Generalized Anxiety DisorderEdit01Sukolita Rangga (9168)

1. 1. Definisi & KarakteristikKecemasan tidak selalu memiliki asosiasi dengan hal-hal spesifik seperti pada diri, situasi atau peristiwa tertentu, sebagai pusat atau sumber dari gangguan itu sendiri sedangkan padageneralized anxiety disordertidak ada sumber yang jelas dari kecemasannya. Kecemasan digeneralisasi dalam setiap kejadian dalam tiap harinya.Penderitageneralized anxiety disordermenganggap kekhawatiran mereka sebagai sesuatu yang tidak dapat dikendalikan (Ruscio, Borkovek, & Ruscio, 2001). Usaha mereka untuk mengendalikan kecemasan biasanya gagal dan biasanya menderita sejumlah simptom baik fisik maupun psikologis yang mempengaruhi aspek sosial, pekerjaan dan fungsi kehidupan secara umum. Mereka mudah merasa sering tidak berdaya dan sering berada dalam situasi tertekan dan suli berkonsentrasi. Sering merasakan ketegangan yang sangat besar yang membuat mereka tidak dapat berfikir, pada mala harinya sulit untuk tidur, atau sulit untuk tetap tidur atau meskipun tidur, tidak merasakan kepuasan dari tidurnya. Pada siang hari mereka merasa kelelahan, mudah marah dan tegang. Kekhawatiran seorang dengangeneralized anxiety disorder dapatdialami selama bertahun-tahun. Pada kenyataannya individu dengan gangguan ini menyatakan mereka tidak pernah tidak merasakan ketegangan dan kecemasan setiap harinya. Dan orang lain cendrung melihat mereka sebagai individu yang pesimis.Kekhawatiran yang paling sering dirasakan adalah mengenai kesehatan mereka dan masalah sehari-hari, seperti terlambat menghadiri pertemuan atau terlalu banyak pekerjaan yang harus dikerjakan. Ketikan gangguan ini terjadi pada anak-anak ketakukan dan kecemasan yang mereka rasakan biasanya berhubungan dengan prestasi di sekolah. Gangguan ini memengaruhi 8,3% dari populasi dan biasanya terjadi pada wanita (Kendler.dkk,..2005). pada populasi yang lebih umum. Rasio jenis kelamin, kira-kira dua pertiganya adalah wanita; pada kondisi klinis, 55 hingga 60 persen klien yang mendapatkan diagnosis dengan kondisi ini adalah wanita (APA, 2000). Sebgianbesar terjadi pada individu yang berusia masih sangat muda, tetapi peristiwa yang menimbulkan stress ketika individu berada pada masa dewasa dapat menyebabkan munculnya simptom ini.KarakteristikGeneralized Anxiety DisorderDSM IV TR :

1. a. Mengalami kecemasan yang berlebihan dan perasaan cemas yang sering muncul selama enam bulan. mempemgaruhi berbagai aktivitas atau situasi seperti sekolah atau pekerjaan.2. b. Kekhawatiran, kecemasan dan simptom fisik lainnya yang berhubungan menyebabkan stress yang signifikan atau ketidakmampuan3. c. Merasa kesulitan dalam mengendalikan perasaan cemas4. d. Kecemasan dan kekhawatiran mereka diasumsikan sekurang-kurangnya dengan tiga hal berikut :1. i. Gelisah2. ii. Mudah merasa lelah3. iii. Sulit berkonsentrasi4. iv. Mudah marah5. v. Otot yang tegang6. vi. Gangguan tidur5. e. Fokus kecemasan dan kegelisahannya tidak termasuk dalam fokus yang diutamakan pada pada Axis I; kegelisahan dan kecemasannya bukan mengenai serangan panik (panic disorder), malu dengan masyarakat (sepertischool phobia), tidak termasuk dalamobsessivec ompulsive disorder, tidak terfokus pada menjauh dari keluarga atau kerabat lain seperti padaseparation anxiety disorder, tidak terfokus pada berat badan sepertianorexianervosaataubulimianervosaatau memiliki penyakit serius seperti pada hypochondriasis, and bukan termasuk dalamposttraumatic stress disorder(PTSD) .6. 2. Etiologi1. a. Perspektif SosiokulturalPenting untuk dapat memahami peran faktor sosiokultural dalamgeneralized anxiety disorder,stress hidup dapat menjadi dasar meningkatkan kecendrungan individu mengalami kecemasan kronis secara signifikan. Stress hidup tersebut dapat berupa bermacam-macam dari berbagai hal.

