Generalized anxiety disorder is usually accompanied with physical symptoms like heart pounding, shortness of breath, dizziness, sweating that aren’t related to somatic illness. Episodes of intense fear and panic attacks may also occur. They often lead a person to feel like he is having a health emergency such as heart attack or stroke.
Panic attacks usually last for 20 minutes to an hour. Generally they disappear once a person is able to calm himself down. During generalized anxiety episode you can experience a wide range of physical symptoms.
Physical symptoms of generalized anxiety
- Heart pounding
- Feeling light headed, experiencing feeling of fainting
- Hot flashes
- Difficulty breathing, pressure in chest area
- Choking, lump in throat
- Tiredness, heavy feeling in body, muscles
- Numbness, tingling in body
- Impaired vision, feeling like in a glass box
- Dry mouth
- Sweaty hands and feet
- Need to use restroom more often
- Regular cough
- Muscle twitching in body
- Muscle tightness in shoulders, back.
- Skin or digestive issues
Are generalized anxiety symptoms dangerous?
Generalized anxiety symptoms aren’t dangerous to your health. Although you may feel like you are dying, in reality there isn’t malfunctioning of your organs that would put you in danger. Your nervous system activates stress response that causes you to experience unpleasant physical symptoms. These symptoms aren’t damaging your organs or body cells.
When generalized anxiety symptoms appear?
Most commonly generalized anxiety symptoms appear when you experience additional stress in your life. GAD symptoms can appear during public speaking or presentation. While you are with people you don’t get along. Before and during tests, examinations. In a workplace while you are having too much workload and responsibility.
Generalized anxiety symptoms can also appear without a present stressor. This is a major difficulty people with generalized anxiety encounter. You may feel anxious or on the edge for no particular reason.
Why generalized anxiety symptoms happen?
Generalized anxiety symptoms are associated with stimulation of the sympathetic nervous system which becomes active during times of stress and worry. Every organ of your body is connected to the sympathetic nervous system. When you are stressed, the brain region called amygdala receives signals of danger and sends further signals to adrenal glands that are located on top of your kidneys.
Adrenal glands then release stress hormones into your bloodstream. When nerve cells receive stress hormones they alter different functioning to your body organs. For example, when your heart receives stress hormone cortisol it starts to beat faster. Your blood vessels narrow down allowing your heart to supply more oxygen to other organs of your body.
Causes of generalized anxiety disorder (GAD)
Traumatic events
Traumatic events can leave persistant scars on your psyche that activate fight or flight response. Symptoms of generalized anxiety occur as natural response to stress. Unprocessed emotions, tension related to traumatic event are discharged through sympathetic nervous system causing GAD symptoms.
Anxious attachment
People with anxious attachment often are in a state of distress that causes GAD symptoms. They worry that other people will reject, abandon them. Fear of rejection and being not good enough causes heightened sensitivity towards other people’s behavior. Every little thing, comment is perceived as sign rejection causing anxiety, jealousy, suspiciousness and controlling behavior.
Genetics
You can be born with a highly sensitive nervous system. People with a highly sensitive nervous system experience emotions more deeply and with higher intensity. Higher sensitivity can lead you to experience GAD symptoms more easily under the stress.
Personality traits
Many personality traits can lead you to a state of distress that causes GAD symptoms. Self-consciousness can lead to perfectionism and taking too much responsibility. Agreeableness can make you too concerned about other people’s needs, avoid conflict and express how you truly feel. Neuroticism can make you sensitive towards stress and negative emotion.
Emotional dysregulation
Research shows GAD is marked by experiencing emotions quickly, easily, and with high intensity. Emotional reactivity in GAD makes emotions difficult to regulate which is further complicated by difficulty identifying and understanding emotions. [1] Unregulated, intense emotions activate fight or flight response and cause GAD symptoms.
Family environment
People who suffer from GAD come from unstable family environments. May be family members didn’t get along, there were a lot arguments, fights. Person was raised by one parent and often lacked emotional support, safety. As a child person was left helpless and alone, had to take care, responsibility of other family members. Obtained anxiety during childhood gets carried into adulthood and affects how we perceive, regulate ourselves.
