Generalized Anxiety Disorder (GAD) is characterized by excessive, uncontrollable worry that impairs daily activities, according to the DSM-5. What are the diagnostic criteria? Symptoms ? How to treat?
A generalized anxiety disorder (Or TAG) is characterized by a persistent feeling of insecurity, constant and excessive worry which has an impact on daily activities. The TAG can be accompanied by physical symptomssuch as agitation, nervousness, difficulty concentrating, muscle tension or sleep disturbances, list Inserm.
What is the definition of Generalized Anxiety Disorder (according to DSM-5)?
THE Generalized Anxiety Disorder (TAG) falls under the category of anxiety disorders. “According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it is characterized by the presence of excessive anxiety and worry occurring most of the time for at least 6 months“, explains Dr. Pierre-Louis Sunhary de Verville, Intern in Psychiatry at the time of the interview. The person has difficulty controlling their preoccupations“. For the diagnosis to be made, at least three symptoms of the following must have been present most of the time for 6 months:
- restlessness/feeling overwhelmed or on edge,
- fatigue,
- difficulty concentrating or memory lapses,
- irritability,
- muscle tension,
- sleep disturbance (difficulty falling asleep, frequent nocturnal awakenings, restless sleep, subjective feeling of ineffective sleep).
“As with other psychiatric disorders, these symptoms must alter the usual functioning of the person (social, professional, family sphere), must not be the result of taking psychotropic substances and must not be better explained by another disorder. mental“, specifies our interlocutor.
What are the physical symptoms of GAD?
Generalized anxiety disorder can cause physical (bodily manifestations of anxiety) and psychological symptoms:
- Appetite and sleep disturbances
- Headaches, increase in migraines in migraine sufferers
- Muscle pain, cramps
- Digestive disorders (pain, abdominal discomfort, impaired transit, irritable bowel syndrome)
- Fatigue
- Hypervigilance and startles
- Palpitations
- Tremors
- Nausea
- Excessive sweating
- Sweaty hands
- Dizziness
- Choking feelings
“GAD is often associated with other psychiatric disorders at the forefront of which are other anxiety disorders (eg social phobia, panic disorder) and depressive episode (which can also be a complication of GAD), continues Dr. Guillaume Fond, Psychiatrist. It can be associated with or lead to addictive disorders (tobacco, alcohol, benzodiazepines) according to the self-medication theory (use certain products to alleviate symptoms)“. Finally, it can be associated with all other psychiatric disorders (bipolar disorder for example), which is the most frequent case (it is very rare to identify GAD without psychiatric comorbidity).
What are the causes of a GAD?
Like other mental illnesses, GAD is the result ofan interaction between a personal vulnerability and the person’s environment. “Personal vulnerability is most often genetic: anxious temperament, sensitivity to stress, for example.emphasizes Dr. Sunhary de Verville. Patients with GAD may present with anxiety personality disorders such as avoidant personality or dependent personality“. Environmental constraints can be professional, family, social for example. It can also be psychological trauma or negative life events.
Which profiles are most at risk of having GAD?
The best-studied risk factors are:
- Low socio-economic status
- The female sex
- Exposure to childhood trauma (including abuse, neglect, physical abuse, sexual abuse, and parental alcoholism)
They are not specific for GAD (other anxiety disorders, mood disorders).
The positive diagnosis of GAD is clinical. “The doctor must however eliminate a physical cause for the symptoms encountered and ensure that they are not linked to another mental disorder which would better explain their presence (another anxiety disorder for example)”, says Dr. Fond. Although it is not necessary for the diagnosis, the doctor can use different anxiety rating scales (such as the Hamilton Anxiety Scale For example). “The physician should also screen for the presence of other anxiety disorders and a depressive episode, frequently concomitant with GAD. If present, these disorders will also need to be treated.” he specifies. If GAD only very rarely leads to hospitalization, the depressive episode that accompanies it may in some cases require this exclusion in order to protect the patient.
The most effective strategy is to combineantidepressant treatment with cognitive behavioral therapy (CBT). In the absence of treatment, GAD is most often chronic, with fluctuations however (attenuation then increase in anxiety). First, it is important to remind the patient of the essential rules when suffering from a mental disorder:
→ Stopping stimulants (coffee, tobacco, alcohol, and any other psychoactive substance)
→ Practice of regular physical activity: 150 minutes per week of moderate activity (slight acceleration of the heart rate) in 2 or 3 sessions or 75 minutes of intense activity (great acceleration of the heart rate)
→ Balanced diet of the Mediterranean type (rich in vegetables, legumes, favoring olive oil for seasoning, including two portions of fish per week and limiting meats, processed foods and junk food)
→ Have good sleep hygiene (for example: go to bed and wake up at fixed times, no screen before bedtime, do not stay in bed when awake)
What are the drugs to treat GAD?
Drug treatment for GAD is based on prescription of antidepressant treatment. “Contrary to what its name might suggest, the antidepressant is not reserved for depressive episodes, recalls Dr. Fond. It is effective in many anxiety disorders, including GAD. Its effectiveness is not immediate. It may require regular intake of 4 to 6 weeks before the first effects appear, although improvements are most often observed before this time. The prescribed treatment must be taken for a minimum period of 6 to 12 months, after which it will be reduced very gradually in agreement with the doctor.“. The latter may possibly prescribe in association with the long-term antidepressant treatment, an anxiolytic treatment to be used only during moments of disabling acute anxiety. “Iit is benzodiazepines, which are not long-term treatments for GAD. Their prescription will be limited in time, due to the addictogenic potential of these molecules. Non-addictive hydroxyzine may be an alternative to benzodiazepines but has drawbacks“, specifies our interlocutor. However its effectiveness is inconstant and it can turn out to be very sedative in some people.
What therapy to treat GAD?
Psychotherapy is recommended in addition to or as an alternative to antidepressants. “Cognitive and behavioral psychotherapies have demonstrated their effectiveness in GAD, recalls Dr. Sunhary de Verville. They focus, among other things, on the management of emotions, the restructuring of dysfunctional thoughts, problem solving, exercises in tolerance of uncertainty, relaxation. Mindfulness-Based Stress Reduction (MBSR in English) is a cognitive and behavioral psychotherapy that has proven its effectiveness in the treatment of anxiety disorders. It lowers anxiety thresholds and promotes concentration on the present moment. In this way, it helps the patient to no longer focus solely on his past ruminations and his concerns for the future. acceptance and commitment therapy (ACT in English) is a cognitive and behavioral therapy that refocuses the person on actions that are in accordance with their deep personal values. It includes mindfulness exercises, and allows the patient to defuse dysfunctional ideas and their emotional truths.“. Actions aimed at escaping anxiety are replaced by actions directed towards values.
What are the natural remedies to treat GAD?
Relaxation methods can be used to help the patient manage their anxiety. So, sophrology, relaxation, abdominal breathing and square breathing are all keys that can help the patient in managing his emotions.
Thank you to Dr Pierre-Louis Sunhary de Verville, Intern in Psychiatry at APHM (Assistance Publique – Hôpitaux de Marseille) and Dr Guillaume Fond (psychiatrist teacher researcher at AP-HM and author of “I make my life a Grand Project “Ed. Flammarion)