Monday, February 17, 2014

What Is Generalized Anxiety Disorder?

For as long as I can remember I have been a worrier. I worry about worrying. I expend an incredible amount of time pre-planning, and preparing for everything to the last detail. While it's true that this has been a well developed skill in which I utilize to help my incredibly would-be chaotic, high level of need household functioning smoothly my worrying antics have a dark side. I lose sleep, energy, and optimism to worry. It's hard to see the good side of anything when you're always preparing for the worst.

There is a clinical name for this excessive amount of worry, and anxiety when it impedes one life. It's called Generalized Anxiety Disorder.

What is Generalized Anxiety Disorder, or GAD? 

The DSM IV-TR 300 defines the criteria as the following:

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).
B. The person finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months). Note: Only one item is required in children.
1. restlessness or feeling keyed up or on edge
2. being easily fatigued
3. difficulty concentrating or mind going blank
4. irritability
5. muscle tension
6. sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)

D. The focus of the anxiety and worry is not confined to features of an Axis I disorder, e.g., the anxiety or worry is not about having a Panic Attack (as in Panic Disorder), being embarrassed in public (as in Social Phobia), being contaminated (as in Obsessive-Compulsive Disorder), being away from home or close relatives (as in Separation Anxiety Disorder), gaining weight (as in Anorexia Nervosa), having multiple physical complaints (as in Somatization Disorder), or having a serious illness (as in Hypochondriasis), and the anxiety and worry do not occur exclusively during Posttraumatic Stress Disorder.
E. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
F. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism) and does not occur exclusively during a Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental Disorder.

What can this look like in everyday life? Almost everyone that I know who has been diagnosed with GAD has trouble sleeping at times. We might fall asleep easily, but reawaken in a panic thinking we are late, or feeling like we are unprepared for a task in the morning.  We might not be able to go to sleep due to racing thoughts, and replaying situations, conversations, and planning for tomorrow. We tend to spend more time than we ought to in 'what if land'.

For me, it seems to take on a little bit of all the disorders mentioned in section D above. If you were to ask me if I worry too much, or about unimportant, or even unlikely to occur events I would say no.  Even now, after being diagnosed with GAD several times by several different clinicians over the last 20 years I would still say that I don't identify my worrying as being too excessive. To me my worries are valid, and real. Many of the criteria, and literature about GAD speak of someone who knows that they worry too much, but can't seem to stop, but that has not been my experience overall. Sometimes, in moments of clarity I might be able to logically deduce that my thoughts are consumed with needless, and even downright irrational worry, but only if I am not anxious at the time of being asked if I think I worry too much.

What kinds of things do I worry about?- you might be wondering. The short answer to that question is everything. If I am in a public place I am worrying over what I touch, if it has germs on it, and who has touched it before me. I worry about being sick, getting sick, and my kids getting sick.  I worry that I am gaining weight, or not attractive. I will check, and recheck my weight, and appearance. I worry that I might fall down the stairs, or that my kids will get hurt, I think about what would happen if my husband died 5 or 6 times a day- minimum.  I worry about finances, and am always running numbers in my head trying to budget cheaper.  I worry that I might die. I worry that I might have not said something right in an email, or maybe I'm not seen as a nice person. I worry that I'm going to be late...for everything. I worry that I'm not a good parent. I worry about making my husband mad. I worry that I'm wrong.  Just wrong about everything. I worry that I'm getting old, and am going to look old. I worry that Beans is not safe. I worry he got out.  I check and recheck every lock, and alarm. I can't sleep at night, because I worry he will wake up, and leave the house, or get hurt. I worry that I am not teaching him enough, or well. I worry that Bubby is not getting what he needs, and needs extra help. I worry about my daughter's mental health.

Does any of that sound familiar? Do you have issues with ruminating worries, and being apprehensive without sufficient reason? Stay tuned for part two where I discuss some of the ways I have found, and want to try to deal with GAD.


  1. I could have written this. Looking forward to part 2.

  2. I have this, and its pretty common for people with autism or ADHD. For me I worry a lot that something random will happen to my dogs, or about my parents dying someday, or about my getting a painful disease, but I also worry constantly about doing the wrong thing and people getting mad at me!

    1. Yeah it is pretty common for us to have it. I think clinicians are supposed to hesitate to diagnose it if an ASD has already been established, because it's just a given that almost all people on the spectrum have a high level of anxiety. It's not really as irrational as they'd like to think it is, though. Almost anyone would be worried all the time if they were missing 90% of the social communication around them. The world really is unpredictable to us.

  3. I have Panic Disorder, not GAD, so I can relate to some of it, but not all. It sounds like you get anxious, but you don't have full-blown panic attacks? Is it like being on a high state of alert all the time?

    1. Yes! I have this, too, & it a constant state of feeling unprepared & alert to every possibility. It also comes with a vivid imagination & a thirst for knowledge about every single possible outcome of almost every single situation.

      Imagine you're driving down the road. You're listening to the radio. You're also watching for one of your children to choke or have a seizure as well of thinking about how you'll get out of the car & save the kids if you drive over the bank or into a pond accidentally. Then you're thinking what you'd do if a tire blew out or if you're late arriving where you're headed. What if who you're meeting doesn't show up. What if you run out of gas? Car breaks down? Someone gets out & runs into traffic? A million what-if's that you worry about in every situation. EVERY SITUATION. It's exhausting & you can never turn it off.

    2. Yeah, it is pretty much like a high state of alert all the time. I am always worried, and always preparing. See my above answer to why.

  4. This is totally me. I take high blood pressure medication as well as xanax. It has sure really helped me

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  10. One thing should be kept in mind by the teachers and parents that it is not necessary that the child who suffers from ADHD possess all the three problems. There are various instances in which the child is not able to pay complete attention in the class and they are not impulsive as well as hyperactive. This kind of ADHD is called ADHD-PI. ADHD-PI stands for Attention Deficit Hyperactivity Disorder- Predominantly Inattentive).


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