anxiety associated with anxiety.

Socioeconomic status may also contribute to generalized anxiety. One study found that this mental disorder is more closely associated with the accumulation of minor stressors than with any demographic factors. However, people with lower socioeconomic status have fewer resources to cope with minor stressors and appear to be at greater risk for generalized anxiety.

Physiological causes of generalized anxiety disorder

Another factor in generalized anxiety disorder may be the level of muscle tension. It has been found that patients diagnosed with this disease tend to respond to physiological stress in a rigid, stereotypical manner. Their autonomic responses are similar to those of healthy individuals, but muscle tension shows a significant increase. However, it is not yet known whether the level of muscle tension is a cause or an effect of generalized anxiety disorder.

What are the symptoms of generalized disorder

The symptoms of generalized anxiety disorder have changed somewhat over time. Previously, psychiatrists did not clearly distinguish between generalized anxiety disorder and panic disorder. After specific treatments for panic disorder were developed, generalized anxiety disorder came to be considered anxiety disorder without panic attacks or major depressive symptoms. This definition turned out to be unreliable. As a result, the disease is defined in terms of psychological symptoms (excessive worry) rather than physical (muscle tension) or autonomic symptoms of anxiety.

According to the above, the symptoms of generalized anxiety are:

excessive worry and worry about a series of events or activities occurring over at least six months,
anxiety that cannot be controlled
anxiety associated with several symptoms such as anxiety, fatigue, irritability or muscle tension,
anxiety that causes problems or deterioration in relationships at work or school,
the anxiety is not caused by another anxiety disorder, such as panic disorder, social phobia or obsessive-compulsive disorder,
the anxiety is not caused by a substance (such as a drug).

symptoms associated with high levels of physiological arousal: muscle tension, irritability, fatigue, anxiety, insomnia,
symptoms associated with distorted thinking processes: poor concentration, unrealistic assessment of problems, periodic restlessness,
symptoms related to coping strategies: procrastination, avoidance, inadequate problem-solving skills.

Generalized disorders - demographics and statistics

It is difficult to compare current statistics of generalized anxiety disorder with those of the last century due to changes in diagnostic criteria for the disease. Mental health professionals say that as of 2000, approximately three percent of the total population in developed countries experience symptoms for some time. The figure for children is five percent. Women suffer from generalized anxiety disorder approximately twice as often as men. The prevalence of the disease among different ethnic groups is more difficult to determine due to cultural influences.

Diagnosis of generalized anxiety disorder

Diagnosis of generalized anxiety disorder, especially in primary care settings, is complicated by several factors. One of them is the high level of comorbidity (overlap) between this disease and other mental or physical disorders. The second is the significant overlap between anxiety disorders in general and depression. Some practitioners believe that depression and generalized anxiety cannot be separate disorders because research has repeatedly documented the existence and frequency of “mixed” anxiety/depression syndrome.

Evaluating a patient for a diagnosis of generalized anxiety disorder involves the following steps.

Conversation with the patient

The doctor asks the patient to describe the anxiety and note whether it is acute (hours to weeks) or persistent (months to years). If a patient describes a recent stressful event, the doctor will also assess for “dual anxiety,” which refers to acute anxiety that is added to persistent worry. The doctor may also have the patient fill out a diagnostic questionnaire to evaluate the presence of anxiety disorders. The Hamilton Scale is a widely used tool for assessing anxiety disorders in general. The Generalized Anxiety Disorder Questionnaire is a more recent diagnostic tool and is specific to this disorder.

Medical assessment

Non-psychiatric disorders known to cause concern should be ruled out (hyperthyroidism, Cushing's disease, mitral valve prolapse, carcinoid syndrome, and pheochromocytoma), as well as certain medications (steroids, digoxin, thyroxine, theophylline, and selective serotonin reuptake inhibitors) that may also cause anxiety as a side effect. The patient is also asked about the use of herbal medications.

Substance Abuse Assessment

Because anxiety is a common symptom of substance abuse and withdrawal symptoms, the doctor may ask about the patient's use of caffeine, nicotine, alcohol, and other substances (including medications).

Assessment of other mental disorders

This step is necessary because of the frequent overlap between generalized anxiety disorder and depression or other anxiety disorders.

In some cases, the doctor will interview the patient's family members to obtain more information about the onset of anxiety symptoms, dietary habits, etc.

Treatment for generalized anxiety disorder

There are several types of therapy that have been found effective in treating generalized anxiety disorder. Most patients with this disease are treated with a combination of medications and psychotherapy.

