Generalized Anxiety Disorder
Generalized Anxiety Disorder
Authored by: Christiana Louisa Ticoalu, M.A., Psychology & Management
Language Editor: Alda Belinda
Clinical Editor: Dr. phil. Edo S. Jaya, M.Psi., Psikolog
IndoPsyCare is committed to delivering psycho-educational material to increase your understanding of a vast array of mental health conditions.
Whilst we invite you to research this material, we do caution you to refrain from self-diagnosis. If at any point you feel that you may be experiencing the condition discussed on this page, please do not hesitate to reach out to IndoPsyCare. We have professionals who are here to help.
Generalized Anxiety Disorder vs Worry
In a general sense, anxiety and worry are expected components within the spectrum of human emotions. These cognitions may aid our problem-solving endeavours, increase alertness and facilitate adaptive attention.
Whether its about your exam next week or your next job interview, worry can usually be self-regulated and alleviated. Typically, worry is transient and does not materialize as prolonged or marked discomfort or distress. Amongst individuals struggling with generalized anxiety disorder, the anxiety or worry manifests as excessive, and intense. Furthermore, worry is persistent, lasting over six months, and significantly undermines or impairs day-to-day functioning.
ICD-11 emphasizes that these symptoms may be expected of individuals living in extremely dire circumstances. The difference is that individuals with generalized anxiety disorder respond to stress, and worrisome situations, in disproportionate measures than what is warranted by their environmental circumstances.
What is Generalized Anxiety Disorder?
Generalized anxiety disorder is a condition that is characterized by persistent, excessive, and pathological worry or fear surrounding everyday events. Further, individuals with the condition may experience “free-floating” anxiety, such that they cannot pin-point the specific source of their fear, or their fear is not confined to a specific source. The above-mentioned symptoms will have been apparent for most days over six months.
Sources of worry are multifocal and encompass current, and future concerns surrounding topics across social, economic, psychological, academic and occupational domains. Individuals with generalized anxiety disorder experience symptoms of worry that are disproportionate to the threat posed by the situation.
Generalized Anxiety Disorder also manifests as physiological symptoms including but not limited to: muscular tension, motor restlessness, overactivity of the sympathetic system (responsible for alerting your body to, and responding to, threat), irritability and sleep disturbances. The condition leads to considerable distress regarding the experience of anxiety symptoms, or considerable impairment in everyday functioning. Notably, the condition is not attributable to other medical or mental conditions, and symptoms are not the byproduct of medicine or substances.
For a comprehensive list of generalized anxiety disorder symptomatology, we recommend you visit the ICD-11 webpage.
Comorbidities are co-occurring conditions that lead to a greater symptom burden, and may in some cases predict poorer course and outcome. Common conditions that appear alongside generalized anxiety disorder include but are not limited to:
- Other anxiety and fear disorders (such as social anxiety disorder and panic disorder)
- Mood disorders such as depression
- Substance use and addiction
Development and Course
Below, we present research findings as reported within the ICD-11. Nevertheless, we would like to emphasize that each person is unique and, as such, the development and course that the condition follows in one individual may differ greatly in another. The information is intended, therefore, to address the condition in generalized terms and should not be considered definitive.
- Symptoms of generalized anxiety disorder may manifest at any age. Nevertheless, this is uncommon amongst children under 5 and commonly appears between one’s early and mid-30s.
- Individuals who experience an earlier onset of symptoms of a generalized anxiety disorder typically experience more significant impairment in their day-to-day functioning.
- Complete remission of symptoms is rare: generalized anxiety disorder typically follows a fluctuating course as individuals shift between the sub-threshold and threshold levels.
- The condition is exacerbated when it appears alongside other mental health conditions.
There are variations in the way this condition presents. Below, we present findings reported within the ICD-11.
- Generalized anxiety disorder increases in prevalence during late adolescence. It is theorized that this is because individuals develop the mental capacity to worry.
- The content of the condition tends to vary with age. For instance, children and teenagers may experience worry in relation to academics, performance in sports teams, and worry about the health and safety of others. Adolescents, however, may experience worry about similar issues with the added pressure of their ability to meet the expectations of others and of society in general.
- Adults typically worry about the well-being of themselves and their loved ones.
- Children may also demonstrate a strong need to comply with rules and a desire to gain social approval. They may become distraught if they perceive others as “breaking the rules”. These children may take on the role of an authority figure and voice their disapproval to their peers. In other cases, they may report their misbehaviours.
- Children and adolescents may become reliant upon receiving external reassurance.
