Generalized_Anxiety_Disorder

Generalized Anxiety Disorder is one of the most common mental health problems in America on and off of college campuses. GAD affects approximately 6.8 million adults in the United States in any given year, with women being twice as likely as men to be affected by GAD. A diagnosis of GAD can be made when a patient has experienced intense feelings of anxiety more days than not over a six month period. Other symptoms include fatigue, digestion problems, sweating, rapid heartbeat, restlessness and even depression. The onset of Generalized Anxiety Disorder is most likely to occur between childhood and middle age and is most prevalent between the ages of 15 and 24. GAD is a chronic disorder that is generally regarded as a lifelong issue for most patients, but luckily it is treatable by various psychotherapy treatments, including cognitive-behavioral therapy, as well as the prescription of certain drugs including Benzodiazepines and Buspirone. Prevalence Anxiety disorders are one of the most common mental health concerns in the United States and they tend to be among one of the most frequently reported mental health concerns on college campuses around the country. There are several types of anxiety disorders including: Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Panic Disorder, Posttraumatic Stress Disorder, Social Anxiety Disorder and specific phobias. According to Baez’s article, Evidenced-Based Practice for Anxiety Disorders in College Mental Health, over forty million American adults suffer from some type of anxiety disorder (Baez, 2005). Of those forty million Americans, seventy-five percent reported that they experienced their first episode of anxiety by the age of twenty-two (Baez, 2005). GAD affects approximately 6.8 million adults in the United States in any given year, with women being twice as likely as men to be affected by GAD (“Adaa”). Syndrome Description DSM IV-TR Criteria The Diagnostic and Statistical Manual of Mental Disorders diagnoses GAD when the patient experiences, “At least 6 months of "excessive anxiety and worry" about a variety of events and situations and when there is significant difficulty in controlling that anxiety and worry (American Psychiatric Association, 2000).” Generalized Anxiety Disorder is characterized by persistent, unwarranted, and unrealistic worry about everyday matters (“Adaa”). According to the Anxiety and Depression Association of America, “People who suffer from GAD experience exaggerated worry and tension, often expecting the worst, even when there is no apparent reason for concern (“Adaa”).” Mostly, GAD sufferers anticipate disaster at all times and are excessively troubled by thoughts about money, health, family matters and work related or other various issues. The constant worrying that is associated with GAD generally occurs every day, possibly all day, to the point that it interferes with daily life including work, school and family, as well as causing disruptions to regular social activities and events. Syndrome Epidemiology Generalized Anxiety Disorder is diagnosed when a person worries excessively about a variety of different problems for at least six months, generally on a daily basis. In the article by Lizeretti and Extremera, the authors conclude that anxiety disorders can develop at any point in a person’s life, but the onset of GAD is most likely to occur between childhood and middle age. Most clinically diagnosed cases of GAD occur during the patient’s high school and college years, or between the ages of 15 and 24. (Lizeretti & Extremera, 2011) Other symptoms, besides chronic every day worrying accompany GAD. Muscle tension and discomfort are two of the most common symptoms that coincide with the presence of Generalized Anxiety Disorder. Fatigue, restlessness and also difficulty sleeping are also common symptoms. Not only these symptoms, but also irritability and edginess are often experienced by GAD sufferers. Gastrointestinal discomfort, such as stomach aches and pains and diarrhea also afflict those with Generalized Anxiety Disorder as well. Syndrome Treatment Assessment of Syndrome Description Social anxiety disorder remains under-recognized in primary care practice, with patients often receiving treatment only after the onset of complications, such as clinical depression or substance abuse disorders (Baez, 2005). No specific tests are run on patients who are believed to have GAD, but instead a comprehensive check is done to make sure that any symptoms the patient is experiencing are truly related to Generalized Anxiety Disorder. In some cases, physicians use psychological questionnaires to help with the diagnosis process. Doctors may also execute a physical examination to look for potential underlying medical conditions that may be causing the patients’ anxiety. Commonly, patients complain mostly about feelings of anxiety and have a tendency to be startled easily and jumpy, restless, shaky, experience a pounding heartbeat, indigestion and cramps, feelings of lightheadedness and even exhaustion (Roemer et. al, 1995). Usually when a patient complains about having three or more of these symptoms and can explain in detail how often they occur and their severity, a doctor will be able to accurately diagnose them as having GAD according to the DSM IV-TR criteria (American Psychiatric Association, 2000). Course and Prognosis GAD is a chronic disorder that is generally regarded as a long-term condition that may become a lifelong problem in which the symptoms may appear off and on during the course of its presence, with some symptoms being worse than others at any given time (Ginsburg et. al, 2011). Although Generalized Anxiety Disorder can be debilitating for many sufferers by interfering with their everyday routine, it is treatable. With the right treatment plan and the use of medications, GAD patients are capable of returning to their everyday lives with the ability to function normally without their intense feelings of anxiety. Psychosocial TX One treatment that has proven to be quite beneficial is cognitive-behavioral therapy (CBT). CBT is commonly used to treat a wide range of disorders, including phobias, addiction, depression