People with GAD tend to worry endlessly about simple things. And this much more than normal worrying interferes with the person’s daily activities significantly. The GAD minds always find something to worry about.

A person who heard from the news about a bomb scare may experience extreme anxiety for days or even weeks as negative thoughts race through her mind that something bad might happen again. This dread may eventually limit her to the house for fear of her safety. It can even lead to a nervous breakdown.

Generalized anxiety disorder, unlike phobia has no direct association with objects or situations as the cause of anxiety. It’s a general feeling of fear which defines the person’s daily life, with no provocation or reason in most cases. A friend who failed to show up on agreed time may lead a person to think that an accident might have happened which prevented his or her friend from showing up even if there is no indication of that. When a person cannot stop these anxious, worrying thoughts, it is GAD that is ruling his/her life.

Some people may develop GAD early as a child or later as an adult. Some symptoms of panic disorder, obsessive compulsive disorder, and other types of anxiety can be seen in GAD. People with GAD usually experience headaches and fatigue. GAD may be a life-long challenge especially if they occur along with other anxiety or mood disorders.

Symptoms of GAD

GAD symptoms may show in many different ways, including some of the following:

• Nerve-wracking worrying about little and simple things
• Not having control over constant worrying
• Awareness of obsessive worrying
• Inability to relax
• Inability to focus or concentrate
• Being easily distressed or upset
• Problem with sleeping or staying asleep
• Feeling exhausted easily
• Constantly suffering from some pain such as headaches, muscle pains, agitated stomach, and other unexplained discomfort
• Difficulty in swallowing
• Trembling or twitching
• Irritability, excessive sweating
• Frequent urination
• Shortness of breath

Diagnosis

Doctors and mental health care providers use the Diagnostic and Statistical Manual for Mental Disorder (DSM) criteria, structured interviews, or psychological questionnaires or tests to identify, define, and diagnose a person who thinks he/she may be suffering from anxiety disorder. DSM 5 will be published by the American Psychiatric Association in 2013 and some changes to grouping and criteria listed in DSM-IV are expected to be made.

To be diagnosed with generalized anxiety disorder (GAD), one must meet the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM), summarized below:

• For a duration of at least six months, the person suffers from excessive worrying about events or activities for most days of the week
• Uncontrollable feeling of fear or anxiety
• Severe anxiety or worrying that interferes with normal daily functions
• Fear or anxiety that is not associated with another mental condition like substance abuse, panic attack, post traumatic stress disorder (PTSD), etc.
• At least three of the following symptoms in adults and one in children – fatigue, inability to focus or concentrate, restlessness, sleeping problem, irritability, and muscle tension.

Generalized anxiety disorder usually manifests along with other mental health conditions which makes diagnosis and treatment more challenging for doctors and mental health care providers. Mental health conditions that commonly co-occur with GAD include:

• Panic disorder
• Phobia
• Substance abuse
• Depressive disorders
• Post traumatic stress disorder
• Eating disorders

Treatment  

Like other mental illnesses, GAD likely responds to one of the two types of common psychiatric treatment options: 

• Medications. There are commonly two groups of medication usually prescribed by doctors to help treat the symptoms of GAD – anti-depressant medications and/or benzodiazepines.

• Anti-depressant drugs, although mostly used to treat depression, are also helpful in treating anxiety disorders including GAD. Nowadays selective serotonin reuptake inhibitors (SSRIs) or serotonin neuro-epinephrine reuptake inhibitors (SNRI) are the most commonly used ones. These drugs may have to be taken for several weeks before any positive response to the suffering from GAD symptoms may become evident. Antidepressants can cause some side effects like headache, sleeping problems, or nausea, which are more likely in the beginning of treatment of dose adjustments. Hence it is important to see the prescribing doctor regularly to monitor response and potential adverse events

• Psychotherapy. Cognitive behavioral therapy or CBT is most commonly recommended type of psychotherapy that works to focus on the thought and behavioral patterns that triggers anxiety. Such negative thoughts and behaviors are eventually altered with positive thoughts and behavior.