1. b. Perspektif PsikoanalisisTeori Psikoanalisis berpendapat bahwa sumber gangguan kecemasan menyeluruh (Generalized Anxiety Disorder) adalah konflik yang tidak disadari antara ego dan impuls-impuls id. Impuls-impuls tersebut biasanya bersifat seksual atau agresif, berusaha untuk mengekpresikan diri namun ego tidak membiarkannya, karena tanpa disadari merasa takut terhadap hukuman yang akan diterima. Sumber kecemasan yang sebenarnya yaitu hasrat-hasrat yang berhubungan dengan impuls-impuls id yang selalu berusaha untuk mengekpresikan diri. Namun tidak ada pengalihan dari hasrat-hasrat tersebut melalui suatu objek atau situasi, sehingga tidak adanya suatu pertahanan dan hal ini menyebabkan seorang yang menderitageneralized anxiety disorderselalu merasa cemas.

1. c. Kognitif BehavioralPemikiran utama menurut Kognitif Behavioral tentanggeneralized anxiety disorderadalah gangguan tersebut disebabkan oleh proses-proses berpikir yang menyimpang. Orang-orang yang menderitageneralized anxiety disorderseringkali salah mempersepsikan kejadian-kejadian biasa (seperti menyebrang jalan) sebagai hal yang mengancam dan kognisi mereka terfokus pada antisipasi berbagai bencana pada masa mendatang (Beck dkk., 1987; Ingram & Kendall, 1987; Kendall & Ingram, 1989). Perhatian penderitageneralized anxiety disordermudah terarah pada stimuli yang mengancam (Mogg, Millar & Bradley 2000; Thayer dkk.,2000). Terlebih lagi pasiengeneralized anxiety disorderlebih terpicu untuk mengartikan suatu stimuli yang tidak jelas sebagai sesuatu yang mengancam dan menilai berbagai kejadian yang mengancam lebih mungkin terjadi pada mereka (Butler & Mathews, 1983).

1. d. Perspektif biologisBeberapa penelitian memperlihatkan bahwageneralized anxiety disordermemiliki komponen biologis.Generalized anxiety disordersering ditemukan pada orang-orang yang memiliki keluarga dengan penderita gangguan ini. Pada penelitian anak kembar, ditemukan kemungkinan yang lebih tinggi terjadi pada kembar identik(Monozygote) dibanding kembar tidak identik (Dyzygote). Model neurobiologi menjelaskangeneralized anxiety disorderdapat disebabkan oleh kerusakan dalam sistem GABA (gamma-aminobutyric). Sistem GABA merupakanneurotransmitterpenghambat kecemasan, sehingga kerusakan pada sistem GABA menghasilkan suatu kecemasan yang tidak dapat dikendalikan.

1. e. Perspektif HumanistikCarl Rogers menjelaskangeneralized anxiety disordersebagai suatu kurangnya penerimaan terhadap terhadap penghargaan yang tidak positif dari orang lain yang memilii arti bagi dirinya. Sehingga seorang menjadi terlalu kritis dengan dirinya sendiri dan perkembangan nilai dirinya.

