Lexicon of Madness -- Generalized Anxiety Disorder

Generalized Anxiety Disorder (GAD): Persons suffering from GAD worry excessively about a broad range of events, e.g., What if there is a terrorist attack at my kids' elementary school? What if the economy heads south and my company starts to lose money and my boss decides to fire me? What if I took four aspirins instead of the two I intended? I wonder if that mole on my back is cancer? What if the garbage doesn't get picked up tomorrow? They feel unable to control their worrying, and the worrying causes dysfunction in their lives. GAD was formerly called "free-floating anxiety." Unsurprisingly, people with GAD often have difficulty sleeping. The sleeplessness and feeling of being "on edge" all the time can make them irritable. Constant muscle tension and the inability to relax can lead to feelings of restlessness, fatigue, and "shakiness."  They often report headaches, stomach problems, excessive sweating, or heart palpitations. Most patients with GAD report that they have been like this "all my life," which suggests a possible biological etiology. They may have been born with a nervous temperament, i.e., a nervous system that is more sensitive to potential environmental threats and which recovers more slowly from shocks. People with GAD should avoid caffeine. A serious danger is the potential for dependence on alcohol or benzodiazapines (e.g., Ativan, Xanax, Klonopin, Valium). With these patients, benzodiazapines should be used for a maximum of two months (inclusive of a two week tapering period). Sympathetic and concerned listening can be beneficial, as can relaxation training and biofeedback. It is always interesting to consider what use a patient's symptoms might be serving, i.e., What does having these symptoms do for you? In the case of some people with GAD, it might be that worrying about many small or unlikely things could be a way of avoiding thinking about a few, certain things, e.g., that you will fail to live up to your highest ideals and values, and the expectations of your parents; or, the fact of your mortality and the mortality of your loved ones.