and anxiety. Cognitive-behavior therapy is an effective type of treatment because it aids patients in understanding their personal thoughts and feelings and how they impact their anxiety (Ladouceur et. al, 958). Cognitive-behavioral therapy also enables people with Generalized Anxiety Disorder to learn ways to control their worry and to focus on other aspects of life instead of obsessing over their sources of anxiety. According to Newman et. al, the goal of cognitive-behavior therapy is to teach GAD sufferers that even though they cannot control every facet of the world around them, that they can take control of how they deal with the things in their own personal environment (Newman et. al, 2011). Psychopharmacological TX There are other types of treatments to help overcome anxiety. One of the most common treatments used by medical doctors to treat anxiety is the prescription of various medications that aid patients in overcoming their symptoms. Benzodiazepines are the most common type of medication used in the treatment of GAD (Donegan & Dugas, 493). Benzodiazepines are a type of medicine that helps relieve anxiety symptoms by reducing the response time of the central nervous system to anxiety producing stimulants (“Medications”, 1995). These medicines take effect fairly quickly, starting to work within an hour after they are taken. These types of medications relieve physical symptoms of anxiety such as a pounding heartbeat, breathing problems, irritability, nausea, and faintness (“Medications”, 1995). Buspirone is another drug often used in patients with chronic anxiety and those who relapse after a course of benzodiazepine therapy (“Medications”, 1995). The FDA reports that Buspirone is different from Benzodiazepine medications because it does not employ muscle relaxing effects on the body or slow the central nervous systems’ response time. Buspirone medications also do not have the sedating effects that are typically associated with other anti-anxiety drugs (“Medications”, 1995). Syndrome Etiology Protective Factors for Etiology Although the exact cause of Generalized Anxiety Disorder is unknown, there is evidence of a few potential risk factors that tend to be present in most cases of GAD. These factors include childhood trauma, health issues and serious illnesses, stressful life events, genetics and substance abuse. Social Factors As we learned in child psychology, many events that are experienced during the formative years of one’s life can cause various outcomes that become present later on in life. Studies show that children who endured some type of abuse or trauma are at a higher risk of developing Generalized Anxiety disorder at some point in their lives (Ginsburg et. al, 2011). Another potential risk factor that is possibly linked to the development of an anxiety disorder is the presence of a chronic health condition or serious illness, such as cancer. The existence of such conditions can lead to extreme worry and fears about the future, the treatment process of the illness and even financial stress because medical bills are extremely expensive. A big event looming in the future or an event that happens unexpectedly or a number of smaller stressful life events that occur simultaneously may trigger excessive anxiety that can develop into a particular disorder (Roemer et. al, 1995). Co-occurring Disorders Generalized Anxiety Disorder rarely occurs alone and is usually accompanied by other personality disorders such as depression and other anxiety disorders. People with certain personality types or personality disorders have also been found to be more prone to develop anxiety disorders than others in their lifetime. A 2008 Associated Press survey of college students found that eighty percent said they frequently or sometimes experience daily stress. Thirteen percent of students that responded to the survey reported that they have actually been clinically diagnosed with an anxiety disorder or depression (“Adaa”, 2012). Other anxiety disorders, depression and even substance abuse tend to accompany Generalized Anxiety Disorder. The Associated Press also reported that thirty-four percent of students have felt depressed at some point in the last three months and nine percent reported that they have seriously considered committing suicide in the past year (“Adaa”, 2012). Biological factors Another potential risk factor that seems to be more prevalent than others is that anxiety disorders tend to run in families. Genetic factors may play a key role in the development of Generalized Anxiety Disorder. Other aspects of family life may also be at fault for the presence of GAD running in families (Baez, 2005). Psychological Factors Family dynamics and psychological influence are both potential contributing factors of GAD. Members of a family tend to experience all the same hardships, whether it is financial struggles, divorced parents or even the death of a family member. These shared experiences may tend to cause anxious emotions that lead to the development of an anxiety disorder in multiple members of the family. Finally, the last known potential risk factor of anxiety disorders is substance abuse. The abuse of drugs and alcohol can worsen the symptoms of Generalized Anxiety Disorder. After a stint of abuse of such substances, the withdrawals experienced by those who no longer use them can also cause the development of an anxiety disorder. Studies have shown that substances such as caffeine and nicotine are also closely related in the occurrence of generalized anxiety disorders (Lizeretti, & Extremera, 255). Anxiety disorders are the most common mental health problems on college campuses. According to Bjornsson et. al, one in eight college students will experience relentless episodes of anxiety during their time in college (Bjornsson, 2011). This is because college is a stressful time in most students’ lives. There is so much to juggle between school, work, friends, and family and even trying to find a little time to have some fun, while still trying to figure out the rest of your life. This schedule can be hectic and hard to balance, leaving college students lacking in certain areas of their lives. This sense of lacking