1. 3. KasusIrene adalah seorang mahasiswa berusia 20 tahun dengan kepribadian yang dikenal baik namun tidak memiliki banyak teman. ia datang ke klinik mengeluhkan kegelisahannya yang berlebihan dan kesulitan dan mengendalikan dirinya. segalanya terlihat sebagai suatu bencana bagi Irene. Walaupun ia memiliki prestasi akademik dengan angka 3,7 ia selalu merasa khawatir bahwa ia akan gagal dalam ujian. Sehingga sebagai bentuk ketakutannya ia selalu mengulang materi yang telah ia pelajari berkali-kali, karena ia khawatir suatu saat ia akan lupa dan tidak mengerti dengan materi tersebut.Irene tidak hanya khawatir dengan sekolahnya. ia juga khawatir tentang hubungan nya dengan pasangannya. Dimanapun saat ia berada dengan kekasihnya, ia merasa cemas dan takut berbuat suatu hal yang bodoh dan membuat ketertarikan pasangnnya hilang padanya.irene juga memperhatikan masalah kesehatannya. ia memiliki penyakit hipertensi minor, mungkin hal ini karena badannya yang agak terlalu gemuk. Hal ini membuat Irene melihat daging seperti sebagai suatu ancaman kematian yang tidak boleh dimakan. ia enggan untuk mengukur tekanan darahnya karena ia takut akan hasilnya yang menurutnya pasti sangat tinggi dan ia tidak menurunkan berat badannya. Irene membatasi porsi makannya dengan sungguh-sungguh, sehingga ia juga pernah berperilakubinge eating(dengan sengaja memuntahkan makanan yang telah dimakan). Irene juga terkadang mengalami serangan panik tiba-tiba, namun ini bukan hal yag utama yang terlihat dari dirinya. Irene juga sering cemas akan kemungkinsn terjadinya suatu musibah atau bencana alam.

1. 4. Prevensi1. a. Prevensi SekunderDapat digunakan CBT (Cognitive behavioural therapies)(Borkoves dan Ruscos, 2001) yang mengarahkan klien blajar untuk mengendalikan pikiran yang menimbulkan kecemasan, mencari alternatif bentuk kecemasan lain yang rasional, dan mengambil tindakan untuk menguji alternatif tersebut. Penekanannya adalah menghentikan siklus pikiran dan kecemasan negatif. Jika siklus ini telah putus, maka individu dapat mengembangkan kemampuan untuk mengendalikan prilaku cemas dan semakin pandai dalam mengatur serta mengurangi pikiran yang menimbulkan kecemasan. Pada keadaan tertentu, terapi ini dapat dikombinasikan dengan latihan relaksasi.

1. 5. TerapiSelain dapat menggunakan CBT, dapat juga menggunakan obat-obatan sebagai pendkatan biologis. Anxiolytic dapat digunakan untukgeneralized anxiety disorder (juga sering digunakan pada gangguan phobia tau gangguan kecemasan lainnya). Obat-obatan terutama yang dapat digunakan adalahbenzodiazepin, sepertiValiumdanXanax, jugabuspirone(BuSpar), seringkali digunakan karena pervasivitas gangguan. Setelah diminum, obat tersebut akan bekerja selama beberapa jam dan dapat menurunkan gejala kecemasan dari penderita. Sejumlah studidouble blindmenegaskan bahwa obat-obatan tersebut memberi lebih banyak manfaat dibandingkanplacebo(Apter & Allen, 1999). Beberapa studi menunjukkan efektivitas beberapa antidepressan tertentu dari jenistricyclicdan SSRI (Pollack dkk., 2001; Roy-Byrne & Cowley, 1998).Terdapat beberapa efek samping dari obat-obatan tersebut mulai dari mengantuk, kehilangan memori, depresi, hingga ketergantungan fisik serta kerusakan organ-organ tubuh. Selain itu jika pasien tidak meminum obat manfaat yang diperoleh biasanya akan hilang.Sumber :

