What is Generalised Anxiety Disorder (GAD)?

By Cristiano Antonino On Sep 3, 2022

Generalised Anxiety Disorder (GAD): what is it? The fear of not being able to cope with events and relationships in our lives generates what we commonly call anxiety

Being anxious about particular events is normal.

However, it becomes a psychological and psychiatric problem when anxiety becomes constant, never goes away and becomes a persistent fear related to interpersonal relationships, things, events, of today and the future.

When the worries, the fear of something, that one experiences in one’s daily life are perceived as excessive to one’s own strength, one experiences anxiety.

When, however, this condition takes the form of constant alertness, it is possible that one is in the presence of a real disorder, Generalised Anxiety Disorder (GAD)

Statistically speaking, anxiety represents a ‘torment’ for more and more people suffering from it in the world and in Italy: 11.1% of the population presents at least one anxiety disorder during their lifetime (ESEMeD study) and the prevalence of anxiety disorders now stands at 4%.

The 8 ‘alarm bell’ symptoms of GAD, Generalised Anxiety Disorder

On some occasions it is perfectly normal to feel anxious and to experience an occasional feeling of anxiety: experiencing mild fear and agitation before a school or university exam, a job interview, a doctor’s appointment, major life choices such as marriage or the birth of a child, the decision to buy one’s first home or other important choices that will affect our future.

But when the fear of events heavily influences our life and lasts for more than six continuous months, it may be appropriate to seek the advice of a specialist.

These are some of the symptoms that, if they appear repetitively and for prolonged periods, should alert us:

sleep disorders: insomnia, difficulty in getting to sleep, sleep disturbed by nightmares, recurring thoughts, frequent awakenings, or you tend to sleep more during the day than at night. There is an irregularity in the sleep-wake rhythm;
recurrent negative thoughts: recurrent and excessive worries about the future (brooding), inability to think of anything else, the mind always ‘falls’ on the same ‘themes/memories’, especially in the evening;
fear and avoidance: fear of not being able to cope with situations, of being overwhelmed by anxiety and having great difficulty coping with one’s everyday life. Over time, one may witness the implementation of avoidance behaviour that leads one to renounce a series of engagements or situations in which anxiety symptoms could manifest themselves, such as, for example, going to work or school, attending events or accepting invitations (warning in advance that one is not going), going to appointments,..;
tiredness: one experiences a feeling of exceptional fatigue in performing daily acts, those same routine actions (habits) that previously did not create any type of discomfort now create it, one feels tired in an unmotivated manner and in the absence of real effort;
agitation: one feels a state of constant alertness, as if at any moment one could be called upon to make important choices or called to action. One experiences, therefore, a sense of restlessness that can lead to particular irritability;
a feeling of being crushed by events: one feels without any possibility of adapting to the current historical situation, one would like to be able to manage the future (the short-term one) and to be able to plan everything in advance by having certain dates. The uncertainty about these missing data creates an exaggerated anxiety response (pathological anxiety) and, in certain cases, control compulsions;
muscle tension: one feels stiffness or pain in certain parts of the body, e.g. the base of the neck, shoulders, back, arms, legs, hands, etc;
difficulty in concentrating and memory lapses: one has more difficulty than before in concentrating in order to carry out a daily and routine activity (e.g. reading a book, writing a text, cooking, washing, etc.) and one may experience memory lapses, i.e. the perception that certain information is missing from the memories stored in the memory, most frequently in the short-term memory, but also in the long-term memory.

The causes of generalised anxiety disorder

Among the most frequent situations capable of provoking an occasional anxiety episode that can turn into GAD are life events (expected or unexpected) that in a subject with chronic anxiety have the effect of provoking excessive (behavioural and/or verbal) reactions.

These include, for example:

taking school exams;
taking a job interview;
feeling unable to manage time;
going on a trip;
going out with new people;
fear of not being able to live a satisfying and lasting relationship;
fear of not being able to live well with one’s partner, parents and children;
being afraid of cognitive impairment in old age or following a neurological disease (fears of the patient and his/her family/caregivers);
experiencing difficulties in relationships with work colleagues;
being afraid of doctors and hospitals;
experiencing performance anxiety in general.

How psychiatric diagnosis occurs

At the psychiatric level, as mentioned above, for DAG to be diagnosed, pervasive and uncontrollable anxiety and worry must be experienced for at least 6 months, interfering with the patient’s functioning at various levels (work, social, school, family).

In addition, at least three of the symptoms described above must be present.

It is then necessary to verify that the symptoms associated with the diagnosis of DAG are not caused by other concomitant psychiatric disorders or other medical conditions or by the intake of specific substances (e.g. psychotropic substances/drugs and alcohol, drugs for the treatment of other pathologies that could have side effects on the increase in anxiety).

The psychiatrist makes the diagnosis of DAG by collecting clinical information on symptoms, their duration, frequency and interference with functioning.

He or she may use self- or hetero-administered scales: a diagnostic questionnaire useful for collecting the anamnesis, i.e. the set of information concerning the patient’s clinical history, to assess the patient’s clinical progress over time and in relation to the proposed therapy.

Anxiety diary: how it works

A very useful tool for the diagnosis of DAG and for setting the most effective psychotherapy, to solve and prevent future anxiety attacks, is the ‘anxiety diary’: the psychiatrist and psychotherapist ask the patient to write down on a diary or calendar the frequency and the reasons triggering anxiety.

They are asked to describe in great detail the situation and the emotions experienced before having the single attack of agitation and irritability, as well as the duration of the uncomfortable feeling experienced.

With the anxiety diary you will achieve 2 things:

one will be able to report to the psychiatrist and psychologist how many and which events are experienced with anxiety in a day, in a week, in a month. At each session you will bring the updated diary and comment on it together;
It will be very useful to increase the patient’s degree of awareness and consequently his self-esteem and sense of control over the facts of life and the management of his own emotions about the events that create anxiety/anxiety, with a preventive effect on the subsequent attack or containment of negative and out-of-control emotions.

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