Medicines

Pharmacological therapy is usually prescribed for patients whose anxiety is severe enough to interfere with daily activities. Several different groups of medications are used to treat generalized anxiety disorder, which include the following.

Benzodiazepines

This group of tranquilizers does not reduce anxiety, but it reduces restlessness by reducing muscle tension and hypervigilance. They are often prescribed to patients with dual anxiety because they act very quickly. However, benzodiazepines have several disadvantages: they are not suitable for long-term therapy because they can cause dependence, they cannot be prescribed to patients who abuse alcohol, and they cause short-term memory loss and difficulty concentrating.

Tricyclic antidepressants

Imipramine, nortriptyline and desipramine are indicated in patients with generalized anxiety disorder. However, they have some problematic side effects; Imipramine has been associated with heart rhythm disturbances, and other tricyclics often cause drowsiness, dry mouth, constipation and mental confusion. They also increase the risk of falls and other accidents.

Buspirone

Buspirone is as effective as benzodiazepines and antidepressants in controlling anxiety symptoms. It is slower acting but has fewer side effects.

Selective serotonin reuptake inhibitors

Paroxetine, an SSRI, has been approved as a drug for the treatment of generalized anxiety disorder. Venlafaxine is useful for patients with mixed anxiety-depression syndrome; it is the first drug to be labeled as both an antidepressant and an anxiolytic. Venlafaxine is also effective in treating patients whose symptoms are primarily somatic.

Psychotherapy

Research shows that cognitive therapy is superior to medications and psychodynamic psychotherapy in treating this disease, but a certain number of doctors fundamentally disagree with this. Typically, people with generalized anxiety, who have a personality disorder, live with chronic social stress, or are distrustful of psychotherapeutic approaches require medication treatment. The greatest benefit of cognitive therapy is its effectiveness in helping patients evaluate their problems in more realistic ways and use better problem-solving techniques.

Alternative and complementary therapies

Several alternative and complementary methods may be useful in treating people with generalized anxiety disorder. These include hypnotherapy; music therapy; Ayurvedic medicine; yoga; meditation. Biofeedback and relaxation techniques are also recommended for patients with generalized anxiety to reduce physiological arousal. Additionally, massage therapy, hydrotherapy, shiatsu, and acupuncture relieve muscle spasms or soreness associated with this condition.

Forecast and prevention of anxiety disorders

Generalized anxiety disorder is usually viewed as a long-term condition that can become a lifelong problem. Patients often find that their symptoms flare up or worsen during stressful periods in their lives. Less commonly, people with generalized anxiety disorder recover spontaneously.

Genetic factors contributing to generalized anxiety disorder have not been fully identified. In addition, many of the stressors of modern life that raise people's anxiety levels are difficult to avoid. The best preventative strategy, given the early onset of the disease, is to model realistic parental appraisals of stressful events and teach effective steps to cope with them.

Disclaimer: The information presented in this article about generalized anxiety disorder is intended to inform the reader only. It is not intended to be a substitute for advice from a healthcare professional.

Generalized anxiety disorder (GAD) is a psychopathological condition characterized by a persistent disorder that occurs without apparent, objective reasons. This type of anxiety disorder should be discussed only in cases where the patient has been bothered by severe, unremitting anxiety for 6 months or more.

Generalized anxiety disorder today is diagnosed in approximately 3-5% of people of different ages, and women suffer from this disease 2 times more often than men. As a rule, pathology develops in a certain type of people who have suffered from increased anxiety since childhood.

The exact reasons for the development of GAD are still not known; researchers believe that it occurs in people with a predisposition or mental characteristics under the influence of risk factors.

Most often, the symptoms of the disease are diagnosed in people 20-30 years old, with an anxious personality type, who have been exposed to any negative factors.

Anxious personality type refers to one of the accentuations of character, characteristics of the nervous system and state of a person’s psyche. This type of character is formed in childhood or adolescence.

Such a person is characterized by an increased sense of anxiety, fears, phobias, self-doubt, lack of initiative, and fear of making a mistake. If a person with this type of character is exposed to psychotraumatic factors, he may develop an anxiety disorder, neurosis, or its most severe manifestation - a generalized disorder.