1. 1. Abnormal Psychology (Fifth edition) - Gerald C Davidson & John M. Neale. Halaman 1472. 2. Abnormal Psychology:Clinical Perspectives on Psychological Disorders Richard. P Halgin & Susan Krauss Whitbourne. Halaman 2113. 3. Abnormal Psychology;An Integrative Approach David H. Barlow & V. Mark Durand. Halaman 127Generalized anxiety disorder(or GAD) is characterized by excessive, exaggeratedanxietyand worry about everyday life events with no obvious reasons for worry. People with symptoms ofgeneralized anxiety disordertend to always expect disaster and can't stopworryingabout health, money, family, work, or school. In people with GAD, the worry is often unrealistic or out of proportion for the situation. Daily life becomes a constant state of worry, fear, and dread. Eventually, theanxietyso dominates the person's thinking that it interferes with daily functioning, including work, school, social activities, andrelationships.Understanding Phobias, From Types to TreatmentWhat Are the Symptoms of GAD?GAD affects the way a person thinks, but the anxiety can lead to physical symptoms, as well. Symptoms of GAD can include: Excessive, ongoing worry and tension An unrealistic view of problems Restlessness or a feeling of being "edgy" Irritability Muscle tension Headaches Sweating Difficulty concentrating Nausea The need to go to the bathroom frequently Tiredness Trouble falling or staying asleep Trembling Being easily startledIn addition, people with GAD often have other anxiety disorders (such as panic disorder orphobias), obsessive-compulsive disorder, clinicaldepression, or additional problems with drug or alcohol misuse.What Causes GAD?The exact cause of GAD is not fully known, but a number of factors -- including genetics,brainchemistry, and environmental stresses -- appear to contribute to its development. Genetics: Some research suggests that family history plays a part in increasing the likelihood that a person will develop GAD. This means that the tendency to develop GAD may be passed on in families. Brainchemistry: GAD has been associated with abnormal functioning of certain nerve cell pathways that connect particularbrainregions involved in thinking and emotion. These nerve cell connections depend on chemicals called neurotransmitters that transmit information from one nerve cell to the next. If the pathways that connect particularbrainregions do not run efficiently, problems related to mood or anxiety may result. Medicines, psychotherapies, or other treatments that are thought to "tweak" these neurotransmitters may improve the signaling between circuits and help to improve symptoms related to anxiety ordepression. Environmental factors: Trauma and stressful events, such as abuse, the death of a loved one, divorce, changing jobs or schools, may lead to GAD. GAD also may become worse during periods of stress. The use of and withdrawal from addictive substances, including alcohol,caffeine, and nicotine, can also worsen anxiety.

How Common Is GAD?About 4 million adult Americans suffer from GAD during the course of a year. It most often begins in childhood or adolescence, but can begin in adulthood. It is more common in women than in men.How Is GAD Diagnosed?If symptoms of GAD are present, the doctor will begin an evaluation by asking questions about your medical and psychiatric history and perform aphysical exam. Although there are no lab tests to specifically diagnose anxiety disorders, the doctor may use various tests to look for physical illness as the cause of symptoms.The doctor bases his or her diagnosis of GAD on reports of the intensity and duration of symptoms -- including any problems with functioning caused by the symptoms. The doctor then determines if the symptoms and degree of dysfunction indicate a specific anxiety disorder. GAD is diagnosed if symptoms are present for more days than not during a period of at least six months. The symptoms also must interfere with daily living, such as causing you to miss work or school.How Is GAD Treated?If no physical illness is found, you may be referred to a psychiatrist orpsychologist,mental healthprofessionals who are specially trained to diagnose and treat mental illnesses like GAD. Treatment for GAD most often includes a combination of medication and cognitive-behavioral therapy. Medication: Drugs are available to treat GAD and may be especially helpful for people whose anxiety is interfering with daily functioning. The drugs most often used to treat GAD in the short-term (since they can be addictive, are sedating, and can interfere with memory and attention) are from a class of drugs called benzodiazepines. Thesemedicationsare sometimes also referred to as sedative-hypnotics or "minortranquilizers" because they can remove intense feelings of acute anxiety. They work by decreasing the physicalsymptoms of anxiety, such as muscle tension and restlessness. Common benzodiazepines includeXanax,Librium,Valium, andAtivan. These drugs can cause added sedation effects when combined with many other medicines, and they are also dangerous if mixed with alcohol. Certainantidepressants, such asPaxil,Effexor,Prozac,Lexapro,Zoloft, andCymbaltaare also used to treat GAD for longer periods of time. Theseantidepressantsmay take a few weeks to start working but they're safer and more appropriate for long-term treatment of GAD. Cognitive-behavioral therapy: People suffering from anxiety disorders often participate in this type of therapy, in which you learn to recognize and change thought patterns and behaviors that lead to anxious feelings. This type of therapy helps limit distorted thinking by looking at worries more realistically.In addition, relaxation techniques, such as deep breathing andbiofeedback, may help control the muscle tension that often accompanies GAD.Are There Side Effects of GAD Treatment?Dependency on sedative-hypnotic medications (benzodiazepines) is a potential complication of treatment. Side effects of antidepressants vary by specific drug and the person taking them. Common side effects can include sleepiness,weightgain, and sexual problems.What Is the Outlook for People With GAD?Although many people with GAD cannot be cured and symptoms can return from time to time, most people gain substantial relief from their symptoms with proper treatment.Can GAD Be Prevented?Anxiety disorders like GAD cannot be prevented. However, there are some things that you can do to control or lessen symptoms, including: Stop or reduce your consumption of products that containcaffeine, such as coffee, tea, cola, andchocolate. Ask your doctor or pharmacist before taking any over-the-counter drugs or herbal remedies. Many contain chemicals that can increase anxiety symptoms. Exercisedaily and eat a healthy,balanced diet. Seek counseling and support after a traumatic or disturbing experience. Practicestress managementtechniques likeyogaormeditation.

