Generalized anxiety disorder (GAD) is marked by excessive, uncontrollable, and unrealistic worry about a number of events or activities.  Diagnosis requires that the person has worried more days than not for at least 6 months and that the worry has been associated with significant distress or impaired functioning.  Moreover, while the person is worrying, he or she must be typically experiencing three of six symptoms (restless/keyed-up/on-edge, easily fatigued, difficulty concentrating, irritability, muscle tension, and sleep disturbance).  GAD is a common and disabling problem that has a lifetime prevalence rate of about 5%.
Anxiety and worry are a normal part of life and most people will worry at least a little bit about how things will turn out.  Not only is anxiety a common human emotion, but moderate amounts of anxiety can be helpful by motivating people to prepare for an exam, complete a work assignment, or deliver an energized speech.  But excessive anxiety is more than butterflies in your stomach.  It is a real, medical illness that can disrupt people’s lives, interfere with performance, and trigger physical discomforts.  When persistent and unrealistic worry becomes a habitual way of approaching situations, an individual may be suffering from GAD.  Experts believe GAD is probably caused by a combination of biological factors and life events.  In fact, many people who have GAD also have other medical disorders, such as depression and/or panic disorder, that seem to be influenced by certain neurotransmitters in the brain, such as serotonin.  Some researchers believe that its early onset, chronicity, and resistance to change provide evidence that GAD may be the basic anxiety disorder out of which additional anxiety disorders commonly arise.
GAD can be hard to diagnose.  It lacks the obvious symptoms of a panic attack or an anxiety response to a traumatic experience or specific stimulus.  Its physical symptoms are typical of many other disorders, and these individuals often suffer from other physical ailments and concomitant symptoms.  As a primary diagnosis, GAD has a high rate of concurrence with axis I and II conditions.  The most common comorbid axis I conditions are social phobia, simple phobia, panic disorder, major depression, dysthymia, and somatoform disorders.  The most common comorbid axis II conditions occur in clusters B and C. Persons with GAD report that they have been worriers their whole lives.  As a result, they may fail to fully process the negative impact of their current worry-related symptoms.  Clients with GAD often initially deny that worrying impairs their functioning.  Such clients are so used to worrying that they are able to function fairly well and accomplish various tasks throughout their day.  Therefore, when assessing impaired functioning, it is often helpful to ask about the impact of specific GAD symptoms such as sleep disturbance, diminished concentration, muscle tension, and feeling tired all the time.  Such a focus often reminds clients that they could probably function much better in the absence of these symptoms. 

continue to page 2...