The following factors can cause the development of increased anxiety or anxiety disorder:

Heredity - the type of nervous system, character traits and tendency to anxiety are transmitted genetically; in the family of a person suffering from GAD, there are usually people suffering from depression and other types of nervous disorders. According to recent studies on this topic, it has been proven that in patients with GAD, the levels of certain neurotransmitters, substances that regulate the emotional state and overall functioning of the human brain, are altered in the brain. Changes in the normal level of neurotransmitters, according to scientists, may be a predisposing factor in the development of GAD, inherited or resulting from nervous pathology.
Emotional trauma - especially in childhood, traumatic situations, punishment, too strict, despotic upbringing, the death of someone close and other similar situations often become the cause of the development of anxiety in the future. Basic anxiety - a feeling of loneliness and helplessness, formed in childhood, from - due to a lack of parental attention, unstable or antisocial behavior of parents, it becomes the cause of the emergence of many complexes and disorders in the future, including as one of the predisposing factors in the development of GAD.
Severe stress - the death of loved ones, divorce, a disaster, loss of a job and other stresses can cause the development of GAD.
Diseases of the nervous system - sometimes a generalized disorder develops as a secondary pathology in individuals suffering from depression, nervous disorders and other psychopathologies.

Generalized anxiety disorder can develop in both a healthy person and someone who suffers from nervous diseases. Neither an anxious personality type nor the effects of stress and herbs on the nervous system are decisive factors in the development of the disease. The exact cause of GAD has not yet been established.

Symptoms of increased anxiety

It is not so easy to distinguish manifestations of pathological anxiety from the “normal” state of a person who worries about his loved ones, his health and other factors.

The feeling of anxiety and fear is physiological and in difficult conditions helps a person to be as attentive and careful as possible, and therefore increases his chances of survival. Pathology is a condition in which such emotions arise without good reason and interfere with the patient’s normal life.

With GAD, the distinctive features of symptoms are as follows:

Duration – anxiety, fears, tension and other symptoms torment the patient constantly for 6 months or more.
Severity - with this type of disease, anxiety interferes with all areas of the patient’s life, he constantly experiences severe tension, fear, anxiety and other unpleasant experiences.
Absence of a specific cause - pathological anxiety occurs under normal conditions, without any specific reasons or if such reasons should not cause severe anxiety.

Main symptoms of GAD:

Emotional disorders: the patient constantly feels anxiety and restlessness, and these feelings are not under control and have no specific reason. A person cannot rest normally, calm down, do normal activities or lead a normal lifestyle.
Muscle tension: hypertonicity of the muscles of the limbs, tremors, muscle pain, a “muscle helmet” type headache may occur - the head is squeezed in the back of the head and temples, muscle weakness is less often diagnosed, up to a complete loss of mobility of the limbs.
Autonomic disorders: during anxiety attacks, the patient experiences tachycardia, increased sweating, dry mouth, dizziness, and attacks of loss of consciousness. Autonomic disorders can also manifest themselves as attacks of pain in the epigastrium and intestines, a feeling of constriction and heaviness in the chest, difficulty breathing, lack of air, impaired vision, hearing, loss of balance, and so on.
Sleep disturbance: almost all patients with GAD have difficulty falling asleep, often wake up at night, have nightmares, incoherent dreams, after which they wake up exhausted and sleep-deprived.
General deterioration of the condition: often with increased anxiety, patients consider a somatic illness to be the cause of their condition. They may complain of weakness, chest or abdominal pain, and other similar symptoms. But, unlike hypochondriacal disorder, with GAD, the anxiety and fear of patients are not associated only with their condition or the supposed illness; most often, the health condition is only one of many reasons for worries, or it is they that explain the general deterioration of the condition.

How does a doctor make such a diagnosis?

It is quite difficult to identify and diagnose generalized anxiety disorder; only a specialist can distinguish between the manifestations of anxiety and pathological anxiety.

For this purpose, special scales for assessing the level of anxiety, tests, questionnaire methods, conversations with a specialist and other similar methods are used. Unfortunately, there is no unambiguous method that makes it possible to make this diagnosis with 100% certainty; it is also impossible to confirm or refute the disease using tests, ultrasound, CT and other similar methods.

It is necessary to understand that the use of even the most accurate scales, tests and other methods for assessing the level of anxiety is not a sufficient basis for making such a diagnosis on your own.

Only a qualified psychiatrist or psychotherapist, assessing the patient’s condition, his life history, after a survey and examination, can make a diagnosis of “generalized anxiety disorder”; all tests here are used only as additional assessment methods and to determine the level of anxiety.