WebMD Medical ReferenceView Article SourcesReviewed by Joseph Goldberg, MD on February 08, 2014 2014 WebMD, LLC. All rights reserved.

Generalized anxiety disorder (GAD)DefinisiGeneralized anxiety disorder (GAD) adalah kebiasaan yang ditandai oleh sebuah pola kecemasan yang sering dan menetap dan cemas pada banyak aktifitas atau kejadian.

Nama lainGAD; Anxiety disorder

Penyebab, kejadian, dan faktor resikoGeneralized anxiety disorder (GAD) merupakan kondisi umum yang dikarakterisasikan sebagai kecemasan yang berlebihan. Contoh, seorang pelajar sering cemas seputar test, yang selalu selalu cemas akan gagal - meskipun ia mendapat nilai yang baik mempunyai pola tipikal gangguan kecemasan.

Seseorang akan mengalami kesulitan untuk mengontrol rasa cemasnya. Situasi kehidupan yang penuh stress, berada di lingkungan stress, bisa menyumbang GAD.

Gangguan ini bisa dimulai kapan saja dalam kehidupan, termasuk saat masih kecil. Banyak orang melaporkan bahwa mereka mengalaminya sudah lama sejauh yang dapat mereka ingat. GAD terjadi lebih sering pada wanita daripada pria.

Gejala-gejala (Symptoms)Kecemasan sering berhubungan dengan symptom berikut: Kegelisahan Mudah merasa lelah Sulit berkonsentrasi Mudah marah ketegangan pada otot gemetar, sakit kepala kesulitan tidur (baca juga kesulitan tidur) keringat yang berlebihan, palpitasi, sesak nafas, dan variasi symptom gastrointestinal

TreatmentBeberapa treatment yang dapat anda pilih: pemberian obat.-- Cara ini melibatkan pemberian obat yang memberikan rasa kantuk atau efek penenang, antidepressant, antihistamines, Benzodiazepines. Sering pemberian obat dalam jangka lama menjadikan anda ketergantungan dan memiliki efek samping lainya. Teknik relaksasi.relaksasi yang sistematis pada bagian tubuh Cognitive behavioral therapy membantu pasien mengenali pikiran yang berkontribusi pada kecemasan. Cara ini biasanya membutuhkan waktu berbulan-bulan bahkan bertahun-tahun. Energy psychology memanfaatkan energy dalam tubuh dengan cara menstimulasi pada titik-titik meridian tubuh untuk memperbaiki aliran energy tubuh. Cara ini merupakan cara yang efektif dan cepat untuk mengatasi tidak hanya kecemasan, tapi juga masalah emosional lainnya dalam hitungan jam atau hari.

KomplikasiOrang yang mengalami GAD bisa berkembang menjadipsysical disorder, sepertipanic disorderatau depresi klinis, atau depresi. Akan menjadi masalah lagi bila seseorang mencoba mengatasinya dengan narkoba atau alkohol untuk menghilangkan kecemasan.

Mental and health providerHubungi Mental and emotional health provider jika anda mendapati symptom kecemasan, terutama bila hal ini terjadi lebih dari 6 bulan atau lebih lama, atau hal ini telah mengganggu fungsi keseharian anda.

