ANXIETY DISORDERS AND GENERALIZED ANXIETY DISORDER

ANXIETY DISORDERS

Traditional anxiety disorders: 

• Generalized anxiety disorder (GAD)

• Panic disorder & agoraphobia

• Specific phobia

• Social anxiety disorder

Newly added disorders: 

• Separation anxiety disorder

• Selective mutism

These disorders are often complicated by panic attacks or other anxiety-related features. GAD differs because its anxiety is generalized across everyday life events

GENERALIZED ANXIETY DISORDER

Persistent, uncontrollable worry that doesn’t lead to solutions, feels unproductive, and negatively impacts both the individual and those around them.

CLINICAL DESCRIPTION OF GENERALIZED ANXIETY DISORDER (GAD)

DSM-5 Criteria for General Anxiety Disorder:

• Duration: At least 6 months of excessive anxiety and worry, more days than not.

• Control: Worry must be difficult to turn off or control.

• Difference from normal worry:

1. Normal: worry is temporary and stops after the event.

2. GAD: worry continues endlessly, moving from one crisis to the next.

Physical & Cognitive Symptoms of GAD

Children: only one physical symptom is required for diagnosis.

Panic Disorder vs GAD

PANIC DISORDER	GAD
autonomic arousal (sympathetic surge: ↑ heart rate, sweating, trembling, palpitations).	Muscle tension, mental agitation, fatigue, irritability, sleep disturbances, difficulty focusing (mind jumps crisis to crisis).

Content of Worry

• Mostly worry excessively about minor, everyday life events (distinguishes GAD from other anxiety disorders).

• Common concerns in adults: children’s safety, family health, job responsibilities, chores, and punctuality.

• Children with GAD: Worry about competence in academics, athletics, social performance, and family issues.

• Older adults with GAD: Worry about health, with sleep problems worsening anxiety.

Common Experiences of GAD

• Worry and physical tension are normal.

• Severe, persistent generalized anxiety (as in Irene’s case) is relatively rare.

PREVALENCE of GAD

ADULTS	ADOLESCNETS (13-17)	GLOBAL PERSPECTIVE
3.1% of the population meet GAD criteria in a 1-year period	1.1% one-year prevalence	Similar rates reported internationally.
5.7% meet criteria at some point in their lifetime

Treatment-Seeking Behavior of GAD

• Fewer people with GAD seek treatment compared to panic disorder.

• Anxiety clinics:

• ~10% of patients meet criteria for GAD.

• 30–50% meet criteria for panic disorder.

• Likely Explanation

• Many GAD patients seek help from primary care doctors instead

• Found in large numbers in primary care settings

SEX DIFFERENCES of GAD

About twice as many females as males have GAD in epidemiological studies.

These studies include individuals identified from population surveys, not only those seeking treatment

CROSS-CULTURAL VARIATION of GAD

The female-to-male ratio may be specific to developed countries.

• South African study: GAD was more common in males.

ETHNIC/RACIAL PREVALENCE of GAD

Prevalence of GAD is significantly lower among compared to White adults:

• Asian adults

• Hispanic adults

• Black adults

ONSET of GAD

Some report onset in early adulthood, often triggered by a life stressor.

• Most studies: GAD has an earlier and more gradual onset than most other anxiety disorders

• Median age of onset (interview-based): 31 years 

• Many individuals report feeling anxious and tense throughout their lives.

COURSE of GAD

Once developed, GAD is chronic.

• Recovery statistics:

• One study: 8% probability of becoming symptom-free after 2 years of follow-up 

• After 12 years, only 58% chance of recovery

• Of those who recovered, 45% relapsed later

Pattern: chronic course, with waxing and waning symptoms

GAD IN OLDER ADULTS

Prevalence in older adults

• GAD most common in age 45+ group

• Least common in ages 15–24

• Reported prevalence rates in older adults: up to 10%

• Older adults may be especially susceptible to anxiety about:

• Failing health

• Life situations that diminish control over events

• Increasing lack of control, failing health, and gradual loss of meaningful functions are major factors.

• Older adults with GAD experience substantial impairment in quality of life