You can suspect the presence of an anxiety disorder if the following signs are combined (to make a diagnosis, the patient must have at least 3-4 symptoms simultaneously):

Unreasonable anxiety - usually patients themselves cannot explain what is happening to them and describe their condition as “heaviness in the soul”, “constant anxiety”, “I can’t find a place for myself”, “premonition of some kind of trouble”, “something for sure” something bad is going to happen” and so on. At the same time, they are able to assess their condition quite sensibly and understand that there are no objective reasons for such experiences, but patients are not able to cope with themselves.
Impaired attention, memory and other functions of the higher nervous system - with GAD, patients have difficulty concentrating on the work at hand, they have difficulty concentrating on something, performing complex intellectual tasks, remembering new information, and so on.
General deterioration of the condition - weakness, increased fatigue, decreased performance - are necessarily present with this disease.
Sleep disturbance is also one of the characteristic symptoms of GAD.
Autonomic disorders - during attacks of fear or severe anxiety, most patients experience certain signs of autonomic disorders.
Changes in emotional state - due to constant anxiety, patients feel irritated, apathetic or show aggression; their character and behavior also change.
Muscle tension - tremors and muscle rigidity are also characteristic of GAD.

Anxiety Treatment

Treatment of generalized anxiety disorder requires the use of medication and psychotherapy.

Taking medications helps to cope with attacks of fear and anxiety, normalize sleep, mental activity, mitigate or get rid of autonomic disorders and somatic manifestations of the disease. Psychotherapy should help the patient understand the causes of the anxiety disorder and teach him to cope with them without developing such a severe reaction.

Unfortunately, no reliable and effective treatment for GAD has yet been developed; taking medications makes it possible to stop the acute manifestations of the disease, but only a portion of patients can completely get rid of anxiety after long-term treatment and work on themselves.

Drug treatment

Depending on the predominance of certain symptoms of GAD, the following is used:

Tranquilizers or sedatives - reduce fear and anxiety, help restore mental balance. Most often used: Phenazepam, Lorazepam, Clonazepam, Alprozolam and others. Tranquilizers are addictive, reduce reaction speed and have many side effects. They can be taken only in short courses and only as prescribed and under the supervision of a doctor. Taking sedatives is prohibited during pregnancy and during work that requires extreme concentration and reaction speed.
B-blockers are used for severe autonomic disorders; they help cope with tachycardia, increased blood pressure and other similar symptoms. Propranolol, Trazicor, Obzidan, Atenolol are recommended for the treatment of GAD. All of the above drugs are used for diseases of the cardiovascular and pulmonary systems, have many contraindications and side effects, and are quite dangerous in case of overdose, so the feasibility of their use and dose are calculated individually for each patient.
Antidepressants - stabilize mood, help neutralize symptoms of anxiety and fear. Generalized anxiety disorder is treated with the latest generation of antidepressants: Prozac, Zoloft, less commonly used classical antidepressants: Amitriptyline, Azafen and others.

Psychotherapy

The goal of all these techniques is to determine the cause of an anxiety disorder, identify what emotions or actions cause an attack of fear and anxiety, and teach the patient to independently cope with these emotions.

All techniques contain elements of relaxation or various methods that help the patient relax and relieve an anxiety attack in critical situations.

Generalized anxiety disorder (GAD) is a common psycho-emotional disorder that involves constant worry, irritability and a feeling of tension.

Unlike phobias, in which the fear is rooted in a specific thing or situation, generalized anxiety disorder dissipates, leaving behind a general feeling of apprehension or worry.

People with GAD cannot get rid of their problems, although they usually understand that their worries are unfounded: they may include worries about health, money issues, the environment, or the state of affairs at a local, national or global level.

This also includes dissatisfaction with marriage and family; educational or sports indicators, as well as much more. Anxiety is excessive and uncontrollable; occurs over more than a day, accompanied by at least three physical symptoms: fatigue, problems concentrating, muscle tension.

Nature of the clinical picture

Not all patients with generalized anxiety disorder have the same symptoms, but most patients develop a complex of emotional, behavioral and physical symptoms that often change and become more pronounced during times of stress.

Physical manifestations:

fussiness, tension, restlessness;
muscle pain (usually in the neck and shoulders);

Emotional manifestations:

anxiety/excitement;
sadness;
anger;
feelings of shame, guilt;
apathy, irritability.

Behavioral manifestations:

insolence, rudeness;
difficulty concentrating;
insomnia or interrupted, short sleep;
excessive study of the problem, close attention to it, focusing on details, analysis;
seeking support;
if it is a child or teenager – refusal of further education.

