Worrying in GAD Diagnosis and Treatment

Jerry Kennard Health Pro
  • Most people can relate to Generalized Anxiety Disorder (GAD) in some fashion because its key feature is worry. What makes someone with GAD different is that they worry about absolutely everything. From whether it's best to have tea or coffee, to whether their clothing is coordinated, to issues at work. The issues flit from one to another and cover a whole spectrum of activities and situations. To the casual observer the level of worry expended over the most trivial of issues seems absurd. To the person suffering with GAD these constant worries lead to high levels of distress, problems of concentration, agitation and sleep disturbance.

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    If we take a group of ordinary people and ask them about the things they worry about the answer invariably settle around family, personal relationships, finances, work, illness, and various things that crop up at the time. People with GAD tend to worry about exactly the same things although in some experiments greater emphasis on illness, injury and health is reported by GAD sufferers. What really distinguishes GAD worrying from normal worrying is the perceived level of controllability.


    Two main theories have developed as to why worry might become uncontrollable. The first suggests that GAD sufferers use worry as a means to avoid other forms of thought associated with negative feelings. In other words worry becomes used as a kind of avoidance strategy, possibly for preventing access to fear memories. The second possibility is that GAD sufferers simply try too hard to control their worrying. Attempting to suppress thoughts gives rise more and more to something known as the rebound effect in which worrying becomes a more central activity and spreads to a whole variety of situations and events. This can lead to a situation known as meta-worrying which is the negative appraisal of one's own worrying - i.e. I'm worried that I worry so much.


    To be diagnosed with GAD a set of criteria must first be met. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) lists six major categories and several sub-categories of symptoms. The key parts of the diagnostic criteria are that worry must be uncontrollable, happen most days and persist for more than six months. Worry also has to be associated with a variety of physical symptoms such as muscle tension, restlessness and sleep disturbance.



    It can take a little time to settle on a diagnosis of GAD as many of its symptoms overlap with other anxiety disorders. Then there are the issues of whether a patient is deemed to have crossed the GAD threshold. The diagnostic criteria take a good level of care in distinguishing between what might be considered as everyday worrying, to a level where worry is regarded as a disorder. Even so, there remains a level of subjectivity as to what might constitute a significant impairment. For example, is refusing to go to work worse than often being incapable at work? Also, what happens if symptoms persist for five months rather than six? Why are three physical symptoms required and not more? If someone presents with approximately the right symptoms but does not neatly cross the diagnostic threshold does it mean they don't have GAD? Realistically, a trained clinician should weigh up the evidence and apply their knowledge to a more flexible interpretation.


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    People who suffer with anxiety perceive more threat from their environment than people without anxiety disorders. Cognitive therapies therefore tend to use this information in constructing treatment approaches that address worry as a central feature.

Published On: June 29, 2010