Generalized Anxiety Disorder: what are we really talking about?

In common parlance, the term “anxiety” is often used improperly, referring to generic conditions of apprehension, nervousness and stress, very common in everyday life, which have nothing to do with the actual psychiatric disorder.

Pathological anxiety is not a simple transient discomfort, but an abnormal reaction that seriously interferes with the psycho-intellectual performance, preventing the subject from fixing their mind on specific problems and situations and processing them, thus limiting their possibility of carrying out their usual activities.

Generalized Anxiety Disorder does not necessarily occur in response to external stimuli, although stressful events or a generally unfavorable environment can unhide or aggravate their manifestation. Just like depression, the origin of anxiety disorder is related to the altered functioning of some brain circuits, which is not yet fully known, but that involves, at least in part, the serotonin and noradrenaline systems.

Anxiety disorder can occur at any stage of life, often at particularly critical transition periods, or when one is faced with difficult choices. It is mainly women who suffer from it (they’re affected twice as often as men), as well as children and the elderly (especially if suffering from chronic diseases).

Factors that increase the likelihood of developing an anxiety disorder

• Being a woman.
• Having endured traumatic experiences or witnessed dramatic events in childhood.
• Suffering from chronic diseases (particularly cardiac, respiratory, digestive, and metabolic conditions) or having experienced a serious medical condition (for example, cancer).*
• Having been exposed to a source of intense and acute stress, or to a more modest but repeated/extended over time stressful situation.
• Having a psychological profile characterized by a poor ability to adapt to external stimuli, and a spontaneous tendency to nervousness and worry.
• Genetic predisposition.
• Intake of substances (alcohol, drugs, medicinal products, caffeine, nicotine, herbal extracts, etc.) that tend to worsen the response to stress and increase the tendency to anxiety.**

* In this case, we speak about an “anxiety disorder due to another medical condition”.

** In this case, we speak about a “substance- or drug-induced anxiety disorder”.

Symptoms and Diagnosis

Contrary to what happens in the case of depression, reaching a generalized anxiety disorder diagnosis is quite simple, because the symptoms are well recognizable and the discomfort experienced leads patients to seek medical attention relatively quickly. In addition to psychological symptoms, such as agitation and irritability, anxiety syndrome is usually associated with insomnia, changes in appetite and a whole series of distinctive physical manifestations (rapid heartbeat, breathing difficulties, increased thirst, need to move constantly, repetitive gestures, etc.), which can significantly reduce the quality of life.

In the presence of manifestations of this type, for an initial general evaluation one can refer to the GP, but to obtain a correct classification of the anxiety disorder, precisely define its severity and identify the most suitable therapeutic strategy, it is advisable to contact a specialist.

Psychophysical signs and symptoms of anxiety

• Muscle aches and contractures, tendency to clench teeth both during the day (grinding) and at night (bruxism), trembling voice.
• Ringing in the ears, blurred vision, hot flashes, localized pains without obvious organic causes.
• Tachycardia, palpitations, pain in the center of the chest, pressure drops, irregular pulse.
• Sense of constriction and tightness in the chest, difficulty in breathing, feeling of suffocation.
• Increased urinary frequency, disturbances in the menstrual cycle and the sexual desire.
• Difficulty swallowing, digestive difficulties, lack of appetite, nausea, vomiting, diarrhea.
• Headache, dizziness, increased sweating, flushing or paleness, decreased salivation.
• Constant or recurring worry, unjustified or for futile reasons, pessimism.
• Irritability, inability to relax, hypersensitivity to stimuli and startles, proneness to crying, specific phobias.
• Insomnia with difficulty falling asleep, or sleep interrupted by nightmares, problems concentrating, impaired memory capacity.

In order to be able to make a diagnosis of Generalized Anxiety Disorder, adults must present at least three psychophysical symptoms among those listed, in addition to persistent anxiety and worry and not commensurate with the actual severity of the events or in the absence of triggering factors. The events must have been present for at least six months, most of the time. In children, only one additional psychophysical symptom is sufficient, and the duration of the manifestations necessary for diagnosis may be shorter.

Treating Generalized Anxiety Disorder

There are many ways to treat generalized anxiety disorder: relaxation techniques, drug therapy, and psychotherapy. It is up to the doctor to choose the most suitable one, on a case-by-case basis, possibly combining them, in relation to the severity and duration of the disorder, the characteristics and age of the patients, their willingness to engage in treatment and their expectations with respect to clinical outcomes.

Relaxation techniques

Mild forms of anxiety and stress can be alleviated thanks to more or less specific relaxation techniques, which can range from massages to yoga, from a hot bath to guided mental visualization, from deep breathing techniques to acupuncture. But also listening to one’s favorite music, a swim or a walk in nature can lead to significant improvements in the level of tension.

When these countermeasures prove insufficient, and the state of alert is also associated with sleep disturbances, a mild additional help can be found in some active ingredients of natural origin, capable of positively influencing the functionality of the nervous circuits that control stress reactions. Infusions of lime or chamomile, herbal teas of mallow, California poppy or valerian, extracts of hawthorn or passionflower and mixtures of all the plants mentioned are the most tested and harmless “green” remedies to ease tension and promote sleep. If one chooses to use them, however, it’s better to opt for certified preparations sold in pharmacies, and inform the doctor before starting to take them, especially if one is already using drugs for anxiety or for the treatment of other diseases, during pregnancy and breastfeeding, or if a child needs them.

Psychotherapeutic approach

Drugs are very useful for attenuating the acute manifestations of anxiety disorder and favoring their overcoming, but to solve the problem in the long term it is also necessary to carry out a process of elaboration and adaptation to the anxiety-inducing stimulus, relying on a psychological support. In this context, the technique that has been shown to be able to produce the greatest benefits is the behavioral therapy, aimed at “deconditioning from the anxiogenic stimulus”, that is, at dissolving the link between critical situations and the patient’s anxious reaction.

This strategy requires that the anxious person, instead of avoiding them, gradually expose herself to events considered stressful, analyze them with the help of the specialist and elaborate them in a positive way, in order to bring the lived experience back into a normal context and deal with it better on following occasions. Behavioral therapy is also very useful in case of “anticipatory” anxiety: this is a form of anxiety that occurs prior to exposure to a stimulus known to be disturbing, and which is often induced from having lived highly traumatic experiences in similar situations previously.

Supportive interventions

• Following regular rhythms of life.
• Getting enough sleep every night.
• Eating healthily.
• Practicing moderate physical activity every day.
• Avoiding excessive work stress and taking small breaks to relax during the day.
• Taking all the therapies prescribed by the doctor regularly, at the indicated dosages.
• Avoiding drinking alcohol and caffeinated beverages.
• Not smoking or trying to reduce the habitual number of cigarettes.
• Attending self-help groups and sharing your experience with other people with a similar problem.