If the presence of GAD in a patient is not determined in a timely manner, the following consequences may occur:

absenteeism from school;
inability to establish and maintain friendly relationships due to fears;
general decrease in quality of life;
rare participation in activities, desire to be isolated;
having limited interests.

Medical care and correction of the disorder

There are several types of treatment for generalized anxiety disorder: medication, cognitive behavioral therapy, and relaxation therapy.

Medication for GAD is usually only recommended as a temporary measure to provide symptom relief. There are three types of drugs intended for this purpose:

is a sedative drug known under the brand name Buspar. Based on its pharmacological effects on the patient’s psyche, it is considered the safest drug for the treatment of generalized anxiety disorder. Although Buspirone is a fairly effective drug, taking it alone cannot completely eliminate anxiety.
Benzodiazepines– anti-anxiety drugs act very quickly (usually within 30 minutes), but after a week of use, they cause physical as well as psychological dependence. They are generally only recommended for severe cases of GAD because they paralyze anxiety episodes.
Antidepressants – The full effect of taking drugs of this pharmacological group is not felt for the first six weeks, since they have a cumulative property. Some antidepressants can also worsen sleep problems and cause nausea.

Calm, just calm

Relaxation techniques for patients with GAD:

Deep breathing. When a person is nervous, he breathes more quickly, but shallowly. This hyperventilation causes dizziness, shortness of breath, and a tingling sensation in the limbs. These phenomena are frightening, leading to further development of anxiety. By breathing deeply, diaphragmatically, the patient can prevent the occurrence of these symptoms by calming down.
aimed at reducing muscle tension. It is permissible to perform the exercises independently, not under the supervision of an instructor. The technique involves systematically tensing and then weakening various muscle groups. When the body relaxes, the psycho-emotional state normalizes.
Meditation. This type of relaxation, restoration of vital energy and awareness, can change the state of the brain. Regular meditation practice activates the left part of the prefrontal cortex, the area of the brain responsible for feelings of calm and joy.

Cognitive behavioral therapy (CBT) is one type of therapy that is particularly helpful in treating GAD. The doctor will help identify automatic negative thoughts that contribute to the patient's anxiety.

For example, if he tends to overcomplicate, always imagining the worst possible outcome of any given situation, a specialist may be able to change his mind by challenging this tendency. Treatment is in the nature of a conversation, the course is determined by the doctor, depending on the degree of the patient’s disease, as well as the individual susceptibility of his body.

Away with worries and fears!

There are several measures aimed at preventing the development of generalized anxiety disorder:

To control the symptoms of generalized anxiety disorder and prevent it from taking over you, you need to make lifestyle changes.

The support of loved ones plays an important role in overcoming this psycho-emotional disorder, since the feeling of powerlessness and loneliness aggravates the course of the disease, increasing the likelihood of its transition to a more severe mental disorder.

Social interaction with a person who can calm and support is the most effective way to calm the nervous system, eliminating diffuse anxiety.

Generalized anxiety disorder is a mental disorder in which a person has generalized, persistent anxiety that is not related to specific objects or situations. This disease is quite common; according to statistics, every year about 3% of the world's population show signs of generalized anxiety disorder: constant nervousness, trembling throughout the body, muscle tension, sweating, tachycardia, dizziness, discomfort and discomfort in the solar plexus. A person lives with a constant feeling of anxiety, worry, fear for himself and for the health of his loved ones, a premonition of trouble, illness, death.

This mental disorder is most often found in women and is usually associated with severe traumatic situations or is a consequence of chronic stress. Generalized anxiety disorder has an undulating course and most often becomes chronic.

Reasons

There are several reasons for the development of generalized anxiety disorder: chronic alcohol dependence, chronic stress, and the presence of panic attacks in patients. It may also be one of the symptoms of depression.

The development of constant anxiety in humans has a neurophysiological mechanism.

A. Beck developed a cognitive theory of the emergence of generalized anxiety disorders. He believes that anxiety is a person's reaction to perceived danger. People who constantly suffer from anxious thoughts have a distorted reaction to the perception and processing of information, as a result of which they consider themselves powerless in the face of existing life problems. The attention of patients with constant anxiety is selectively directed precisely to the probable danger. On the one hand, this mechanism allows a person to adapt to external circumstances, but on the other hand, anxiety arises constantly and is not controlled by the person. Such reactions and manifestations create a “pathological circle” of the disease.