can lead to depression, which often correlates to the development of Generalized Anxiety Disorder. College calls for a significant transition, in that students experience many firsts, including a new lifestyle on their own and being away from home, meeting new friends and roommates and being exposed to new cultures and alternate ways of thinking than they have previously been exposed to. When students struggle to adequately manage these common stressors, they are much more susceptible to developing anxiety disorders. For college students, there is so much pressure to do well academically, this pressure can stem from themselves or from their parents, but nonetheless, the pressure to be successful is always something that weighs heavily on most students’ shoulders and is usually a top priority. Trying to adjust to all of colleges’ new and exciting experiences can also cause student’s to question who they are. They no longer are surrounded with all of the familiar faces from their childhood and high school days and often wonder who they will be friends with or what they are going to do now that they are on their own, which can cause many students to lose their sense of confidence and leave them feeling depressed, which often coincides with feelings of anxiety. A loss of a student’s self-identity and confidence can lead them to make bad decisions and even be pressured by their peers to make poor choices such as drinking and substance abuse which has also been found to coincide with the development of Generalized Anxiety Disorder in people, particularly between the ages of 18 and 24 (Tartakovsky, M., 2008). In a recent survey conducted by the National Center on Addiction and Substance Abuse (CASA), forty-five percent of college students at American Universities reported that they binge drink with the intention of getting drunk and nearly 21 percent of students reported that they abuse both prescription and illegal drugs (Roemer et. all, 1995). These high rates of alcohol and drug abuse are definitely a potential risk factor in aiding in the development of an anxiety disorder for many college students that emanate such behaviors. With rates of GAD diagnoses increasing every day on college campuses, more students need to become more aware of the symptoms and treatments of this disorder before it’s too late. An untreated anxiety disorder can lead to other serious health issues and life altering consequences, including dropping out of college. The survey conducted by CASA also reported that anxiety and panic disorders are cited as one of the most frequent reasons that students give when dropping out of school and that women are twice as likely as men to drop out of school because of stress and anxiety related problems (Ginsburg et. al, 2011). Luckily, Generalized Anxiety Disorder can be treated successfully and most college campuses offer counseling services to their students, usually at no cost. It is of the utmost importance that college students who begin feeling anxious or depressed seek professional help immediately so that they can return to their normal lives and be as successful and happy as possible. A student’s college years are said to be some of the greatest times of a person’s life and every student disserves to be able to experience all of the great times and memories that come along with being a college student without experiencing debilitating anxiety. References “Adaa” . Anxiety and depression association of America. (2012). Retrieved from http://www.adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (4th Ed., Text Revision). Washington DC: American Psychiatric Association. Ayers, C. R., Sorrell, J. T., Thorp, S. R., & Wetherell, J. (2007). Evidence-based psychological treatments for late-life anxiety. Psychology and Aging, 22(1), 8-17. Baez, T. (2005). Evidenced-Based Practice for Anxiety Disorders in College Mental Health. In S. E. Cooper (Ed.), Evidence-based psychotherapy practice in college mental health. New York, NY: Haworth Press. Bjornsson, A. S., Bidwell, L., Brosse, A. L., Carey, G., Hauser, M., Mackiewicz Seghete, K. L., & ... Craighead, W. (2011). Cognitive–behavioral group therapy versus group psychotherapy for social anxiety disorder among college students: A randomized controlled trial. Depression and Anxiety, 28(11), 1034-1042. Donegan, E., & Dugas, M. J. (2012). Generalized anxiety disorder: A comparison of symptom change in adults receiving cognitive-behavioral therapy or applied relaxation. Journal of Consulting and Clinical Psychology, 80(3), 490-496. References Ginsburg, G. S., Kendall, P. C., Sakolsky, D., Compton, S. N., Piacentini, J., Albano, A., & ... March, J. (2011). Remission after acute treatment in children and adolescents with anxiety disorders: Findings from the CAMS. Journal of Consulting And Clinical Psychology, 79(6), 806-813. Ladouceur, R., Dugas, M., Freeston, M., Léger, E., Gagnon, F., Thibodeau, N. (2000). Journal of Consulting and Clinical Psychology, Vol 68(6), 957-964. Lizeretti, N. P., & Extremera, N. (2011). Emotional intelligence and clinical symptoms in outpatients with generalized anxiety disorder (GAD). Psychiatric Quarterly, 82(3), 253-260. "Medications." National Institute of Mental Health Page. 1995. Retrieved on November 3, 2012 from http://www.nimh.nih.gov. Newman, M. G., Castonguay, L. G., Borkovec, T. D., Fisher, A. J., Boswell, J. F., Szkodny, L. E., & Nordberg, S. S. (2011). A randomized controlled trial of cognitive-behavioral therapy for generalized anxiety disorder with integrated techniques from emotion-focused and interpersonal therapies. Journal of Consulting and Clinical Psychology, 79(2), 171-181. Nydegger, R. (2012). Dealing with anxiety and related disorders: Understanding, coping, and prevention. Santa Barbara, CA US: Praeger/ABC-CLIO. References Roemer, L., Borkovec, M., Posa, S., & Borkovec, T. D. (1995). A self-report diagnostic measure of generalized anxiety disorder. Journal of Behavior Therapy and Experimental Psychiatry, 26(4), 345-350. Tartakovsky, M. (2008). Depression and anxiety among college students. Psych Central. Retrieved on November 3, 2012, from http://psychcentral.com/lib/2008/depression-and-anxiety-among-college-students.