Gender and Sex-Related Differences
- The lifetime prevalence of generalized anxiety disorder is twice as high in females compared to males.
- During childhood, the disorder commonly manifests in females at younger ages.
Etiological Risk Factors
The factors contributing to the onset and maintenance of this condition are heterogeneous and multifactorial in nature. In most cases, the condition is a result of several precipitating factors interacting together in concert. For instance, dispositional factors typically interact with the environment in which the condition develops.
Nevertheless, we remind you that whilst a correlation exists between these variables and the manifestation of the condition, its onset, prognosis and outcome are not definitively based upon the presence of one, or even several, of the variables.
Temperamental or personality factors
- Higher levels of neuroticism and negative emotional affectivity
- Although hereditary rates vary across studies, generalized anxiety disorder is more prevalent amongst individuals who have close relatives with the condition.
- Individuals with generalized demonstrate heightened emotional reactions to fear-provoking stimuli. Hyperresponsivity of the amygdala has been repeatedly observed amongst individuals with the condition.
- Neurotransmitter imbalances
- Adverse childhood experiences
- Insecure parental attachment style
- A history of traumatic experiences
- Stressful and sudden life changes
The symptoms of generalized anxiety disorder have widespread consequences across social, economic, academic, occupational domains and otherwise. Previous studies (e.g. Brenes et al., 2008) have suggested that the impairments endured by those with this condition are comparable to those experienced by persons with major depression and physical illness. Further, the condition is often more disabling that substance use.
Whilst not everyone experiencing this condition will experience these disruptions, those with the condition have been observed to be at heightened risk for:
- Compromised mood and overall wellbeing
- Averse somatic symptoms
- Compromised health
- Marital strife
- Lower occupational functioning
A Gentle Reminder
We sincerely appreciate your dedication; you have made it through this section of our IndoPsyCare library. We trust that you have gleaned valuable information from this page. Before we part ways we would like to reiterate the importance of refraining from diagnosing yourself, or other individuals, based on the information provided. If you feel as though you or others are experiencing this condition, we implore you to seek professional help.
Sources and Readings
We would like to emphasize that the information presented herein was derived from external sources. IndoPsyCare does not claim ownership of any information or research within these pages. For your convenience, our team has constructed a list of the sources utilized and included further research and reading.
Brenes, G., Knudson, M., McCall, W., Williamson, J., Miller, M., & Stanley, M. (2008). Age and racial differences in the presentation and treatment of Generalized Anxiety Disorder in primary care. Journal Of Anxiety Disorders, 22(7), 1128-1136. doi: 10.1016/j.janxdis.2007.11.011
Taher, D., Mahmud, N., & Amin, R. (2015). The Effect of Stressful Life Events On Generalized Anxiety Disorder. European Psychiatry, 30, 543. doi: 10.1016/s0924-9338(15)30427-2
Hayes-Skelton, S., Roemer, L., Orsillo, S., & Borkovec, T. (2013). A Contemporary View of Applied Relaxation for Generalized Anxiety Disorder. Cognitive Behaviour Therapy, 42(4), 292-302. doi: 10.1080/16506073.2013.777106
Hoge, E., Ivkovic, A., & Fricchione, G. (2012). Generalized anxiety disorder: diagnosis and treatment. BMJ, 345(nov27 2), e7500-e7500. doi: 10.1136/bmj.e7500
Newman, M. G., Shin, K. E., & Zuellig, A. R. (2016). Developmental risk factors in generalized anxiety disorder and panic disorder. Journal of Affective Disorders, 206, 94–102. https://doi.org/10.1016/j.jad.2016.07.008
Newman, M., Llera, S., Erickson, T., Przeworski, A., & Castonguay, L. (2013). Worry and Generalized Anxiety Disorder: A Review and Theoretical Synthesis of Evidence on Nature, Etiology, Mechanisms, and Treatment. Annual Review Of Clinical Psychology, 9(1), 275-297. doi: 10.1146/annurev-clinpsy-050212-185544
Turki, M., Thabet, J., Charfi, N., Mezghanni, M., Bouali, M., & Zouari, N. et al. (2017). Generalized anxiety disorder comorbidities: Panic and depressive disorder. European Psychiatry, 41(S1), S486-S486. doi: 10.1016/j.eurpsy.2017.01.580
Yoon, K. L., & Zinbarg, R. E. (2007). Generalized anxiety disorder and entry into marriage or a marriage-like relationship. Journal of anxiety disorders, 21(7), 955–965. https://doi.org/10.1016/j.janxdis.2006.10.006