While some may respond positively to medication, others may show improvement with psychotherapy. The doctors will discuss and determine the appropriate treatment for each individual based on the level of severity of the disorder. Combination of both modalities might get better response rates especially in complicated, treatment resistant cases, though each modality may work alone, too.

Everyone’s life is faced with problems, challenges, hassles, and pressures. No one is exempted from that. For some, these experiences help them respond well to stressful situations. Unfortunately, there are those who are not able to respond well to problems or situations that warrant stress or fear or anxiety.

Stress, like fear is a normal human response activated when faced with events or situations that make you upset or threatened. Technically, it is defined as the way the brain responds to any stimulation. If the situation presents some kind of danger or uncertainty, the stress caused by such will let the body and mind respond in a protective way. One becomes alert and focused, ready for any eventuality. In some cases and situations, the stress response could even be lifesaving.

Types of Stress

Stress can be categorized in three groups:

• Good stress or Routine Stress – This is when stress is used to rise to the challenges. This kind of stress usually has good outcome and can be helpful in one’s learning and growth. This usually stems from pressures derived from work, family, and other daily responsibilities.

• Tolerable stress – This is the person’s response to some bad events like losing a job. Most has the tools to hold up and contain the emotion. Reaching out to one’s support network helps in one’s coping with the bad situation.

• Toxic stress – This stress is elicited when something bad happens and some people cannot activate inner resources or reach out to their support network to deal with the situation. These people seem to have vulnerability in coping or controlling their response to stress, which is likely triggered by environmental factors. This may cause major emotional and physical crisis.

Like fear, people respond to stress in different ways. It is important that a person understands the level of stress he can tolerate and cope well, and what level of stress can cause uncontrollable situations and anxiety disorders. Generally, people respond to stress in three ways:

• Angry or agitated response. Your emotions are high, restless, disconcerted, tense, and jumpy.
• Withdrawn or depressed response. Low energy and no significant reaction or emotion. You shun people and isolate yourself.
• A tense and frozen response. It’s a concealed agitated response, showing no violent reaction. You may look paralyzed but underneath is extreme distress.

Symptoms of Stress Overload

There are signs and symptoms which indicate if your stress level is overboard.

• Cognitive Signs – The warning signs include failing memory, lack of focus or concentration, poor judgement, racing thoughts, and constant, endless worrying.
• Emotional Signs – The warning signs may range from frequent mood swings, irritability, extreme nervousness, overpowering feeling, severe loneliness, feeling of isolation, and depressed mood.
• Physical Signs – The warning signs evident are constant bodily pains and aches, upset stomach, bowel movement problems (diarhea or constipation), nausea, vomiting, palpitation or hyperventilation, tightness of chest, loss of sexual desire and frequent bouts of cold.
• Behavioral Signs – Stress is manifested by poor eating habits, bad sleeping habits, isolation from other people, forgetting responsibilities, alcohol and drug consumption to relieve stress, constant jittery gestures like nail-biting, cracking of knuckles, etc.

Common Stressors

Factors that contribute to the onset of stress symptoms are called stressors or triggers. These factors may be external or self-generated, such as:

• Big life changes
• Work, business or profession
• Difficulties in relationships (family members, wife, children, friends, associates, etc.)
• Financial crisis
• Hectic schedule
• Pessimistic attitude
• Unrealistic projections and expectations
• Perfectionism
• Passiveness
• Negative value on self

Managing and Coping with Stress

If stress is not addressed and resolved, the effects it may have on a person might lead to an uncontrollable emotional outburst. One needs to undertake practical measures to maintain one’s physical and mental health which can reduce or minimize these negative effects. Learn how to:

• Maintain a good support group or network of people who can help you talk through the situations
• Recognize signals sent out by your body about overwhelming feeling of stress like sleeping problems, increase in alcohol or drug consumption, etc.
• Focus on positive thoughts like accomplishments for the day and not dwelling on failures or disappointments
• Set priorities according to urgency. Don’t get yourself overwhelmed with numerous tasks
• Keep a regular 30-minute exercise regimen to help improve mood and get rid of stress.
• Explore and engage in relaxation activities
• Get proper care and treatment for existing or new problems
• Consult with a professional mental health specialist when feeling overpowered by stress, feeling you are unable to function well and resorting to alcohol and drugs as coping mechanism.
• If you are entertaining suicidal thoughts, it’s time to seek professional help. Remember to call crisis/help lines or 911.