NoteInformasi di atas diambil dan diterjemahkan dari www.healthline.com

Generalized Anxiety Disorder SymptomsByPsych Central Staff~ 2 min read

Generalized anxiety disorder (GAD) is more than the normal anxiety people experience day to day. Its chronic and exaggerated worry and tension, even though nothing seems to provoke it. Having this disorder means always anticipating disaster, often worrying excessively about health, money, family, or work. Sometimes, though, the source of the worry is hard to pinpoint.Simply the thought of getting through the day provokes anxiety.People with GAD cant seem to shake their concerns, even though they usually realize that their anxiety is more intense than the situation warrants that itsirrational. People with GAD also seem unable to relax. They often have trouble falling or staying asleep. Their worries are accompanied by physical symptoms, especially trembling, twitching, muscle tension, headaches, irritability, sweating, or hot flashes. They may feel lightheaded or out of breath. They may feel nauseated or have to go to the bathroom frequently. Or they might feel as though they have a lump in the throat.Many individuals with GAD startle more easily than other people. They tend to feel tired, have trouble concentrating, and sometimes suffer depression, too.Usually the impairment associated with GAD is mild and people with the disorder dont feel too restricted in social settings or on the job. Unlike many other anxiety disorders, people with GAD dont characteristically avoid certain situations as a result of their disorder. However, if severe, GAD can be very debilitating, making it difficult to carry out even the most ordinary daily activities.GAD comes on gradually and most often hits people in childhood or adolescence, but can begin in adulthood, too. Its more common in women than in men and often occurs in relatives of affected persons. Its diagnosed when someone spends at least 6 months worried excessively about a number of everyday problems.Specific Symptoms of Generalized Anxiety DisorderExcessive 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).The person finds it difficult to control the worry.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; children do not need to meet as many criteriaonly 1 is needed). Restlessness or feeling keyed up or on edge Being easily fatigued Difficulty concentrating or mind going blank Irritability Muscle tension Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)Additionally, the anxiety or worry is not specifically about having aPanic Attack(though panic attacks can occur within a person with GAD), 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 (PTSD).The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.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.Generalized Anxiety DisorderExtreme, unfounded worry that can interfere with sleep is usually accompanied by body symptoms ranging from tiredness to headaches to nausea. Treatment with antidepressants or other medications and psychotherapy, alone or combined, may alleviate the condition. Definition Symptoms Causes TreatmentsDefinitionGeneralized anxiety disorder (GAD) is much more than the normal anxiety people experience day to day. Without provoking, it is chronic and exaggerated worry and tension. This disorder involves anticipating disaster, often worrying excessively about health, money, family or work. Sometimes, though, just the thought of getting through the day brings on anxiety.People with GAD can't shake their concerns, even though they usually realize that much of their anxiety is unwarranted. People with GAD also seem unable to relax and often have trouble falling or staying asleep. Their worries are accompanied by physical symptoms, especially trembling, twitching, muscle tension, headaches, irritability, sweating, hot flashes and feeling lightheaded or out of breath.Many individuals with GAD startle more easily than other people. They tend to feel tired, have trouble concentrating and may suffer from depression. GAD may involve nausea, frequent trips to the bathroom or feeling like there is a lump in the throat.When their anxiety level is mild, people with GAD can function socially and hold down a job. Although they don't avoid certain situations as a result of their disorder, people with GAD can have difficulty carrying out the simplest daily activities if their anxiety is severe.GAD affects about 6.8 million American adults, including twice as many women as men. The disorder develops gradually and can begin at any point in the life cycle but usually develops between childhood and middle age. There is evidence that genes play a modest role in GAD.Other anxiety disorders, depression, or substance abuse often accompany GAD, which rarely occurs alone. GAD is commonly treated with medication or cognitive-behavioral therapy, but co-occurring conditions must also be treated using the appropriate therapies.SymptomsGeneralized anxiety disorder (GAD) is characterized by six months or more of chronic, exaggerated worry and tension that is unfounded or much more severe than the normal anxiety most people experience. People with this disorder usually: Expect the worst Worry excessively about money, health, family or work, when there are no signs of trouble Are unable to relax Are irritable are easily startled can't control their excessive worrying Suffer from insomniaCommon body symptoms are: feeling tired for no reason; headaches; muscle tension and aches; having a hard time swallowing; trembling or twitching; sweating; nausea; feeling lightheaded; feeling out of breath; having to go to the bathroom a lot; and hot flashesIn