An Essay About Generalized Anxiety Disorder

Generalized Anxiety Disorder

An Owner’s Manual for the Uninitiated

When I was first diagnosed with Generalized Anxiety Disorder (by a neurologist in the middle of a migraine appointment), I thought, “Great! Search terms! Let’s get cozy, Google.”

But I was wrong to assume simple screen time was going to help me find my path with my anxiety disorder. I found little online that informed me in any real way. For one thing, the word “worry” was used again and again. At the time, worry wasn’t what I did or how I identified. Thinking and overthinking, yes. Worry, no.

A few months after my July diagnosis, in Sept 2015, the tennis player Mardy Fish wrote a great essay that captures the experience of anxiety in vivid detail. At one point he sums it up: “I was, objectively, doing great. And looking back, I wish I had been able to tell myself that. But doing great wasn’t something that my frame of mind back then had time to process. All I could focus on was doing better. It was a double-edged sword.”

By the time I read Fish’s piece, he was confirming something I already knew. I’d talked to many people to piece together what GAD meant, found a book that helped a lot, and started to figure out my own particular form of anxiety for myself.

The goal of this short FAQ is to help people like me when they’re just beginning their journey. You may be realizing you have anxiety. Maybe you’ve been told that that you’re exhibiting some of the symptoms of Generalized Anxiety Disorder. If you are Googling the hell out of your keyboard right now and not finding answers to your questions, welcome, fellow mind traveller.

Q. What is Generalized Anxiety Disorder, exactly?

A. You’ve probably been researching this topic, so I’m not going to give you the same bland answer you’ve already seen about how it’s a psychological disorder characterized by excess “worry” particularly about work, finances, and relationships. I will say that some of the people I know with GAD didn’t know they had it for a long time. They didn’t characterize themselves as “worriers.” Books and doctors tell you that GAD means you worry about worry, but if you don’t even consider it worry, that doesn’t help. And if you are so habituated to pushing away the worry as a coping mechanism, then again, talking in those terms just leads to more trouble.

For me, GAD meant that I was overthinking nearly everything in my life, scrupulously trying to figure it all out. If a problem came up, I’d write it down and begin my crazed attack in every direction. It also meant I had a ton of crippling shoulder and neck pain. I’d be nauseated frequently, especially on buses. I’d get dizzy occasionally, almost to the point of fainting. It was the physical symptoms that led my neurologist to know I had GAD.

Q. Can a person have GAD and not know it?

A. Absolutely. It’s common for people who have GAD to see many doctors before they get properly diagnosed. Gastroenterologist, chiropractor, neurologist, acupuncturist, and gynecologist offices are some of the common stops along the path to diagnosis.

Q. Is it hereditary?

A. I don’t know if this is everyone’s question, but it was one of mine. I wanted to understand where GAD was coming from. Yes, there is a genetic component. As is often the case, that’s only one part of the equation. You may have genetic roots and predisposition to anxiety disorders, but they are also triggered by environmental factors. The death of a loved one, divorce, the sudden loss of a job or your house, or a big change in circumstance can bring on episodic fare-up of GAD.

Q: If it flares up, does that mean it’s dormant at other times?

A: My understanding (I’m a patient, not a doctor!), is that you’re predisposed to GAD, but with proper treatment, you can bring your symptoms into check. But since you are predisposed to this condition, when things happen to you, you will be more likely to have bigger anxiety responses than other people. I almost think of it as a GAD sine wave, and the equation is your life, and what’s happening in it.

Q. How messed up are you, exactly? Please be specific.

A. Very recent example:

We have had a few ants in the bathroom lately. They appeared to be coming through the window. “We should probably replace the window,” was my immediate thought, and suggestion to my husband, even though we can’t afford it.

I don’t see 5–10 ants. I see the inevitable 100–200 ants that I imagine will invade and eventually carry off our house. It’s very hard for me to deal with the here and now when I am catastrophizing. (That’s a cognitive distortion. Learning to recognize cognitive distortions is one important element of cognitive behavioral therapy, the best method for treating GAD.)

