Thursday, September 11, 2008

Generalized Anxiety Disorder

FD is about to leave the house and I look at him and say, "Maybe we should have my brother take off that skin tag on ___(one of the kids)."

He looks at me, furrows his brow. "Have him look at it." He's looking into my eyes. It's early in the morning.

I explain, "I have to have something to worry about. It's what I am."

He says, "It's the GAD."

"Huh?" (I know what it is, but don't want to believe he's even be saying this, even though I'm pretty sure he's joking).

"Generalized Anxiety Disorder."

"Uh, duh. Like I don't know what GAD is? I invented GAD."

On that exaggerated note, how about taking a look at the symptoms of GAD? What's the worst thing that can happen? You'll worry you have it?

Diagnostic criteria 300.02 Generalized Anxiety Disorder *

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance)

B. The person finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months). Note: Only one item is required in children.
(1) restlessness or feeling keyed up or on edge
(2) being easily fatigued
(3) difficulty concentrating or mind going blank
(4) irritability
(5) muscle tension
(6) sleep difficulty (difficulty falling or staying asleep, or restless unsatisfying sleep
D. The focus of the anxiety and worry is not confined to features of an Axis I disorder, e.g., the anxiety or worry is not about having a Panic Attack (as in Panic Disorder), being embarrassed in public (as in Social Phobia), being contaminated (as in Obsessive-Compulsive Disorder), being away from home or close relatives (as in Separation Anxiety Disorder), gaining weight (as in Anorexia Nervosa), having multiple physical complaints (as in Somatization Disorder), or having a serious illness (as in Hypochondriasis), and the anxiety and worry do not occur exclusively during Posttraumatic Stress Disorder.

E. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

F. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g. hyperthyroidism) and does not occur exclusively during a Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental Disorder.

See, to diagnose stuff, you really have to know the entire DSM-IV like the back of your hand. Wait a minute. What do I see there?

therapydoc

* The diagnostic criteria listed about come straight out of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, 1994 (DSM-IV). We're all anxiously awaiting the DSM V.

27 comments:

Syd said...

When I was in therapy, that was what my diagnosis was. I don't feel much anxiety in general these days. I think that living with active alcoholism could cause just about anyone to have GAD. Al-Anon has done more to help me than therapy did--maybe because I wasn't working on myself but still clinging to the idea of changing another.

cardiogirl said...

It would appear my middle name is GAD. I scored 6 out of 6 -- I RULE!

Cardio GAD Girl, at your service.

nashbabe said...

Boy, close relatives know how to hit below the belt with a therapist, eh? ;-) I posted about the DSM-IV recently, from my very very very layperson's perspective: http://nashbabe.blogspot.com/2008/08/complete-with-photo-illustrations.html

therapydoc said...

Syd, thanks for a word to the wise on treatment. I really like the social support of the anonymous programs.

And way to go, Cardio! It's a good thing you exercise, right?

Nash, I think he's teasing. Not sure, though. Anyway, a few features of a disorder doth not a disorder make :)

Blognut said...

Wow! I love having a new label to hang on myself! I've been looking for something new because I'm tired of PTSD and I've been thinking I should be over it by now. ;)

Christina Shaver said...

Thanks for posting this. My son has severe anxiety that manifests in psychotic episodes. I never knew the exact qualifications for anxiety, but now that you've spelled them out here, I see he meets every single one. Now, then, what say you on how to address it best?

Tzipporah said...

Hey Doc,
how do you distinguish between GAD and ACOA (Adult Child of an Alcoholic) who doesn't worry about specific things, but is just always, generally, "on" in case things go wrong?

linrob63 said...

It is interesting that you posted this on September 11. I am a native New Yorker and it seems that many of my friends/colleagues from Manhattan exhibited lots of anxiety for a long time after the towers fell, though it was specific. (PTSD?) Now many are still anxious though it does not seem as so focused.

I am pretty sure (ok absolutely certain) that I too was/am PTSD relative to a violent crime when I was a kid. Still anxious -- about that and other things not directly related, though I largely attribute it to my bad day.

So...does PTSD evolve into GAD? Are they co-occurring?

This is confusing. And I am eager to learn.

Merelyme said...

I have never been officially diagnosed with it but I think anxiety goes hand in hand with being a depressive. I tend to ruminate and obsess about the things I really can't control and replaying conversations in my mind...thinking about what I could have and should have said. Yes I could spend days worrrying...I am quite skilled at it!

