Anxiety

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Also known as generalised anxiety disorder, fear, gad

In stressful situations we all get anxious, and that’s completely normal. If we have money worries or a sick loved one we feel stressed and worried.

If we see an item on TV that is disturbing, such as a terror attack, we feel horror, temporary distress and dismay, yet we continue with our activities and can put it out of our minds. 

However, some people may see the same item on TV and suffer considerably more distress and worry. They may be up all night worrying about what to do if such an attack came to their town, and this worry can go on for days. This type of ongoing, all-over anxiety is called generalised anxiety disorder (GAD).

If you experience this level of anxiety, you feel worried about many things. You worry about your finances, your family, your car, your pets, literally anything can cause concern. Sometimes even thinking about how to get through your day makes you feel anxious. This is mentally and physically exhausting.

It’s common for people with GAD to have other conditions such as depression, or other anxiety disorders. These anxiety-related disorders can include:

  • Panic attacks – where you have a sudden and severe surge of anxiety and fear that happens in response to something in particular that affects you (a trigger).
  • Obsessive-compulsive disorder (OCD) – where you have obsessive, uncontrollable thoughts and perform deliberate repetitive actions (compulsions).

GAD comes on gradually and can begin at any time in your life, though the risk is highest between childhood and middle age. Anxiety levels in most people with GAD fluctuate – when their anxiety level is mild, people with GAD can function socially and be gainfully employed. When their anxiety is severe, some people may have difficulty carrying out the simplest daily activities.

What causes anxiety?

It is unknown exactly what causes GAD. What is known is that the wiring of some areas of the brain are affected in those with GAD and other anxiety disorders, and scientists continue to try to understand what that means and how it could lead to a better understanding of the condition and how to provide better treatment for those who experience it.

There is also a family, or genetic link. A person with a family history of anxiety disorder or obsessive compulsive disorder is more prone to develop this type of problem.

Signs to look for (symptoms)

The symptoms of GAD can vary between individuals and, over time, within an individual. You may notice better and worse times of the day. And while stress doesn’t cause generalised anxiety disorder, it can make the symptoms worse.

People with GAD will usually:

  • expect the worst
  • worry excessively about money, health, family or work, when there are no signs of trouble
  • be unable to relax, enjoy quiet time, or be by themselves
  • avoid situations that make them anxious
  • be irritable
  • have constant worries running through their head
  • have difficulty concentrating or focusing on things
  • feel edgy, restless or jumpy
  • suffer from stomach problems, nausea, diarrhea
  • suffer from poor sleep
  • need to know what’s going to happen in the future

Children and young people

If a child has GAD, their worries focus on their family, school and what could happen in the future, especially with their parents. Children and teens with GAD often don’t realize that their anxiety is out of proportion to the situation, so adults need to recognise their symptoms.

As well as many of the symptoms that appear in adults, children with GAD may have:

  • a fear of making mistakes
  • “what if” fears about situations far in the future
  • a feeling that they’re to blame for any disaster, and their worry will keep tragedy from occurring
  • a need for frequent reassurance and approval.

How the doctor or mental health professional determines if you have GAD (diagnosis)

There is no test to diagnose GAD, and it can be somewhat hard to determine because it does not have some of the more noticeable symptoms of other anxiety disorders.

A diagnosis is made by your health professional, ie, doctor, psychiatrist or clinical psychologist, based on whether you (or your child) have some or all of the typical symptoms, and the length of time you have had them. Your health professional is likely to say you have GAD if you’ve felt anxious most days for over six months. For this reason it’s important that he or she spends time with you to get a full understanding of what has been going on.

Treatment options

Treatment of GAD can involve a number of aspects, each of which is tailored to your individual need. For most, a combination of medication and talking therapies, such as counselling, can be effective.

Medication

Your doctor may prescribe antidepressants. Finding the right medication can be a matter of trial and error – there is no way to predict which medication will be effective and tolerated (have fewer troublesome side effects) by any one person.

If you are prescribed medication you are entitled to know:

  • the names of the medicines
  • what symptoms they are supposed to treat
  • how long it will be before they take effect
  • how long you will have to take them for and what their side effects are (short and long term).

If you’re breastfeeding no medication is entirely safe. Before making any decisions about taking medication at this time you should talk with your doctor about the potential benefits and problems.

An assessment by a psychiatrist specializing in child and adolescent mental health problems should be undertaken before medication is prescribed for children and adolescents. Your doctor will help you find an appropriate psychiatrist.

Talk to your doctor if you are considering stopping treatment, and work with them to find some compromise that will ensure continuing wellness but address your concerns about the treatment. It is very important that any decision to stop medication is made with the input of your doctor.

Therapy, such as talking therapies

Talking therapies are very useful for anxiety, especially with children and young people. Your doctor should be able to explain what is available locally and which type of talking treatment such as Cognitive Behaviour Therapy (CBT) is most suitable for you. CBT looks at two things: how your negative thoughts contribute to your anxiety and what might help you feel better.

Psychoeducation (providing education)

Education about GAD can be extremely important to help you, your family/whānau and supporters. Your doctor should give you information about your condition, suggest different ways to handle it, and discuss any complications which could occur.

Also, talking things over with people you feel comfortable with can be useful and may help to define a problem and ways to begin to tackle it.

Complementary therapies

The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and that may be used to complement and support it.

Certain complementary therapies may enhance your life and help you to maintain wellbeing. In general, mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress.

Physical exercise

It's also really important to look after your physical wellbeing. Make sure you get an annual check up with your doctor. Being in good physical health will also help your mental health.

Thanks to Janet Peters, registered psychologist, and Lisa Ducat, Like Minds, Like Mine mental health promoter, for reviewing this content. Last reviewed: September, 2014.