Generalized Anxiety Disorder

The term ‘generalized anxiety’ was included in anxiety neurosis and pantophobia in the 19th century. Such terms as pain occurrences and nervous mental state were also used to define the generalized anxiety disorder. In 1980, during the third version of DSM-III (Diagnostic and Statistical Manual of mental Disorders), Generalized anxiety disorder was considered as a diagnostic classification. This was after anxiety neurosis was divided into panic and GAD (Crocq, 2017). The distinct reactions that the two conditions had to imipramine intervention were distinguishing between the two. This paper will focus on Generalized anxiety disorder giving the history of the disorder and the issues linked to the diagnostic criteria.

History of Generalized Anxiety Disorder

Generalized anxiety disorder has been considered an anxiety disorder characterized by uncontrollable, excessive, and unreasonable worry about activities or events (Crocq, 2017). Worry has greatly interfered with the normal function with symptoms such as restlessness, excessive worry, exhaustion, trouble sleeping, sweating, irritability, and trembling. Ideally, when a body experiences a condition that is supposed as a threat, the sympathetic nervous system tends to active the flight response, and what one feels is anxiety, which results in the process.

Anxiety has been considered as an ordinary response to daily trials. However, when the anxiety fails to decrease or dissipate with time, this may specify an anxiety condition. Generalized anxiety disorder is characteristically diagnosed if an individual unreasonably worries over their day to day hitches for over six months. Ideally, other factors must be first ruled out, such as hyperthyroidism and caffeine intoxication.

The central structure of GAD (Generalized anxiety disorder) entails a chronic free-floating unease that go together with by nervous apprehension about various situations in the natural life and apprehension have been labelled differently since the late 18th century. Authors in the late early days defined GAD as a type of chronic anxiety that could impact paroxysmal attacks. People with this condition often expect the worse if even when there is a good reason. This interrupts the everyday life of the individual and may last for more than six months. An individual with this kind of condition feels that their lives are beyond control and cannot be governed. GAD has disrupted all areas of the patient social work, life, family, and school.

GAD was first introduced as the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) but was more considered a residual for people who failed to meet the diagnostic criteria for any other anxiety disorder (Crocq, 2017). Ideally, this is a common psychiatric condition described by excessive worrying that led to the disruption of normal life and causing stress that lasted at least six months. GAD has been linked with both physical and psychological effects. Women have been highly exposed to the condition twice more than men.

Medical terms were utilized in the early 20th century, which have now evolved to the current anxiety neurosis, the immediate precursor of Generalized anxiety disorder. The term panophobia was the first term to be employed, describing patients allegedly worried and afraid of everything. Panophobia was a state of worry, but not permanent anxiety, where the paid was worried about everything, and the patient gets hooked in random circumstances (Crocq, 2017). GAD was later defined as Anxiety neurosis characterized by uncontrollable worry linked to physiologic symptoms such as muscle tension, relentlessness, disturbed sleep, and impaired concentration.

Boissier de Sauvages drafted the initial and most essential French Medical nosology. Considerably, his standing at the evolution from traditional to up-to-date medicine is exemplified since his draft was the last vital medical book to be drafted in Latin. Boissier de Sauvages subdivided the conditions of mental disorders into four, which included Morositates, Hallucinations, Folies, and Deliria (Crocq, 2017). The disorder that was mainly related to anxiety and worry was Panophobia. The patients with features of GAD were individuals with extreme worries and bodily tension.

Diagnostic Category

Generalized anxiety disorder was first defined in 1980 as diffused and uncontrollable worry or anxiety that is unrealistic or excessive. In the past, the symptoms were linked to anxiety neurosis in which the panic attacks and panic attacks lumped together. The American Psychiatric Association introduced general anxiety disorder after splitting anxiety neurosis into panic disorder and GAD. GAD’s definition in the DSM-III required diffused and uncontrollable worry and anxiety that is unrealistic, excessive, and persistent within the first month.

The high comorbidity rates in GAD and other major depressions led to man commentators suggesting that Generalized anxiety disorder should be considered as an aspect of major depression rather than being a disorder on its own. However, DSM-IV modified the definition of excessive worry and the various psychophysiological symptoms needs for diagnosing GAD. DSM-IV stated and emphasized that excessive worry has to occur more days (Cuijpers et al., 2016). Considerably, Freud’s original definition of anxiety neurosis included anxious expectation, chronic apprehension, anxiety attacks, general irritability, and secondary phobic avoidance. In DSM-III, panic attacks’ encounter was described as a distinct disorder, recognized as panic condition. Simultaneously, the remaining related signs and symptoms were utilized to form the basis of Generalized anxiety disorder.