The patient, as a rule, does not realize the excessiveness of his fears, but they cause discomfort to the person and poison his life. A person with generalized anxiety disorder may miss classes at college or stop going to work. This disease does not only affect adults; symptoms can appear in children and adolescents. Generalized anxiety disorder in a child can occur due to separation from the mother, unexpected or frightening circumstances, or because adults deliberately intimidate children “for the purpose of education.” Children are often afraid of going to kindergarten or school after a frightening situation or conflict with peers or teachers has arisen there.

Risk factors

Clinical manifestations

To be diagnosed with generalized anxiety disorder, a patient must have experienced anxiety symptoms for several weeks to several months.

Patients with symptoms of this disease look pale, tired, their torso is tense, their eyebrows are frowned and drawn together, their hands and head are trembling. When talking, they exhibit autonomic reactions: diffuse red spots on the chest, vascular white spots on the upper and lower extremities, sweating of the palms, feet, and armpits. The patient is tearful and in a depressed mood.

Usually a person cannot accurately formulate what scares him. There is no area of his life that does not bother him. Students may experience fear before taking exams or an important test, although there are no objective reasons for such expressed anxiety (the student prepared, studied, and always has good grades).

A woman with generalized anxiety disorder constantly worries about the life and health of her children; if she returns home and sees an ambulance near the entrance, then she has only one thought: that something terrible happened to her child. A woman’s consciousness paints a picture of a terrible illness or even death. Arriving home and making sure that all her close and dear people are alive and well, and the ambulance has arrived at an unfamiliar neighbor, a woman can throw out all her emotions and experiences on her unsuspecting children. In family life, such people bring discord and constant nervous tension with their violent reactions, anxieties and experiences.

People with generalized anxiety disorder exhibit a lack of emotional engagement in interpersonal and social aspects of life.

A distinctive feature of patients with symptoms of this disease is that they experience a painful state of uncertainty.

Most often, patients do not evaluate their increased anxiety as a mental disorder and turn to doctors with complaints about problems of the digestive, respiratory, cardiovascular systems, and insomnia.

Diagnostics

The psychiatrist examines the patient, collects anamnesis, finds out hereditary predisposition to mental illness, bad habits (chronic nicotine intoxication, consumption of alcohol, medications, caffeine-containing drinks, drug addiction). In a patient with generalized anxiety disorder, it is necessary to exclude somatic pathology, including thyrotoxicosis. It is also necessary to carry out a differential diagnosis with panic attacks and psychopathy, social phobias, hypochondria, obsessive-compulsive disorder, and depression.

Increased anxiety requires timely diagnosis and treatment, as it affects the course and prognosis of concomitant somatic pathology.

Therapy

The main goal of treatment for generalized anxiety disorders is to relieve the main symptoms of the disease - the patient’s chronic anxiety, reduce muscle tension, autonomic manifestations and normalize sleep. The main methods of treatment for this disease are psychotherapy and medication. It is necessary to exclude the patient from chronic caffeine intoxication, alcohol consumption, smoking, and drug dependence.

The main medications for the treatment of generalized anxiety disorders are anxiolytics and antidepressants. To eliminate unpleasant symptoms from the cardiovascular system, beta-blockers are prescribed. Drug treatment is prescribed to the patient when symptoms of increased anxiety do not allow the person to live, study, or work.

Anxiolytics and antidepressants must be prescribed under the supervision of a physician; the dosage must be effective but safe.

Among antidepressants, drugs from the group of selective serotonin reuptake inhibitors (paroxetine) and tricyclic antidepressants (imipramine) are mainly prescribed. Very often, drugs from the group of benzodiazepines (clonazepam, phenazepam, diazepam, alprozalam) are used in the treatment of generalized anxiety disorders. With prolonged use of these drugs, dependence is formed, the sensitivity of receptors to them decreases (in order to achieve a therapeutic effect, an increase in the dose of the drug is required) and side effects appear.

Some patients with symptoms of constant anxiety begin to independently use Corvalol and Valocardine in treatment; these drugs contain phenobarbital; they can be purchased at a pharmacy without a doctor’s prescription. But after some time after using these drugs, barbiturate dependence occurs (one of the most severe forms of drug dependence).

Generalized anxiety disorder is a chronic mental illness. In most cases, patients complain of constant anxiety, which is not associated with any events or objects, and worsens at night and in the evening. But the disease has many symptoms and can masquerade as depression and chronic fatigue.