A friend put it well: “I realized that I did everything in a rush. Even simple things like brushing my teeth or making coffee. And 80 percent of what I do on a typical day does not require hurrying and rushing. That creates a lot of stress and worry throughout the day.” I know exactly what he means. I sometimes have the feeling that if I don’t get whatever small household task done at any given moment, the world might end. GADs are not known for their patience.

The worst era of my anxiety disorder was the time before I knew I had it. I knew something was wrong, but not what. I desperately wanted to figure it out. I’d go down every known avenue trying to get an answer. My diagnosis was one of the best things that’s ever happened to me. I am very thankful for it.

Q. If I have GAD, how do I make it go away? Does it last forever?

A. Here’s my thinking on it. The ideal situation is that I’m able to ride the wave. Maybe even get to the point where I can hang in the lull for a long time with little anxiety. When stressful things happen, I expect that my particular gremlin will poke his head out of the wave’s crest. Knowing what to do with him and that I’ve survived his visits before helps a lot.

Meditation.Medication. A moderate amount of reading and learning (in other words, don’t overdo it). Communication.

Q. Can anyone develop it? What’s the line between having it and just being a regular stressed out American?

A. Right now, I am seeing the world through anxiety-tinted lenses, so I tend to see anxiety in a lot of people around me. Ultimately, though, the difference between regular anxiety, stress, and GAD comes down to degree. Most people aren’t fainting or getting up in the middle of the night. Most don’t need neck rubs every day. And most aren’t negatively predicting the outcomes of regular social interactions in a way that adds extra stress to daily life.

One of my friends, who learned through my experience that he has GAD too, said, “I tend to project into the future as I experience almost everything. And I’m often planning how to deal with some negative turn of events that might happen in the future, but most likely never will. So I’m worrying in the present about something that will never happen in the future.” If that sounds familiar, you might want to read more about Generalized Anxiety Disorder.

Q. Is this what has been wrong with me?

A. I can’t tell you that, but I can tell you that if anything that I’ve said has rung true, a great place to start is the book The Worry Cure. Don’t think about the title too much and don’t think about the word “worry.” Just investigate your physical symptoms through the lens of your thoughts, and see if what this book has to say relates to you. If not, then you don’t have GAD.

Q. Will I ever feel better?

A. I believe that you will feel better if you have GAD. This is a hard won statement coming from me. I am a skeptic and not one to placate you, reader. But I think that simply the fact of you reading this means that you are going to feel better.

Q. How do you know?

A. Times are changing. People are talking openly about depression, anxiety, and other forms of mental suffering in a way that they never did when I was in my 20s. I’m so glad to see it on behalf of my 5-year-old daughter. The more people speak openly about the spectrum of mental conditions, the more they can be helped earlier on.

I wouldn’t have dreamed of writing something this personal just one year ago. I now feel as though my anxiety needs to be an integrated part of me in order to be managed in a healthy way. I hope that others will feel that way too.

Q: What should I do if I’m a friend or family member of a Gaddie?

A: I feel for you. It’s not easy to deal with an anxious person, especially at the high pitch levels that people with GAD specialize in.

It’s hard to avoid the role of friend-therapist. You might find yourself talking your friend down and trying to give them a more realistic view of their surroundings. The goal is to help them build those muscles for themselves without exhausting yourself. Bottom line: get the oxygen mask on yourself first.

On the other hand, it can also be confusing because GAD often presents as perfectionism, or invulnerability. How do you help someone who doesn’t seem to need help? Take in the information you have and tune in to your instincts. Is the person talking super fast? Are they in a lot of physical pain? Do they seem complainy? If so, they may need to learn to tune in to how they are responding to the world around them. As a friend, you can help by gently encouraging them to go easy on themselves and stay grounded in the moment. Send them a link to this piece. Do it with love.