GAD then became a new diagnosis that required the psychophysiology symptoms listed under leading automatic hyperactivity and motor tension. Since the introduction of GAD, debates have existed about where GAD symptoms are part of another primary disorder or prodrome of residual form. The uncertainty has developed from several factors such as lack of specified focus of anxiety, which may vary over time, and the overlapping symptoms.

According to DSM-III, generalized anxiety disorder had a low occurrence and infrequently led to more than minor deficiency. In DSM-IV, GAD was obligated to cause impairment and clinically substantial pain since the condition became portion of the explanation of a disorder in DSM-IV. GAD’s most significant progression since DSM-III, was worry or general anxiety that are not limited to any incitement have been progressively considered the core as well as distinctive symptom of GAD.

Worrying over everything has been considered a relatively specific sign compared to the somatic symptoms of generalized anxiety disorder. The concept of anxiety and worry has emphasized psychological symptomatology, especially on cognitive function. Another essential feature of GAD has been intolerance of uncertainty. Considerably, the long term effects of worry entail preservation of anxiogenic conditions and reticence of emotional processing. Studies have offered indication for the variations of worry, and thus GAD’s main feature is an excessive worry, which could be quantitatively varying from normal functioning.

 

 

Diagnostic Criteria

The diagnostic criteria are the set of symptoms, signs, and tests developed for use during routine clinical care to guide and offer care to patients with Generalized anxiety disorder. Although no one understands the cause of generalized anxiety disorders, various factors may have contributed to this emotional issue. There are various biological factors, life experiences, family dynamics, and causes of a psychological break. People with GAD don’t know how to lower their negative thoughts and worries since they continue feeling as if the condition is beyond their control. The nature of their worry and thoughts has been hard to describe.

Patients with GAD have presented unnecessary nervousness about usual daily circumstances. The anxiety is disturbing and has caused functional deficiency and distress related to multiple domains such as health, work, and finances. Due to the great extent of comorbidity with other disorders, there was a new revision for the DSM. This is because generalized anxiety disorder shows high comorbidity with other anxiety disorders. This has led to GAD’s criteria to be modified through the succeeding versions of DSM to increase the rationality of this classification. There are no lab tests used to examine if an individual has a generalized anxiety disorder. Ideally, if the patient is excessively worrying for more than six months, that is considered GAD. The anxiety has been linked to physical symptoms such as muscle tension, restlessness, chronic headaches, and gastrointestinal symptoms. The diagnostic criteria for GAD include:

  • Excessive worry and anxiety occurring more days that are not less than six months and are linked to several activities and events such as school performance or work.
  • The individuals find it challenging to control the worry.
  • The worry and anxiety are linked with three or more of the following six symptoms, with most of these symptoms appearing for more than six months.
  1. Being fatigued easily.
  2. Occasions where the mind is going blank and challenges in concentration.
  3. Muscle tension.
  4. Sleep disturbance, struggle in staying or falling asleep and unsettled sleep.
  • The anxiety, physical indications, and worry cause great impairment and stress in occupation, social and other essential areas of human functioning
  • The disturbance is not linked to the biological impacts such as medication or drug abuse and other medical conditions.
  • The mental disorder is not better described by any other mental condition such as worry or anxiety about having panic occurrences in social anxiety disorder, adverse evaluation in panic disorder, infection, and obsessive-compulsive disorder, and gaining weight in anorexia disorder. Additionally, post-traumatic stress disorder due to reminders of traumatic events, physical complaints due to somatic symptom disorder, serious illness due to illness anxiety disorder, and body dysmorphic disorder. This criterion clearly indicates that GAD is an exclusion, which means that it cannot be diagnosed if the degree of anxiety can be interpreted for other anxiety conditions like social anxiety, panic, phobic and obsessive-compulsive disorder.

Several scales have been utilized in assessing and establishing the diagnosis and severity of generalized anxiety disorder. The GAD-7 has been one of the validated and most effective diagnostic tools with a severity assessment scale. The assessment scale has a score of 10, which is good for indicating specific diagnostic specificity and sensitivity. Considerably. The greater the GAD-7 score, the more the functional impairment is linked to generalized anxiety disorder (Hinz et al., 2017). The scale was established and validated based on the DSM-IV criteria but remains clinically effective after the publication of DSM-5.

