Worry is a universal experience. All of us worry from time to time, especially during periods of heightened stress or uncertainty in our lives. For most people, this period of worry is relatively short-lived and things get back to normal once the stressful situation has passed. But for some people, this intense worry and the anxiety that comes with it doesn't go away, causes intense distress and interferes with effective functioning. This experience is typical of people with Generalized Anxiety Disorder or GAD. This article provides information to help you better understand the experience of GAD.

What is worry?

Worry typically consists of a series of distressing thoughts about possible negative future events. Worries often come in the form of "what if" questions. For people with GAD, these questions can lead to a worry "spiral": "Why is my husband late coming home from work? What if something has happened to him? What if he's been in an accident? What if he is seriously injured and can't call for help? What if he dies before he gets proper medical attention?" Some experts believe that worrying is really an attempt to problem-solve or to gain control over uncertain future events.

What is Generalized Anxiety Disorder?

Approximately 4% of the population (approximately 67,000 people in B.C. in any one year period), are affected by Generalized Anxiety Disorder. People with this disorder suffer from chronic, excessive and uncontrollable worry about a number of different events and activities in their daily lives. This worry happens more days than not for at least six months and is associated with a number of uncomfortable physical symptoms, including sleep problems, fatigue, restlessness, severe muscle tension, and irritability. The excessive worry and associated anxiety cause considerable distress and interferes with the person's ability to function effectively.

Generalized anxiety disorder typically begins in late adolescence or early adulthood, although many people with GAD report that they have been worriers since childhood. Approximately twice as many women as men are affected by GAD. GAD is also more common in the elderly and among those of lower socio-economic status, possibly because of a higher rate of life stressors that can make a person vulnerable to uncontrollable worry. Generalized anxiety disorder tends to be chronic, although it may worsen or intensify during times of stress. People with generalized anxiety disorder are prone to developing other anxiety and mood disorders. In fact, approximately 75% of people with GAD have at least one other anxiety or mood disorder.

How is worry in GAD different from "normal worry"?

People with GAD worry about the same things as the rest of us: work/school, finances, relationships, health & wellbeing of friends and family or the self, community/world affairs, and more "minor" matters, like being on time for appointments and attending to daily chores or errands. However, worry in GAD differs from "normal" worry in its breadth, frequency, intensity and controllability. People with GAD tend to worry about a greater variety of topics than people without GAD, and the focus of worry in GAD can shift over time depending on the person's life experiences. However, many people with GAD will say that they worry about "everything". People with GAD tend to worry most days, for a significant portion of the day. It is not uncommon for people with GAD to report that they are worrying for almost all of their waking hours. They often find it extremely difficult to concentrate or "live in the moment" because of all of the worries swirling around in their heads. People with GAD also find that their worry is difficult to control - once they have started worrying about something, they find it difficult to let go and turn their attention to other tasks. Worry in GAD tends to be "exaggerated", or out of proportion to the actual situation - that is, people with GAD worry more than other people would in the same situation.

Worry in GAD is more often associated with physical symptoms than normal worry. In addition to the physical symptoms described above, some people with GAD report feeling shaky or twitchy, muscle soreness, sweating, dry mouth, nausea, diarrhoea, "jumpiness", trouble swallowing, or a "lump in the throat". The rates of stress-related conditions such as recurrent tension headaches and irritable bowel syndrome are generally higher in people with GAD than in the rest of the population. Because people with GAD have so many physical symptoms associated with their worries, they very often seek out medical advice about these ailments, rather than seeking help for their worrying. Many times the underlying worry that drives these symptoms goes unrecognized.

What about treatment for GAD?

The good news is that effective treatments for GAD do exist. Both pharmacological and psychological treatments have been shown to be helpful in reducing the symptoms and impairment associated with GAD. For example, some anti-depressants are effective treatment options for GAD - talk it over with your physician or psychiatrist to see if medication is an option for you. Cognitive-behaviour therapy (CBT) has also been shown to be an effective treatment for GAD. CBT for GAD involves learning more about your particular worry triggers, worry topics and about the factors that serve to keep worry going (e.g., positive beliefs about worry, difficulty tolerating uncertainty in life). The strategies taught in CBT help clients to "short circuit" the worry process and invest their energy in more effective coping strategies.

Because many people with GAD have been worrying excessively for years, they often think that they are just "worry warts" and that their worry is just part of their personality that cannot be changed. For this reason, many continue to suffer needlessly for years before getting an accurate diagnosis and appropriate treatment. If you or someone you know has symptoms of GAD, encourage them to get an assessment from a qualified mental health professional.

- Dr. Michelle Haring received her PhD in clinical psychology from the University of British Columbia. She has speciality training in cognitive behaviour therapy (CBT) for anxiety disorders, depression and stress-related problems and maintains an active clinical practice at the North Shore Stress & Anxiety Clinic.

Other resources:

From Anxiety Self-Help section - What is Generalized Anxiety Disorder?

From Anxiety Parenting section - Generalized Anxiety