Generalized anxiety disorder

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Classification according to ICD-10
F41 other anxiety disorders
F41.1 Generalized anxiety disorder
ICD-10 online (WHO version 2019)

The generalized anxiety disorder (GAD), according to ICD-10 (F41.1) a form of "other anxiety disorders". In the process, fear becomes independent and loses its usefulness and relation.

Symptoms

The patient experiences a generalized and persistent fear that is not (as in the case of phobic disorders ) limited to certain environmental conditions, but rather floats freely.

The content of the fear is in most cases an unfounded concern and fear of future accidents or illnesses that affect you or your loved ones, as well as a large number of other worries and premonitions. The patient is hardly or not able to cope with the daily tasks. He has states of anxiety that leave little strength for a normal lifestyle. The anxiety states occur in many situations. The person concerned panics from crowds, elevators, public transport, in simple and everyday situations in which the fear of the person concerned cannot be understood by the common man. The lifetime prevalence is 4–5%, the disease usually begins between the ages of 20 and 30, women are more often affected than men, often in connection with stressful living conditions. The course is different, but tends to fluctuate and become chronic. Areas of concern are:

  • Family / social relationships
  • Work and performance
  • Health concerns
  • Finances
  • Everyday

Fear manifests itself in the patient through physical complaints such as tremors, palpitations , dizziness , derealization and depersonalization , nausea, inner restlessness, inability to relax, hot flashes , muscle tension, difficulty concentrating , nervousness, sleep disorders , tension headache, drowsiness, tingling.

According to the ICD-10 criteria, the prevailing tension, apprehension and apprehension regarding everyday events as well as at least four of the following symptoms must be fulfilled on most days for at least 6 months (of which at least one vegetative symptom):

  • Vegetative symptoms (sweating, tachycardia or tachypnea , dizziness, dry mouth, tremors)
  • Symptoms in the chest or abdomen (difficulty breathing, tightness, pain, nausea, or tingling in the stomach)
  • Mental symptoms (feeling dizzy, insecure and light-headed, derealization and depersonalization , fear of loss of control, fear of dying)
  • General symptoms (hot flashes or chills; numbness or tingling sensations)
  • Tense symptoms (muscle tension, restlessness, inability to relax, nervousness, a feeling of lump in the throat, or difficulty swallowing)
  • Nonspecific symptoms (increased nervousness, difficulty concentrating or emptiness in the head, persistent irritability, difficulty falling asleep)

There must be no organic causation or the criteria for a phobic disorder , obsessive-compulsive disorder , panic disorder, or hypochondriac disorder.

Those who suffer from generalized anxiety disorder usually see a doctor because of their physical symptoms . It often takes many years to realize that chronic anxiety is hidden behind physical complaints. The physical complaints of those affected are mostly the result of their negative thoughts, worries and ruminations. The disease used to be underestimated. Today we know that it is associated with serious impairments in quality of life.

Creation and maintenance

Genetic and social factors are assumed to be the cause of the development of generalized anxiety disorder. However, GAS is not specifically inherited; rather, there seems to be an inheritable biological vulnerability to the development of pathological fear. This biological vulnerability to experiencing anxiety can lead to stress caused by social factors. Stress-inducing social factors are mostly critical life events. The stress experienced can lead to the fear of expectation (worries) characteristic of GAS. This anticipatory anxiety is characterized by negative emotions associated with "the perceived inability to predict, control, or achieve desired outcomes in upcoming events or situations." Above all, this leads to a shift in attention to internal, self-evaluating content and excessive vigilance towards fear-inducing stimuli. The vigilance then in turn leads to the fact that many different living conditions are perceived as threatening. The GAS seems to be sustained by worry: According to Borkovec and colleagues, worry is a form of mental avoidance. The process of worry dampens the emotional processing of fear-inducing stimuli and also leads to somatic suppression effects: the fear-inducing stimuli are rationalized (due to cognitive processing) and people become calmer through worrying. This short-term improvement in emotional and physical well-being has a negative reinforcing effect: the fear is perpetuated.

Other cognitive factors discussed are internal and external misjudgments that result from the changes observed by the patient in himself, such as reduced ability to concentrate and impaired working memory: I am not up to the task, have little control or the ability to cope with difficult situations that harm worry me. The negative meta worries can result in control attempts which increase the frequency of worries and trigger avoidance and reinsurance behavior. But positive meta-worries like: “Worry equals precaution” can intensify the worry process. Through control, avoidance and reassurance, there can be no getting used to and thus no end to the worrying process, and the vicious circle is created.

therapy

In psychodynamic psychotherapy, both the psychological structure and the fears and the associated fear-inducing situations are dealt with. Just as much attention is paid to the “fear-maintaining conditions” as the content of the fears or the triggering conditions in the life of the person concerned. Biographical relationships can also be conveyed in the course of therapy; unlike other anxiety disorders, these are never in the foreground. In the transfer , the focus is on the level of security needs of the person concerned. The therapist's interventions are based on this. Attachment issues can also come into play in therapy. There are also short-term psychodynamic psychotherapies that have proven to be just as effective as cognitive-behavioral therapy programs in the treatment of GAS.

In cognitive behavioral therapy , the first goal is for the patient to experience an understanding of his disorder through a behavior analysis and the conveyance of his individual disorder model, thereby creating a willingness to participate in behavioral interventions such as confrontation with fear in sensu (thought) or in vivo (in real life, i.e. in the concrete situation). This enables him to learn new behavioral patterns by facing his fear and experiencing in practice that the consequences he feared will not materialize. Through cognitive therapy elements such as cognitive restructuring , reality testing, decastrophizing or dealing with meta-worries, the patient should acquire a new attitude towards life or a new view of their own abilities. The effectiveness of cognitive behavioral therapy has increased dramatically since clinical researchers improved the techniques used in it. One of the most important further developments in cognitive behavioral therapy for the treatment of generalized anxiety disorders is metacognitive therapy , the effectiveness of which has been proven by meta-analyzes.

Another important therapeutic element, the Applied relaxation . Only in severe cases that are otherwise unable to benefit from psychotherapy, as their fears and tensions are too large, a drug therapy has with antidepressants, especially SSRIs or SNRI , in order to generate a therapeutic ability at all. However, additional fears and discontinuation of therapy due to side effects or fear of discontinuation of the drug are to be expected negatively.

Many clients with generalized anxiety disorder see general practitioners for treatment for their nervousness and somatic complaints. In this case, benzodiazepines are often mistakenly prescribed to relieve nervousness. However, there are quick habituation effects. Benzodiazepines also quickly create addiction, making it difficult to stop taking the medication.

literature

  • H. Mitterhammer: Psychiatry for medical professionals . Service company OEH Uni Graz, 1997, p. 35f.
  • E. Becker, J. Margraf: Generalized anxiety disorder . Beltz, 2002.
  • J. Hoyer et al.: Counselor Generalized Anxiety Disorder . Hogrefe, 2007.
  • M. Linden, H.-J. Möller: Pocket Atlas GAD: Generalized Anxiety Disorder in Clinics and Practice. 1st edition. Aesopus, 2006.
  • S. Schmidt-Traub: Generalized Anxiety Disorder: A Guide for Overly Concerned and Afraid People. 1st edition. Hogrefe Publishing House, 2008.

swell

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