children and adolescents with Generalized Anxiety Disorder, their anxieties and worries are often associated with the quality of performance or competence at school or sporting events. Additionally, worries may include punctuality, conformity, perfectionism and are so unsure of themselves that they will redo tasks in order to reach that level of perfection.CausesLike heart disease and diabetes, anxiety disorders are complex and probably result from a combination of genetic, behavioral, developmental and other factors.Using brain imaging technologies and neurochemical techniques, scientists are finding that a network of interacting structures is responsible for these emotions. Much research centers on the amygdala, an almond-shaped structure deep within the brain. The amygdala is believed to serve as a communications hub between the parts of the brain that process incoming sensory signals and the parts that interpret them. It can signal that a threat is present, thus triggering a fear response (anxiety). It appears that emotional memories stored in the central part of the amygdala may play a role in disorders involving very distinct fears, like phobias, while different parts may be involved in other forms of anxiety.By learning more about brain circuitry involved in fear and anxiety, scientists may be able to devise more specific treatments for anxiety disorders. It someday may be possible to increase the influence of the thinking parts of the brain on the amygdala, thus placing the fear and anxiety response under conscious control. In addition, with new findings about neurogenesis (birth of new brain cells) throughout life, perhaps a method will be found to stimulate growth of new neurons in the hippocampus in people with severe anxiety.Studies of twins and families suggest that genes play a role in the origin of anxiety disorders. However, experience also plays a part. In PTSD, for example, while trauma triggers the anxiety disorder, genetic factors may explain why only certain individuals exposed to similar traumatic events develop full-blown PTSD. Researchers are attempting to learn how genetics and experience interact in each of the anxiety disorders -- information they hope will yield clues to prevention and treatment.TreatmentsMedication and specific types of psychotherapy are the recommended treatments for this disorder. The choice of one or the other, or both, depends on the patient's and the doctor's preference, and also on the particular anxiety disorder.Before treatment can begin, the doctor must conduct a careful diagnostic evaluation to determine whether your symptoms are due to an anxiety disorder, which anxiety disorder(s) you may have, and what coexisting conditions may be present. Anxiety disorders are not all treated the same, and it is important to determine the specific problem before embarking on a course of treatment. Sometimes alcoholism or some other coexisting condition will have such an impact that it is necessary to treat it at the same time or before treating the anxiety disorder.If you have been treated previously for an anxiety disorder, be prepared to tell the doctor what treatment you tried. If it was a medication, what was the dosage, was it gradually increased and how long did you take it? If you had psychotherapy, what kind was it, and how often did you attend sessions? Oftentimes people believe they have "failed" at treatment, or that the treatment has failed them, when in fact it was never given an adequate trial.When you undergo treatment for an anxiety disorder, you and your doctor or therapist will be working together as a team. Together, you will attempt to find the approach that is best for you. If one treatment doesn't work, the odds are good that another one will. And new treatments are continually being developed through research.AntidepressantsA number of medications that were originally approved for treating depression have been found to be effective for anxiety disorders. These must be taken for several weeks before symptoms start to fade, so it is important not to get discouraged and stop taking these medications before they've had a chance to work.Some of the newest antidepressants are called selective serotonin reuptake inhibitors, or SSRIs. These medications act on a chemical messenger in the brain called serotonin. SSRIs tend to have fewer side effects than older antidepressants. People do sometimes report feeling slightly nauseated or jittery when they first start taking SSRIs, but that usually disappears with time. Some people also experience sexual dysfunction when taking some of these medications. An adjustment in dosage or a switch to another SSRI will usually correct bothersome problems. It is important to discuss side effects with your doctor so that he or she will know when there is a need for a change in medication. Venlafaxine, a drug closely related to the SSRIs, is useful for treating GAD.Similarly, antidepressant medications called tricyclics are started at low doses and gradually increased. Tricyclics have been around longer than SSRIs and have been more widely studied for treating anxiety disorders. For anxiety disorders other than OCD, they are as effective as the SSRIs, but many physicians and patients prefer the newer drugs because the tricyclics sometimes cause dizziness, drowsiness, dry mouth, and weight gain. When these problems persist or are bothersome, a change in dosage or a switch in medications may be needed. Tricyclics are useful in treating people with co-occurring anxiety disorders and depression. Imipramine, prescribed for panic disorder and GAD, is an example of such a tricyclic.Anti-anxiety