Angelissima said...

GAD ZOOKS! I think I'm going to blog about GAD.

Essiewb said...

It would also be nice if you could talk about living with someone who has GAD. Their anxiety can make you crazy. How do you keep from spending all your time reassuring them?

therapydoc said...

Okay, okay. I'll work on it.
(you know that doesn't mean I'll ever post it, right, because I'll be too anxious that it isn't complete enough, or isn't well-written, etc.)

Start with empathizing with a person's "disorder." A nice interactional sequence goes like this:

Someone says, "I can't" because of some kind of emotional something.

You, the partner, ask him or her to talk about it. Then you support, listen, validate, and eventually get to what's real, The Problem.

Then you're into problem solving mode, which we're going to get to next week.

I think.

Along with more on complaining, nagging, venting, etc.

Isle Dance said...

I love this blog! :o)

A.Decker said...

GAD!!! Ha!Ha! I just LOVE (hate) the medical communities current penchant for acronyms. I've been diagnosed with GERD (used to be chronic heart burn, but how could you get an acronym out of that!?)

I know, I'm a bit off topic; that part just gets me. (It's enough to make me exclaim, ""Gad!" ;-)

therapydoc said...

Love it, A.D.

White Trash Academic said...

Yep, that's me. I diagnosed myself with this as a psychology undergrad (don't we all diagnose ourselves with something?). My Mother has had a depressive disorder all of my life and I sometimes was depressed, but soon realized it was a byproduct of the anxiety.

I decided this year, for the first time in my whole adult life, to initiate therapy as it seems to have gotten worse. I think cognitive-behavioral therapy would work best but it's hard to find those covered under my insurance.

jesse said...

Nice blog. Very helpful. ;-)

Samantha said...

Interesting post you have here. Social phobia is not easy to overcome. But you can learn from www.whatcausespanicattacks.comabout simple prevention methods. Can be pretty handy.

Watson Adam said...

Panic attacks have a variety of causes, some physical, some mental and some emotional. Some individuals may have a genetic predisposition to panic attacks, while gender also plays a role, as women are more prone to panic attacks than men. http://www.xanax-effects.com/

Anonymous said...

May 9, 2009
I am a 49 year old woman. I live in Midwestern U.S. I was given a diagnosis of mental illness around age 25, centering around depression, dysthymia, GAD, and OCD personality. I never "suffered" with anxiety but the mental health workers assumed I did. I cannot emphasize enough how everyone seems to have "something" that could be made into a label of mental illness. I don't believe in "mental illness labels."

Sharon (Natural Anxiety Solutions) said...

I've experienced GAD and had a horrid time with medication which made me feel a lot worse. I had the most success with natural remedies, cognitive behavioral therapy and self help techniques: http://www.naturalanxietysolutions.com

therapydoc said...

Thanks, Sharon

Isle Dance said...

Okay, I have to share an update on my anxiety: It's severely diminished and it appears to be due to some really great balancing of the vitamins and minerals. Who knew? Not me. Ironic timing, with my mom just now having a stroke. She's pretty impressed with my calm through this. :o)

therapydoc said...

So glad to hear it, ID.

GettingBetterFromGAD said...

Thank goodness I found your website, I was beginning to think I was the only one with GAD who uses the internet! Just been diagnosed and making some improvement with SSRIs. I live in England (we have generaliSed anxiety order here) and am waiting for 6 months to have cognitive behavioural therapy. In the mean time I'm trying out things to help myself and others get better, one of which is to write a blog http://generalisedanxietydisorder.wordpress.com/ You might like to take a look. Hope this helps, best wishes from across the pond Julie

Mark Gyseo said...

Some sort of Generalized anxiety disorder treatment as well as (GAD) is really a mental state through which your anxieties and also fears take place so much how they obstruct your lifetime to the point where you cannot purpose or unwind. Tiny factors and big things as well allow you to be fret extremely about what might happen or even will occur. As a result enables you to be worried about a thing through out the day pertaining to simply no genuine purpose. Furthermore, it influences you physically. Your body will get tired from all of the actual mental strain as well as anxiety along with your muscle groups can aches, you simply won't be capable of sleeping, and be worn out on a regular basis.

Emma said...

As a community health worker it's sad to see so many people with these disorders suffer in silence for years because they're too ashamed to come forward to seek help.