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Anxiety is a feeling of worry or nervousness about something which is happening or gonna happen.
Everyone is bound to develop anxiety at some or the other point in life for certain things, like money, work, performance, health and others. This feeling of occasional or tolerable anxiety, is considered a normal part and parcel of life.
When this worry becomes persistent or excessive, developing for a number of things which may interfere with day to day life, it is considered abnormal and forms the basis of generalized anxiety disorder (GAD).
DSM-5 has defined GAD, as excessive feeling of anxiety and worry (apprehensive expectation) occurring for more days than not, with at least 3 characteristic symptoms lasting for minimum 6 months. These symptoms can be:
• Feeling of restlessness or keyed up or on the edge
• Getting easily fatigued
• Difficulty in concentrating or mind blanking
• Muscle tension
• Problems with sleep (difficulty in falling or staying asleep or having restless or unsatisfying sleep)
The people with GAD feels worried more than expected, even for unexpected things and feels difficult to control it. Thus, GAD is different from the general worry seen in everyones life, which is limited to a particular stress factor, affects a person for a smaller period of time or till the event lasts.
It is estimated that every 6 in 100 people or about 6% of people in India have generalized anxiety disorder. This is found to be even higher in people living in urban areas.
GAD develops gradually with time, often beginning during teenage hood or in young adulthood.
Indian and other asian people, unlike western populations, have been found to come up with more somatic symptoms than psychological symptoms.
These are physical symptoms or sensations that a person experiences, even in absence of any physical disease or illness. The people experiencing these symptoms generally believe in worse outcome and has constant worry about the underlying disease.
The somatic/physical symptoms can be:
• Pain: This is the commonest somatic symptom. They may have unexplained headaches, pain in abdomen, neck pain, backaches, or nagging pains.
• Muscle pain or muscle tension
• Feeling tired all the time or getting easily tired
• Feeling dizzy or light headed
• Sweating more than usual and feel breathless
• Tremble or twitching
• Feeling of more often going to bathroom
• Persistent anxiety or worry about a number of things including day to day to activities or task.
• Worrying for a thing out of proportion to its real significance and impact.
• Thinking of worst outcome for even simplest of the situations.
• Preparing and planing for the perceived threats and outcomes.
• Difficulty in taking decisions and fear of making wrong decisions.
• Knowing that they worry too much and inability to overcome it.
• Difficulty in relaxing and falling asleep or sustain sleep. Feeling tired due to poor sleep.
• Feeling of restlessness, living on edge or keyed up (feeling excited or nervous for an upcoming event).
• Problem in concentrating or mind blanking.
In adults, the worry could be for day to day activities or events and basic concerns like:
• Money and finances
• Performance at work and job security
• Health of their own and relatives
• Health and well-being of their children
• Timeline or being late
• Household chores and other works
They generally present with following:
• Excessive worry for their performance in academics or sports.
• Strive for approval or feel worried to fit in.
• Lack of confidence
• Try to things with perfection and may redo things
• Frequent abdominal pain or headache
• Avoiding social situations and school
• Worries about having catastrophic events like, earthquakes, floods, mob or wars.
These intensity and number of symptoms may fluctuate with time getting better or worse. The symptoms often gets worse during times of physical or mental stress, such as seen in physical illness, upcoming stressful events like exams, or during family or relationship issues or breakage.
The object of worry may also change with time and age.
The exact mechanism or cause is not known till now. However, multiple risk factors has been found that contributes to development of GAD in a person:
• Genetics: GAD is believed to run in families, but not all members tend to develop GAD.
• Brain chemistry and functioning: studies have found that certain parts of the brain and chemicals are associated with production and management of stress and worry which seems to play vital role in understanding susceptibility of certain people for GAD.
• Personality: people with negative thoughts, lack of confidence and timid nature are more prone to develop GAD.
• Experiences and stress: personal life experiences and events of significant or repeated stress or hurt may contribute in development of GAD in susceptible people. These events could be emotionally or physically stressful experiences in childhood or young age such as loss of someone, family troubles, abuse, chronic illness.
The generalized anxiety disorder can affect a persons day to day life depending on the severity of the symptoms:
It can decrease the efficiency and performance of a person at school or work by:
• Making it difficult for them to focus on a given task or job.
• It may affect their ability to take decisions quickly.
• A person may spend significant time and energy in thinking and planning for the worst outcomes of given tasks and basic activities.
• It may make a person feel out of place and ineffective to utilize resources and help from their peers or colleagues.
It may affect a persons family and social life bringing them more misery and making them susceptible to more stress:
• Constant fear about relationships or losing someone.
• Irritability and low confidence may hurt a relationship and develop stress.
• Avoidance of social interaction and fear of meeting people may affect the social life and relationships.
These issues can directly or indirectly affect a persons ability to earn money, manage finance and their lives better bringing in more stress which in turn adds up to worsening of symptoms.
Generalized anxiety disorder is often seen accompanied by other mental health issues such as:
• Obsessive compulsive disorder
• Post traumatic stress disorder
• Substance abuse
• Suicidal tendency and suicide
These issues can accompany or follow GAD and thus may make the diagnosis and treatment difficult.
Clinical History: The doctor generally starts with taking detailed history of symptoms. He would like to know about about any substance abuse or any medicine being taken.
The treatment of generalized anxiety disorder is decided on the basis of severity of symptoms and their effect on life.
There are multiple treatment options available for GAD amongst which psychotherapy and medicines are considered main treatment options which can be used individually or together:
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