MedicationsHigh-potency benzodiazepines relieve symptoms quickly and have few side effects, although drowsiness can be a problem. Because people can develop a tolerance to them -- and would have to continue increasing the dosage to get the same effect -- benzodiazepines are generally prescribed for short periods of time. People who have had problems with drug or alcohol abuse are not usually good candidates for these medications because they may become dependent.Some people experience withdrawal symptoms when they stop taking benzodiazepines abruptly instead of tapering off, and anxiety can return once the medication is stopped. Potential problems with benzodiazepines have led some physicians to shy away from using them, or to use them in inadequate doses, even when they are of potential benefit to the patient. Alprazolam is a benzodiazepine that is helpful for panic disorder and GAD. Clonazepam (Klonopin) is used for social phobia and GAD.Some people experience withdrawal symptoms if they stop taking benzodiazepines These potential problems have led some physicians to shy away from using these drugs or to use them in inadequate doses.Buspirone, a member of a class of drugs called azipirones, is a newer antianxiety medication that is used to treat GAD. Possible side effects include dizziness, headaches and nausea. Unlike the benzodiazepines, buspirone must be taken consistently for at least two weeks to achieve an antianxiety effect.Other MedicationsBeta-blockers, such as propanolol, are often used to treat heart conditions but have also been found to be helpful in certain anxiety disorders, particularly in social phobia. When a feared situation, such as giving an oral presentation, can be predicted in advance, your doctor may prescribe a beta-blocker to keep your heart from pounding, your hands from shaking and other physical symptoms under control.PsychotherapyPsychotherapy involves talking with a trained mental health professional, such as a psychiatrist, psychologist, social worker or counselor to learn how to deal with problems like anxiety disorders.Cognitive-Behavioral and Behavioral TherapyCognitive-behavioral therapy (CBT) is very useful in treating anxiety disorders. The cognitive part helps people change the thinking patterns that support their fears, and the behavioral part helps people change the way they react to anxiety-provoking situations.For example, CBT can help people with panic disorder learn that their panic attacks are not really heart attacks and help people with social phobia learn how to overcome the belief that others are always watching and judging them. When people are ready to confront their fears, they are shown how to use exposure techniques to desensitize themselves to situations that trigger their anxieties.The behavioral component of CBT seeks to change people's reactions to anxiety-provoking situations. A key element of this component is exposure, in which people confront the things they fear. Another behavioral technique is to teach the patient deep breathing as a relaxation aid.Exposure-based behavioral therapy has been used for many years to treat specific phobias. The person gradually encounters the object or situation that is feared, perhaps at first only through pictures or tapes, then later face-to-face. Often the therapist will accompany the person to a feared situation to provide support and guidance.If you undergo CBT or behavioral therapy, exposure will be carried out only when you are ready; it will be done gradually and only with your permission, and you will work with the therapist to determine how much you can handle and at what pace you can proceed. To be effective, the therapy must be directed at the person's specific anxieties and must be tailored to his or her needs. There are no side effects other than the discomfort of temporarily increased anxiety.A major aim of CBT and behavioral therapy is to reduce anxiety by eliminating beliefs or behaviors that help to maintain the disorder. For example, avoidance of a feared object or situation prevents a person from learning that it is harmless. Similarly, performance of compulsive rituals in OCD gives some relief from anxiety and prevents the person from testing rational thoughts about danger, contamination, and so forth.CBT or behavioral therapy generally lasts about 12 weeks. It may be conducted in a group, provided the people in the group have sufficiently similar problems. Group therapy is particularly effective for people with social phobia. Often "homework" is assigned for participants to complete between sessions. There is some evidence that, after treatment is terminated, the beneficial effects of CBT last longer than those of medications for people with panic disorder; the same may be true for OCD, PTSD and social phobia. If you have recovered from an anxiety disorder, and at a later date it recurs, don't consider yourself a treatment failure. Recurrences can be treated effectively, just like an initial episode. The skills you learned in dealing with the initial episode can be helpful in coping with a setback.For many people, the best approach to treatment is medication combined with therapy. As stated earlier, it is important to give any treatment a fair trial. And if one approach doesn't work, the odds are that another one will.Sources Archives of General Psychiatry Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition - TR National Institute of Mental Health - Anxiety Disorders National Institute of Mental Health (Genetics Workgroup) - Gentics and Mental Disorders British Journal of Psychiatry Supplement Psychiatric disorders in America: the Epidemiologic Catchment Area Study