Jason, a 33 year old law enforcement sergeant, is constantly plagued by worry. His body is often tense; he has headaches and muscle spasms. He feels tired during his shift, yet he has difficulty sleeping at night. He is often irritable and quick tempered. Jason is always keyed-up, expecting the worst. He spends hours each day worrying about his career, his health, his financial situation, and his wife and kids. However, none of these issues are in distress or jeopardy. He can't shut his thoughts off; they constantly run through his mind. His concentration at work is off; he can't stay focused, and frequently feels like his mind is drawing a blank. He frequently feels sad and lonely; he is unable to enjoy most aspects of his life because of his constant and excessive worries.
Jason is one of between four and five million Americans who have a generalized anxiety disorder. Generalized anxiety disorder is a relatively common disorder. The chance that any given person in the United States will develop it over a lifetime is estimated at 8% to 9%. The disorder affects twice as many women as it does men. The disorder usually comes on gradually. Onset can begin at any age, although it is most frequently seen between childhood and middle age. Although the disorder can be chronic, it is treatable.
Generalized Anxiety Disorder
Anxiety is a normal response to actual or perceived danger, prompting the body to respond with purposeful actions. It's also a normal response to physical and emotional stress. Anxiety generally produces feelings of uneasiness or dread. An individual may suffer from chronic anxiety that can be considered mild, moderate or severe. While mild anxiety may cause slight physical or psychological discomfort, severe anxiety can be very debilitating, making it difficult to carry out even the most ordinary daily activities.
Everyone experiences anxiety intermittently throughout their lives. People with generalized anxiety disorder experience anxiety constantly. The hallmark symptom of GAD is excessive, exaggerated, and chronic worry. This anxiety is free-floating and is not triggered by any one issue. Individuals spend extensive energy thinking, dwelling and ruminating on the what ifs? A person with a generalized anxiety disorder may worry about anything and everything in their lives or in the world. The most common worries center on their health, money, family, and work. These thoughts turn into a vicious cycle and becomes chronic, leaving the individual feeling isolated, misunderstood and depressed. A person who suffers from GAD can't seem to shake their relentless concerns even though they usually realize that their anxiety is more intense than the situation warrants. As the disorder progresses even the thought of getting through the day brings on anxiety symptoms. Untreated, GAD can be disruptive and destructive, and produce a life full of fear.
The emotional fears of an individual with generalized anxiety disorder can be quite strong. 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, stiffness, general aches and pains, abdominal difficulties, shortness of breath, difficulty swallowing or feeling like there is something stuck in their throat, trembling, uncontrollable twitching, hot/cold flashes, sweating, lightheadedness 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 or substance abuse. Most people with GAD have mild symptoms that do not affect their interactions socially or in the work place. GAD is not associated with panic attacks, however people who do have panic attacks may also have generalized anxiety.
GAD 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.
- Have you experienced an unusually excessive level of worry about various aspects of life lately?
- Do you find yourself feeling overly restless or edgy?
- Lately, do you find yourself more easily angered or irritated by events that would normally be minimally annoying?
- Even when you're aware that the worry is needless, do you still find yourself feeling anxious?
- Do you find it unusually difficult to concentrate or stay focused?
- Do you find yourself getting tired easily, even after activities that are minimally taxing?
- Do you use cocaine, alcohol, amphetamines, or marijuana on a regular basis?
- Have you been experiencing sleep problems lately such as difficulty falling asleep, difficulty staying asleep, tossing and turning, or waking feeling tired?
- Have you been getting into arguments often with family and friends?
- 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?
- 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?
- Do you feel unable to relax, even when nothing really stressful is happening?
- Have you also been experiencing feelings of sadness or emptiness alongside the tension and worry?
- Have you been experiencing physical symptoms of tension such as chronic upset stomach, agitation, or inability to sit still?
- Has your excessive worry stayed relatively constant for the last 6 months or longer?
These are all symptoms of a generalized anxiety disorder. Individuals who experience these symptoms for six months or more are typically diagnosed as having generalized anxiety disorder.
Treatment for Generalized Anxiety Disorder
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. Your symptoms may indicate another anxiety or mood disorder. Certain medicines can cause worry and stress or make your stress worse, such as medicines used to treat ADHD (Strattera, Ritalin, Adderall, and Concerta,), or even too much caffeine. Steroids and illegal drugs such as cocaine and methamphetamine can also cause these symptoms. Be sure to tell your doctor about any medicines you are taking.
GAD symptoms cannot be overcome by sheer willpower. Research indicates that generalized anxiety is fully treatable and can be successfully overcome over the course of 3-4 months. 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 others 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. 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.
Pamela Kulbarsh
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.