The pathology has a wave-like character - attacks of anxiety and fear recede for a while, then appear again without any provoking factors. If left untreated, generalized anxiety disorder becomes chronic and can lead to personality distortion and severe mental syndromes.

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Description of the pathology
Generalized anxiety disorder is a mental disorder accompanied by persistent anxiety that is not associated with any objects, events or people. It can be accompanied by a number of conditions – mental and physical.
Usually the disorder occurs against a background of constant stress, neurosis, but it also occurs in those people who do not experience constant stressful situations in their lives.

Anxiety persists for several months, significantly worsening the patient's quality of life. The pathology is almost always combined with other disorders, for example the following:
- neurosis;
- panic disorder;
- phobia;
- depression;
- obsessive states.
Differences from normal anxiety
Feelings of anxiety are a normal component of human psychological behavior. A feeling of anxiety and tension accompanies important events, but does not cause pathological changes.
Characteristics of normal anxiety:
- it does not interfere with everyday life;
- easy to control;
- does not cause severe stress;
- has a clear rationale;
- passes within a short time.
Characteristics of the condition with GAD:
- anxiety interferes with work and daily functions;
- not controlled;
- causes panic attacks;
- I feel it all the time, every day.
In this case, it is almost impossible to overcome the state of excitement; a person considers only the worst development of any situation and is not able to control his feelings.
Reasons
The causes, predispositions and triggers for the development of generalized anxiety disorder are not fully understood. But psychologists have classified the most common characteristics found in patients with GAD.
Internal conflict
According to the first researcher of the psychology of anxiety, Sigmund Freud, the cause of GAD is the conflict between human instincts and behavioral norms laid down in childhood. Freud's followers expanded on this concept and came to the conclusion that the cause was internal conflict. It occurs against the background of some threat to the future of a person or due to chronic dissatisfaction of basic needs.
Peculiarities of information perception
A predisposition to GAD is considered to be selective assimilation of information - only that which is negative in nature.
If a loved one complains of a headache, a person with anxiety pathology will think about his imminent death, and not about the fact that he can offer his loved one a pill for the headache and recommend a visit to the doctor.
Character traits
Character traits are also considered a predisposition to GAD. Anxiety disorder most often affects impressionable, vulnerable people who hide their experiences or cannot express them. GAD is often found in people who have suffered any type of violence: physical, psychological or sexual.
Factors contributing to the development of GAD may be long-term poverty, lack of ambition and prospects, unsolvable problems and pressure from society. It is rooted in the dissatisfaction of a basic need: the fewer financial opportunities, the more a person limits himself and suffers from it.
Errors in education
Most researchers are inclined to believe that anxiety disorder is partly congenital and partly acquired. The tendency to chronic anxiety is further complicated by errors in upbringing from childhood:
- constant criticism;
- excessive demands;
- non-recognition of the child’s achievements;
- lack of parental support;
- humiliation.
All of the above reasons lead to the fact that a person cannot adapt to difficult situations.
The subconscious gives signals that he cannot cope with such a situation, and he worries about his failure and worse events, without trying to believe in his strength. Self-esteem also suffers, which is why a person cannot achieve anything and, as a result, worries about himself even more.
Symptoms
Signs of the disease can vary widely. At some time of the day, patients feel better; in the evening, unreasonable fear and anxiety worsen, preventing them from solving everyday problems, sleeping, and even contacting loved ones. Any little thing that an ordinary person does not pay attention to leads patients with GAD to an anxious-phobic state.
Emotional
These are the very first symptoms that signal the development of generalized anxiety disorder. Emotional symptoms are characterized by:
- constant nervous excitement, anxiety;
- lack of a clear cause of the problem - the person does not understand what exactly is bothering him so much;
- obsessive thoughts about the worst outcome of any situation;
- increasing fear.
The patient expects terrible events that are unlikely to take place in reality. When watching the news, the patient sees only the prerequisites for global war, poverty, disease and death, and begins to think about his fate and the fate of his loved ones.
Behavioral
Behavioral symptoms develop after emotional ones and are already noted by people around them. Behavioral symptoms:
- inability to relax;
- fear of being alone even for a couple of hours;
- constant procrastination;
- avoiding any contact with people.
A person tries to withdraw into himself, but feels the need for someone to be nearby. When alone, almost all patients immediately develop a panic attack.
Physical
Physical signs appear already in the case of attacks and exacerbations in generalized panic disorder of moderate severity.
More often, the physical symptoms of GAD occur in people who consider mental disorders to belittle their honor. They do not turn to a psychotherapist, considering it shameful, and try to treat the physical symptoms.

