Mental health articles

generalized anxiety disorder Clinical Features
Epidemiology.Probably because of the ‘‘normality’’ of Generalized Anxiety Disorder, it is difficult to obtain estimates of its prevalence and incidence because such estimates are likely to be very dependent on minor definitional differences. Nevertheless, several studies in recent years have indicated that Generalized Anxiety Disorder is one of the more prevalent disorders; it is diagnosed at around 3% of the population over a given 12-month period and around 5% across the lifetime. Similar figures are reported in children. Interestingly, despite its prevalence, it is one of the least common anxiety disorders presenting to mental health practitioners and accounts for around 10% of anxiety disorder patients.
Generalized Anxiety Disorder is found commonly, however, among patients in general medical practice. Sex Distribution.As with most of the other anxiety disorders, Generalized Anxiety Disorder is more common in females. However, Generalized Anxiety Disorder has a more equal sex distribution than some of the other disorders; most populations of Generalized Anxiety Disorder contain around 60% females. Onset.Most studies report that Generalized Anxiety Disorder generally begins around the midteens to early 20s. However, calculation of a mean age of onset for this order is probably fairly meaningless because a large number of Generalized Anxiety Disorder patients report experiencing symptoms all of their lives. This indication of a lifelong existence for Generalized Anxiety Disorder is consistent with some growing speculation that Generalized Anxiety Disorder should actually be considered a lifelong psychological trait or personality disorder. If this is so, then an average age of onset really does not provide any useful information. Along similar lines, Generalized Anxiety Disorder patients generally describe the onset of their disorder as gradual and insidious. This evidence is also consistent with a personality orientation in Generalized Anxiety Disorder. Thus, we may describe Generalized Anxiety Disorder as a general characteristic of an individual that perhaps becomes more severe at some point in the person’s life. Alternately, the disorder itself may not become more intense, but it may be that one of a number of reasons eventually leads the individual to decide to do something about the problem. For example, a change in life circumstances may cause people’s usual behaviors to interfere with their lives. Worry.Because worry is the central characteristic in Generalized Anxiety Disorder, these individuals will present as ‘‘chronic worriers.’’ But what do they worry about? One study that examined this question categorized the worries reported by twenty-two Generalized Anxiety Disorder patients during clinical intake interviews into common spheres. The researchers came up with four major spheres in the following descending order of importance: family, finances, work, and personal illness. In addition, 91% of the patients reported ‘‘worrying excessively about minor things,’’ compared to 40% of subjects with other anxiety disorders. A second study asked nineteen Generalized Anxiety Disorder patients and twenty-six nonanxious controls to record three instances of ‘‘significant’’ worry during a 3-week period. Generalized Anxiety Disorder subjects worried most about illness, second most about family, and least about finances. This seemed to be a slightly different pattern from that of the controls, who worried most about work and least about illness. Thus, although the worries reported by Generalized Anxiety Disorder patients cover very normal areas, the relative weight that these individuals give to these spheres may be somewhat different from that given by nonanxious subjects.
Another important difference emerged in the study comparing the worries of GADs and nonanxious controls (note that this study was based on DSM-III-R criteria). The Generalized Anxiety Disorder subjects reported that their worries were significantly less controllable than the normals’ worries and, similarly, that they were less able than the normals to stop or prevent their worrying. This uncontrollability aspect of chronic worrying was also reported in a college sample. It has been suggested that a general sense of uncontrollability is a fundamental characteristic of anxiety disorders, and this quality may be the most distressing to persons with Generalized Anxiety Disorder and most responsible for making Generalized Anxiety Disorder into a ‘‘disorder.’’ Recognizing this crucial role of uncontrollability, this feature is now included as a diagnostic criterion in the DSM-IV.

Tags: DSM, generalized anxiety disorder, symptoms