Recent News About Generalized Anxiety Disorder (GAD)

A recent article published in Comprehensive Psychiatry (1) provides some interesting insight into Generalized Anxiety Disorder, or GAD. The objective of the study was to uncover whether GAD has a clear psychopathological pattern and whether it is truly a distinct category of illness or whether it might be best understood as a symptom that accompanies other mood disorders.

Common symptoms of GAD include exaggerated worry and tension, even if there is no good cause for this worry. Rather than being related to some specific event (such as a big presentation, etc.) a patient suffering from GAD may worry excessively about everything all the time. At the same time, sufferers of GAD have difficulty sleeping, and can experience trembling, twitching, muscle tension, headaches, irritability, sweating, and even hot flashes.

Although GAD was presented as a separate diagnosis in the third edition of the DSM (Diagnostic and Statistical Manual of Mental Disorders), it has always faced some controversy. This controversy arose because a clear definition of the illness has not been established, and at the same time, the disorder is almost always present along with illnesses such as major depressive disorder, social anxiety disorder, specific phobia, or chronic pain conditions. For this reason, the authors of the study sought to investigate the disorder to elucidate the usefulness of considering the disorder a separate condition.

To obtain their data, the researchers used a representative sample of 3500 subjects who were at least 14 years old and who were living in Sesto Fiorentino, Italy. Of those 3500 subjects, the 609 who tested positive based on an initial interview with their general practitioners were selected for further study. Of those 609, a final 375 subjects (201 women, 174 men) were chosen for the final analysis. The subjects had all reported at least one symptom of GAD within the last two years (feeling wound up, tense, or restless; easily becoming fatigued; difficulty concentrating; irritability; muscle tension; and sleep disturbance.

Interestingly, out of the 375 subjects, only 105 met the diagnostic criteria for GAD. Other patients were diagnosed with conditions such as major depressive disorder, depression not otherwise specified, social phobia, anxiety not otherwise specified, obsessive-compulsive disorder, bipolar disorder, nonaffective psychosis, eating disorder, and impulsive disorder. The symptoms of these illnesses overlap with GAD to such an extent that the average person in the study was diagnosed with 1.88 disorders – meaning that having more than one at the same time was very common. Furthermore, out of 105 participants who actually did have GAD, only 18 (that is, 17.1%) had GAD and no other disorder.

The authors had expected to find that if GAD represented a discrete syndrome, then all the symptoms of GAD would occur more frequently in patients who had been diagnosed with GAD as compared to those diagnosed with other illnesses. They also expected to find that there were distinctive features associated with the disorder and that GAD would not appear most frequently along with another psychiatric condition.

Contrary to their expectations, one main finding was that GAD is usually associated with other mood disorders and that its occurrence as the solitary illness is rare. A second main finding was that GAD symptoms are common in all of the disorders which are included in the mood/anxiety spectrum (such as depression, phobias, etc.). The third finding was that none of the symptoms actually required for GAD (with the exception of muscle tension) is specifically associated with this disorder. Based upon these findings, the authors suggest that perhaps physicians should rethink their approach to these types of disorders, and consider them clusters rather than as separate illnesses. Treatment could be considered using a broad spectrum of protocols which can alleviate a range of illnesses and associated symptoms.

(1) Faravelli C, Castellini G, Benni L, Brugnera A, Landi M, Lo Sauro C, Pietrini F, Rotella F, and Ricca V. Generalized anxiety disorder: is there any specific symptom? Comprehensive Psychiatry 2012; 53: 1056-1062