Physical symptoms:
- increased muscle tone;
- body pain;
- difficulty falling asleep;
- daytime sleepiness;
- rapid heartbeat;
- increased sweating;
- disturbances in the digestive tract, nausea;
- headaches.
The mental state at the time of attacks significantly worsens physical well-being. Individual symptoms cannot be ruled out, since each person’s reaction to stress may be different: increased appetite or weight loss, trembling hands, difficulty breathing.
The genitourinary system responds with symptoms such as decreased libido, disruption of the menstrual cycle, and loss of erection. Physical disorders come to the fore and force patients to seek help from specialists of various profiles.
Diagnostics
The diagnosis is carried out by a psychotherapist. Typically, the Spielberger anxiety scale is used for this, according to which a specialist determines the psycho-emotional state in adults. Symptoms for diagnosis must be observed for at least a week - long-term emotional disturbances characterize GAD. Symptoms of reactive depression may appear and then disappear again - in this case, GAD cannot be ruled out and depression cannot be diagnosed.
The following studies are prescribed for diagnosis:
- general tests;
- examinations of the cardiovascular system;
- consultations with a urologist, sex therapist;
- consultation and examination with an endocrinologist.
These measures make it possible to exclude organic causes of the disease and differentiate generalized anxiety disorder from diseases of the internal organs.
Treatment methods
To get rid of obsessive anxiety, both psychotherapy and drug treatment tactics are used.
The choice of method depends on the severity of the disease, the character, personality and body of the patient.
Cognitive behavioral psychotherapy
Aimed at identifying misconceptions in a person’s values and correcting them. They prevent a person with GAD from perceiving information rationally, which is why they are replaced by various methods of cognitive-behavioral psychotherapy with more adaptive and adequate ones.
Patterns of catastrophizing are eliminated—constantly imagining the worst possible development of events and their consequences. An example of such a pattern would be a situation where a person leaves the house and is sure that he will pass out on the roadway or get into a car accident.
Mindfulness Method
This technique can be used both at home and under the supervision of a specialist. It helps to cope with the situation and reduce internal worries thanks to a simple principle: allow yourself to worry, but think about the reasons for these experiences.
If a friend is late for a meeting, the person with GAD will imagine that the person running late had an accident or suffered a heart attack on the way. You shouldn’t try to relieve anxiety, just ask yourself: how often is he late, does he have heart problems, does he drive carefully? By answering these questions, the patient is not only distracted from focusing on anxiety, but also realizes that it is unfounded.
Imaginary method
This technique is used only under the supervision of a specialist and is situational. The patient shares his strongest fears and thoughts that cause panic and anxiety, describes situations in which he feels the greatest fear. A psychotherapist asks what a person thinks during an anxiety attack.
By collecting information, the therapist helps you look at the situation differently and respond to it correctly. Situational correction is recorded on a voice recorder and listened to at home by the patient, alleviating his condition.
Suggestion and hypnosis
Hypnosis is used to focus on the most important information provided by the therapist. With its help, the specialist instills in a person more adaptive, adequate beliefs and the ability to assess the situation.
The advantage of the method is that it allows you to remove obsessive anxiety for a long time, if not forever, since it embeds new beliefs not only at the level of the conscious, but also the unconscious.
Group, family treatment
Psychotherapy with the family allows the patient not to be afraid of his thoughts and share them with both the specialist and his loved ones, since usually these thoughts are hidden from them.
A person’s relatives learn to properly support him during anxiety attacks, and the patient himself stops hiding his feelings and thoughts, his fears, thereby allowing himself to rethink them together with loved ones.
Drug therapy
As part of a comprehensive treatment, medications may also be prescribed to help overcome the physical and behavioral symptoms of generalized anxiety disorder.
Drugs for the treatment of GAD:
- anxiolytics: Bromazepam, Diazepam;
- antidepressants: Clomipramine, Miaser, Tianeptine;
- medications: Sedasen, Gelarium Hypericum.
Only a qualified specialist should prescribe medications. Self-administration of tablets can worsen your health.
In the early stages of an anxiety disorder, when anxiety develops frequently but is still manageable, home remedies may also be effective. Psychotherapists give the following advice:
- Add variety to your life - do something new in your free time, visit old friends, places where you spent your childhood.
- Try to let go of the situation and convince yourself that dark thoughts attract equally dark events.