Online Exclusive

Generalized Anxiety Disorder: Excessive, Exaggerated, and Chronic Worry

Steve, a 41 year old law enforcement sergeant, is constantly plagued by worry. He always feels physically and emotionally tense and is often irritable, quick tempered and keyed-up expecting the worst. 

He spends hours each day worrying about his career, his health, his financial situation, and his wife and two preteen sons. However, none of these issues are in distress or jeopardy. He knows that his worries are excessive, yet, he can’t shut off the thoughts that constantly run through his mind. He also has many physical symptoms related to his anxiety.  His concentration at work is off; he can’t stay focused, and often feels like his mind is drawing a blank.  Every day it seems like is worrying increases, people are concerned—so is he.  This is not a good place to be as Sgt, let alone an officer. 

Additionally, he frequently feels sad and lonely; he is unable to enjoy most aspects of his life because of his constant and excessive worries.  Things are increasingly spinning out of control.  Steve eventually goes to his physician and is diagnosed with having a generalized anxiety disorder.

Generalized Anxiety Disorder (GAD)

Generalized anxiety disorder is a relatively common mental illness. In the USA GAD affects 6.8 million USA adults annually (3.1% of the population.).  The chance that any given person in this country will develop the disorder over a lifetime is estimated at 9%.  GAD affects twice as many women as it does men.  The disorder usually comes on gradually, but can become chronic.  The good news is that current research indicates that generalized anxiety is a fully treatable disorder and can be successfully overcome in as little as 3-4 months.  The bad news is that only 1/3 of suffers seek treatment. 

Anxiety is a common reaction to the stress of everyday life or to particular situations. Everyone feels anxious from time to time.   It is a normal response to stress. There are two elements to the stress response. The 1st is the perception of the challenge. The 2nd is an automatic physiological reaction commonly referred to as the fight or flight response which initiates a surge of adrenaline in your bloodstream places your body on red alert.  Daily stress comes from the demands and pressures we experience regularly. Long lines at the gas station, a colicky baby, rush hour traffic, a phone ringing nonstop, or a chronic illness are all examples of things that can cause stress on a daily basis.  Anxiety is associated with feelings of uneasiness, fear, worry or dread.  The hallmark symptom of anxiety is worry.  Worrying is feeling uneasy or being overly concerned about a current or probable situation or problem.  An individual may suffer from chronic anxiety that can be considered mild, moderate or severe.  Most people with GAD have mild symptoms that do not significantly affect their interactions socially or in the work place. 

While mild anxiety may cause slight physical or psychological discomfort; severe anxiety can be severely debilitating, making it difficult to carry out even the most ordinary daily activities.  This type of anxiety is diagnosed as general anxiety disorder if the symptoms have lasted over six months. Individuals with a generalized anxiety disorder worry excessively.  This anxiety is often free-floating and is not triggered by any one issue.   Individuals spend extensive energy thinking, dwelling and ruminating on the “what ifs?”  People with a generalized anxiety disorder live their lives always anticipating disaster.  If a child is ten minutes late a parent with GAD will fear the worst…there was a terrible accident, paramedics are surely transferring him to a hospital, maybe his injuries are fatal, what am I do?  Generalized anxiety symptoms can fluctuate from hour to hour, from day to day.  Some do better in the morning, others at night.  Sufferers will describe "good days" and "bad days".   While many people with GAD appear fine on the surface, behaving normally, seemingly calm and relaxed, their thoughts, emotions and beliefs are in intense and persistent turmoil

Symptoms of Generalized Anxiety Disorder (GAD) 

Physical symptoms of a generalized anxiety disorder include acute or chronic fatigue; headaches, muscle tension or spasms, stiffness, general aches and pains, abdominal difficulties, rapid heartbeat, shortness of breath, difficulty swallowing or feeling like there is something stuck in their throat, trembling, nausea, uncontrollable twitching, hot/cold flashes, sweating, lightheadedness, sleep disturbances, dry mouth and dizziness. People with GAD seek medical help for their physical symptoms frequently. 

Additional symptoms include irritability, frustration, and inability to concentrate. Sleep disturbances are also common. The individual feels constantly on alert, startles easily, and is unable to relax.  Feelings of a lack of energy, a loss of interest in life, and persistent joylessness occur frequently.  A person with GAD may need to be constantly in motion.  Generalized anxiety disorder often co-occurs with mood disorders. Many people with GAD seek relief in harmful ways: overeating, cigarette smoking, or using alcohol and drugs.