Treatment of Generalized Anxiety Disorder (GAD)
Psychotherapy
- Cognitive-behavioral therapy (CBT) is the most commonly used form of psychotherapy for treatment of GAD. CBT will help you to identify and change unhealthy thoughts patterns, beliefs, behaviors that cause GAD. CBT uses methods such as exposure, visualization, role play and relaxation in order to combat, overcome GAD symptoms.
- Psychodynamic psychotherapy (PDT) believes that GAD is caused by prolonged suppression of emotions which are discharged through the sympathetic nervous system. PT will help you to gain deeper contact with your feelings and needs through deep exploration of emotional conflicts you are not aware of. PT focuses on clients ability to express his emotions and needs in a free way.
- Acceptance and commitment therapy (ATC) will help you to accept GAD symptoms and teach you to live a life while having anxiety disorder. People often pay too much attention and worry about their GAD symptoms which causes additional stress. Additional stress often leads to more worry and panic aggravating GAD symptoms.
Lifestyle changes
People who suffer from generalized anxiety disorder are hardworking and ambitious people. Their ambition for a creation and achievement often exceeds the capabilities of their nervous system.
Our nervous system is made out of cells which need regular time away from work, relaxation. People who suffer from GAD tend to overload their mind and don’t get enough rest physically or mentally.
Their drive for success takes a toll and cells get tired accumulating toxic chemicals that forces them to malfunction. This is usually where generalized anxiety symptoms appear and body signals that physical and mental rest is needed.
Lifestyle changes that help GAD
- Creating healthy balanced between work life and rest;
- Regular exercising, physical activities;
- Reducing stimulant intake as caffeine, nicotine;
- Relaxation, meditation exercises;
- Pursuing hobbies;
- Spending more time with friends and family;
- Keeping healthy diet and sleep schedule;
- Writing a self-diary.
Medication
SSRI and SNRI
Selective serotonin reuptake inhibitors (SSRIs) and Serotonin–norepinephrine reuptake inhibitors (SNRIs) are classes of antidepressants that are commonly prescribed for treatment of generalized anxiety disorder. They are often used as first-line pharmacotherapy due to their safety, efficacy, and tolerability.
SSRIs: Fluoxetine, Sertraline, Citalopram, Escitalopram, Paroxetine, Fluvoxamine, Vilazodone.
SNRIs: Duloxetine, Venlafaxine, Desvenlafaxine.
Benzodiazepines and other clases of drugs
If SSRIs and SNRIs pharmacotherapy show only partial response your doctor might prescribe you second-line treatment medication which include long acting benzodiazepines (clonazepam, lorazepam, and diazepam), buspirone, SGAs (primarily quetiapine), and antiepileptic medications (pregabalin).
Although these medications are effective they are associated with less favorable side effect profiles relative to antidepressant medications.
Benzodiazepines such as diazepam and clonazepam may be efficacious in treating GAD, although many clinicians choose to limit their use due to concerns about the risks regarding possible misuse and dependence. [2]
What is the most effective medication for GAD?
A recent 2019 systematic review which included 89 studies with 22 different medications for treatment of generalized anxiety disorder show that quetiapine (3.60 points), duloxetine (3.13 points), pregabalin (2.79 points), venlafaxine (2.69 points), and escitalopram (2.40 points) showed the greatest efficacy among 22 drugs for treatment of GAD.
Study provides good support for the particular efficacy and tolerability of duloxetine, escitalopram, pregabalin, and venlafaxine. Although quetiapine showed the greatest efficacy of all agents it’s also associated with the worst tolerability. [3]
References:
- Cisler, J. M., & Olatunji, B. O. (2012). Emotion regulation and anxiety disorders. Current psychiatry reports, 14(3), 182–187. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3596813/
- Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2018). Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review. Expert opinion on pharmacotherapy, 19(10), 1057–1070. https://doi.org/10.1080/14656566.2018.1491966
- Fagan, H. A., & Baldwin, D. S. (2023). Pharmacological Treatment of Generalised Anxiety Disorder: Current Practice and Future Directions. Expert review of neurotherapeutics, 23(6), 535–548. https://doi.org/10.1080/14737175.2023.2211767