The diagnosis of generalized anxiety disorder has been complicated by the various differential diagnosis situations, also well-known comorbidities. Moreover, several patients with generalized anxiety disorder have met the diagnostic criteria linked to other psychiatric disorders such as social phobia and major depressive disorder such as substance abuse disorders, nervousness, and mood disorders. Anxiety disarrays that occur with other disorders such as physical, historical, and laboratory results may be significant in evaluating the diagnosis and establishing the most effective treatment plans.

Comparing the risk factors for anxiety disorders across the life span can be effective in shedding light on the variations between certain age groups, which can inform the clinicians on the history and profile of persons that develop GAD. Even though GAD seems to be more common among young adults than the elderly, the development of the illness later in life does not seem to be a normal part of aging (Counsell et al., 2017). Most adults with generalized disorder anxiety have shown these symptoms around the same time as heart disease, depression, diabetes, among other medical issues. Relatively, it has also occurred with other physical illnesses such as substance abuse and alcohol, which may make the issue to worsen.

 

 

Treatment

Generalized anxiety disorder is among the most acknowledged mental disorders within the United States. GAD leads to a negative impact on the quality of life and influences the essential activities of daily life. Evidence suggested that the rates of misdiagnosis and missed diagnoses of Generalized anxiety disorder are high, with the symptoms being linked to physical causes (Mossman et al., 2017). Various ways have been scientifically proven to be useful as an intervention of Generalized anxiety disorder.  Cognitive Behavioral therapy has been considered a short-term treatment used to lower the impact of anxiety and control worry in a person’s life. Relatively, this approach has been used over the years to teach people how to create positive responses to stressful conditions. These interventions are individualized, with most people seeing a significant improvement within a short period of time and enjoying a better life.

CBT appears to be an effective treatment for Generalized anxiety disorder. This has been an effective way of reducing the symptoms and signs of the illness. The theoretical basis of CBT (Cognitive-behavioral therapy) was established as an intervention based on the supposition that cognitive factors mediate affective disorder. Considerably, CBT theorists believed that feelings, thoughts, and behavior are interrelated, and so altering negative thinking and modifying it into positive thinking may result in less anxiety. Considerably CBT seems to be useful among the elderly and appears to be less useful among the general adult population. CBT has been considered the most effective psychological treatment and is the most preferred intervention for Generalized anxiety disorder.

Conclusion

In conclusion, the history and evolution indicate that generalized anxiety disorder was first categorized in anxiety neurosis and pantophobia. Anxiety neurosis was then divided into panic and GAD condition, where it was first set as a diagnostic classification in DSM-IV. GAD’s diagnostic criteria show that there has to be too much anxiety and worry for more than six months. Generalized anxiety disorder cannot be directly caused by trauma, stressor contrary to the adjustment disorders.

 

 

References

Counsell, A., Furtado, M., Iorio, C., Anand, L., Canzonieri, A., Fine, A., … & Katzman, M. A. (2017). Intolerance of uncertainty, social anxiety, and generalized anxiety: Differences by diagnosis and symptoms. Psychiatry Research252, 63-69.

Crocq, M. A. (2017). The history of generalized anxiety disorder as a diagnostic category. Dialogues in clinical neuroscience19(2), 107.

Cuijpers, P., Gentili, C., Banos, R. M., Garcia-Campayo, J., Botella, C., & Cristea, I. A. (2016). Relative effects of cognitive and behavioral therapies on generalized anxiety disorder, social anxiety disorder, and panic disorder: A meta-analysis. Journal of Anxiety Disorders43, 79-89.

Hinz, A., Klein, A. M., Brähler, E., Glaesmer, H., Luck, T., Riedel-Heller, S. G., … & Hilbert, A. (2017). Psychometric evaluation of the Generalized Anxiety Disorder Screener GAD-7, based on a large German general population sample. Journal of affective disorders210, 338-344.

Mossman, S. A., Luft, M. J., Schroeder, H. K., Varney, S. T., Fleck, D. E., Barzman, D. H., … & Strawn, J. R. (2017). The Generalized Anxiety Disorder 7-item (GAD-7) scale in adolescents with generalized anxiety disorder: signal detection and validation. Annals of clinical psychiatry: official journal of the American Academy of Clinical Psychiatrists29(4), 227.

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