GAD is not associated with panic attacks, however people who do have panic attacks may also have generalized anxiety. 

Generalized Anxiety Disorder Self Test

The National Center for Health and Wellness has developed a self assessment test to determine if you are at risk for, or are currently suffering from a generalized anxiety disorder. 

1. Have you experienced an unusually excessive level of worry about various aspects of life lately?

2. Do you find yourself feeling overly restless or edgy?

3. Lately, do you find yourself more easily angered or irritated by events that would normally be minimally annoying?

4. Even when you’re aware that the worry is needless, do you still find yourself feeling anxious?

5. Do you find it unusually difficult to concentrate or stay focused?

6. Do you find yourself getting tired easily, even after activities that are minimally taxing?

7. Do you use cocaine, alcohol, amphetamines, or marijuana on a regular basis?

8. Have you been experiencing sleep problems lately such as difficulty falling asleep, difficulty staying asleep, tossing and turning, or waking feeling tired?

9. Have you been getting into arguments often with family and friends?

10. Does your excessive worry revolve around any of the following specifically: gaining weight, having a physical disease, being separated from a loved one, or being involved in social engagements?

11. Do you experience any number of the following to the level that it impairs your ability to function or perform regular daily activities: restlessness, irritability, sleep difficulty, fatigue, trouble concentrating?

12. Do you feel unable to relax, even when nothing really stressful is happening?

13. Have you also been experiencing feelings of sadness or emptiness alongside the tension and worry?

14. Have you been experiencing physical symptoms of tension such as chronic upset stomach, agitation, or inability to sit still?

15. Has your excessive worry stayed relatively constant for the last 6 months or longer?

If you’ve answered “Yes” to more than a few questions, and if you have experienced symptoms of excessive worrying for six months or more you probably have a generalized anxiety disorder. 

Treatment for Generalized Anxiety Disorder

Relentless worrying can affect your daily life so much that it interferes with your lifestyle, health, relationships, sleep, and job performance.  Remember, generalized anxiety disorder is treatable; it can be successfully overcome.  If you believe you may have symptoms of GAD, make an appointment with your primary care physician.  GAD symptoms do occur in some medical conditions such as hyperthyroidism and a heart condition called mitral valve prolapse.  Or your symptoms may indicate another anxiety or mood disorder.  

GAD symptoms cannot be overcome by sheer willpower.  There are several treatment choices available; medication, psychotherapy, or the combination of both. 

Experts believe that the cause of generalized anxiety disorder is due to an imbalance of two neurotransmitters, dopamine and serotonin, in the brain.  SSRI antidepressant medications (Prozac, Zoloft, Lexapro and Paxil) have been found to be effective in treating anxiety disorders.  Beta blockers (Atenolol and Propranolol, most commonly used to treat hypertension) are also used to treat GAD.  Benzodiazepines (Valium, Xanax, Ativan, and Klonpin) are fast acting sedatives that can significantly reduce GAD symptoms; however these medications can be addictive. 

Cognitive behavioral therapy (CBT) is the psychotherapy of choice to treat GAD.  The goal of CBT is to change/recondition the way a person thinks about, and then reacts to, a situation that makes them anxious or fearful.  It is important to find a professional who is knowledgeable about anxiety disorders.

Many people find support groups helpful, as they can share their problems and experiences with other who are also suffering.  Learning how to manage your stress through aerobic exercises and relaxation techniques can also help manage a person with GAD symptoms.  There are also workbooks that can help individuals cope with GAD.  Some studies have found that caffeine and over the counter cold remedies can worsen the symptoms of GAD.  Always check with your doctor or pharmacist before taking any over-the-counter medicines.  Proper diet and adequate sleep routines are also important. 

You may be dispatched to a call in which the reporting party or victim suffers from a generalized personality disorder.  Your clue is in the way they will catastrophize the situation (believing that something is far worse than it actually is).  Know that you will not be able to completely calm them down, no one can.  However, try to take a few extra minutes to reassure him/her and offer some support and referrals. 


About The Author:

Pamela Kulbarsh, RN, BSW has been a psychiatric nurse for over 25 years. She has worked with law enforcement in crisis intervention for the past ten years. She has worked in patrol with officers and deputies as a member of San Diego's Psychiatric Emergency Response Team (PERT) and at the Pima County Detention Center in Tucson. Pam has been a frequent guest speaker related to psychiatric emergencies and has published articles in both law enforcement and nursing magazines.