Generalized anxiety disorder is a diagnosis that is given
to individuals who present with persistent, excessive and uncontrollable
worry for at least six months about multiple concerns. The worry
is also associated with other somatic symptoms such as restlessness,
being easily fatigued, irritability, concentration problems or having
one's "mind going blank", irritability, muscle tension
and sleep disturbance. People with GAD are often perfectionistic
and indecisive. GAD often goes undiagnosed because people (including
many medical professionals) see worry as normal. This may be true,
but excessive and uncontrollable worry is not and so people suffering
with GAD often only tend to present at a mental health professional
once the anxiety spins out of control (into panic attacks) or once
people become depressed. Even at this point people with GAD may
receive a diagnosis of panic disorder or depression, where the underlying
problem is excessive worry.
GAD was previously thought of as the "waste paper basket"
of the anxiety disorders because any cluster of symptoms, which
did not clearly fit in with any of the other anxiety disorders,
would often receive a GAD diagnosis. This should not be the case
and it is important that persistent and recurrent worry must be
present in order for a GAD diagnosis to be made.
Cognitive therapy with a number of behavioural interventions form
the central component to treatment for GAD. There are two levels
to treating worry and GAD. The one is aimed at the content of worry.
The irrational and dysfunctional nature of the thoughts associated
with worry are identified and corrected and individuals are assisted
in drawing more evidence-based conclusions that tend to be less
catastrophic. The second level of intervention is aimed at worry
itself. Worry is a mental activity (like a mental behaviour) that
is believed to be associated with a number of inaccurate beliefs
about the usefulness of worry. Meta-cognitive approaches (Wells
2007) help individuals understand their irrational beliefs about
the usefulness (or dangerousness) of worry that keeps worry alive
and drives the mental behaviour.