This paper reflects the research and thoughts of a student at the time the paper was written for a course at Bryn Mawr College. Like other materials on Serendip, it is not intended to be "authoritative" but rather to help others further develop their own explorations. Web links were active as of the time the paper was posted but are not updated.

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Generalized Anxiety Disorder

Joan Steiner

Anxiety is a common occurrence and emotion in everyday life. Yet there are several individuals today who suffer from great pangs of anxiety and feelings of panic at such extremely high levels that it becomes quite debilitating. A normal, everyday environment can become so overwhelming that the day itself can stop dead in it's tracks while the sufferer rides through the wave of intense emotions and thoughts which seem to be going a million miles a minute and showing no signs of stopping or slowing down.

Generalized Anxiety Disorder (GAD) is one of a multitude of Anxiety Disorders that affect many people around the world. An individual suffering from GAD differs from anyone else dealing with natural anxiety due to the chronic and exaggerated worrying that can occur on a daily basis. The worries and anxieties usually are not provoked by anything, and finding the source of the worries is usually quite difficult. They are associated with daily things, such as but not limited to, health, money, family, or work. People with GAD cannot alleviate their concerns and usually become so overwhelmed by the anxiety that getting through the day and doing their usual activities proves too difficult.(1)

As a disorder, GAD is diagnosable. However, it is usually a difficult thing to do since GAD, unlike many of the other Anxiety Disorders out there, does not have any definite symptoms like a "panic attack". Individuals are diagnosed with GAD when they spend at least six months worrying excessively about a number of everyday problems and the worrying happens more often than not. Other symptoms of GAD may include: Trouble falling or staying asleep, muscle tension, sweating, nausea, gastrointestinal discomfort or diarrhea, cold and clammy hands, difficulty swallowing, or jumpiness.(2)

The cause of GAD is relatively unknown. Many believe and have evidence that GAD can be genetic and may run in families, while others see a correlation to GAD and situations of extremely high pressure and stress. Some research even suggests that there could be a specific gene related to disorders like GAD. GAD often coexists with other anxiety disorders, clinical depression and substance abuse.(3) Doctors who treat patients with diagnosed clinical depression find symptoms of anxiety to be a good sign, because it means that the individual hasn't simply accepted their depressed mood as they would a free meal. They are depressed and they are anxious because they are concerned about the ego dystonic nature of their depressed mood. A thorough initial evaluation is rudimentary to ruling out other possible and more appropriate diagnoses.(4) Some also find GAD caused by an overdose or overproduction of serotonin, a chemical in the brain that usually fights depression and anxiety, but too much can cause a reverse affect.(5)

About ten million adults or 3-4% of the population suffer from GAD, and women are more likely to have it than men. It can start at any time during childhood and adolescence, but can begin in adulthood too, usually around the early twenties.(3)

There are a few ways to go about treatment of GAD. The most common approaches are with psychological treatment, and if necessary medication. GAD patients have been shown to respond best to cognitive-behavioral therapy, an active form of therapy that involves more than just talking to a therapist. The individual gradually learns to see situations and problems in a different perspective and learns the methods and techniques to use to alleviate and reduce anxiety.(6) Drug treatment, although suggestively not the best way to go about treatment is another commonly used alternative. Certain medications are used to help relieve some of the symptoms of GAD, such as Valium and Ativan, the two most prescribed benzodiazepines. A non-benzdiazepine medication used for treatment is buspar (buspirone), a better alternative for long-term treatment. And, of course, self-help and support groups are another source of treatment that is encouraged.(4)

As amazing and complex as the brain is, the development and recognition of the numerous conditions and problems that can go on with the brain show how delicate a human's mentality and stability is, and how vulnerable it seems to be to the rapidly changing times and developments of society. It seems to be the nature of the brain and mentality to be slow in adjusting to the various new outputs that are created as society and the world progresses. Will science be able to find a way to make the brain adjust and accept change more quickly? This can be seen as a task similar to making evolution as fast as the first world's rate of development.


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