Anxiety disorder, generalized
Anxiety is a feeling of apprehension that some describe as an exaggerated sensation of impending doom, dread, or uneasiness. Unlike fear—a reaction to danger from a specific external source—anxiety is a reaction to an internal threat, such as an unacceptable impulse or a repressed thought that’s straining to reach a conscious level.
A rational response to a real threat, occasional anxiety is a normal part of life. Overwhelming anxiety, however, can result in generalized anxiety disorder—uncontrollable, unreasonable worry that persists for at least 6 months and narrows perceptions or interferes with normal functioning. Recent evidence indicates that the incidence of generalized anxiety disorder is greater than previously thought and may be even greater than that of depression.
Causes
Etiology is thought to involve the y-aminobutyric acid (GABA) A receptor–chloride ion channel complex. Benzodiazepines bind two separate GABA-A receptor sites: Type I has broad anatomic distribution, and type II is concentrated in the hippocampus, striatum, and neocortex. Serotonin (5-hydroxytryptamine [5-HT]) also appears to have a role in anxiety. Theorists share a common premise: Con-flict—whether intrapsychic, sociopersonal, or interpersonal—promotes an anxiety state.
Signs and symptoms
Generalized anxiety disorder can begin at any age but typically has an onset between ages 20 and 40. It’s equally common in men and women. Psychological or physiologic symptoms of anxiety states vary with the degree of anxiety. Mild anxiety mainly causes psychological symptoms, with unusual self-awareness and alertness to the environment. Moderate anxiety leads to selective inattention but with the ability to concentrate on a single task. Severe anxiety causes an inability to concentrate on more than scattered details of a task. A panic state with acute anxiety causes a complete loss of concentration,
often with unintelligible speech.
often with unintelligible speech.
Diagnosing generalized anxiety disorder
When the patient’s symptoms match criteria documented in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition – Text Revision, the diagnosis of generalized anxiety disorder is confirmed. The criteria include the following:
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