When a person feels stressed out, she or he may try the following:

• Take deep breaths in longer gaps (do not exhale before counting to ten slowly)
• Have a long warm bath
• Divert attention to music
• Walk around the house, or the park or just taking long walks
• Do yoga exercises
• Go to a spa for a massage
• Drink warm milk or anything that has no alcohol or caffeine content

One’s ability to cope with stress is largely dependent on one’s lifestyle choices. Keeping it to the basics : Healthy and balanced diet, good sleeping habits, regular physical and mental exercise and strong social networking, will help you get the inner strength and resources needed to ward off and manage toxic stress.

• Try to get as much sleep as possible
• Keep in touch with family and friends for support
• Engage in regular physical and mental exercise to help ward off toxic stressful feelings
• If one is smoking, try to quit. Just as alcohol and caffeine triggers stress so does nicotine.

Stress Relief

Stress is part of life. Having some stress is normal. However, if one gets too much stress, it can affect one’s quality of life and health. Hence, certain steps should be taken to get relief from stress.

A person should understand the problems causing stress and carry out actions to solve the problem or manage the response. The first step in successfully relieving stress is identifying what are causing the stress and making a decision to implement changes in how one manages such stressors. A simple example would be changing the TV channel if the program is showing news that are too distressing. If there is no way to avoid a stressful situation, one can think of ways to divert the mind from thinking too much about the situation – listening to music on an mp3 player may be a good way to reduce the stress. One can also ask family and friends for help by checking with them their own ways of handling stress. Or maybe one can try some tai chi, meditation techniques, yoga, or other relaxation exercises. As stress is not about to leave one’s life, one might just as well learn to deal and cope with it.

Relaxation Techniques

One important part of managing stress is doing relaxation exercises. Relaxation is essential in keeping a good health and well-being. And it can be achieved quite easily if a person practices the process. The following activities may help to some during stressful situations:

Hands and arms

• Make your hand into a tight fist
• Bend the hands back at the wrist feeling the tension release
• Bend arms at the elbows with hands made into fists and taut biceps.
• Shrug shoulders

Head and neck

• Make your forehead wrinkle into a deep frown
• Give the widest smile possible
• Press lips tightly together
• Press the head back against the floor
• Touch the chin to the chest

Photo by: Eliminate Anxiety

Social Anxiety Disorder

Social anxiety disorder (SAD) is the extreme fearfulness of specific social events or situations. The person feels being judged by other people. Dropping something accidentally in a public place can cause a person to be extremely anxious, fearful, and overwhelmed. Attending to a party can be very distressing for some people and many would decline invitations to social activities.

The fear of such social situations is clearly exaggerated and unreasonable but the person cannot help himself or herself to manage the fear and associated anxiety. The level of fear can be so intense that it could result in the person’s total avoidance of the social events and social isolation. A student may be so anxious that he or she would totally avoid going to school for fear of being called on in class. The fear of embarrassment could impact on the person’s daily functioning. Fear of public speaking is the most common symptom of social anxiety disorder.

Different situations can make different persons anxious, fearful, stressed out and overwhelmed. To name a few, these situations may include being asked to perform on stage, talk to people of authority, eating in public or  in restaurants, using public bathrooms, etc. Other situations that make a person think they will cause themselves shame and humiliation will most likely trigger anxiety.

Symptoms of Social Anxiety Disorder

Social anxiety disorder affects the person’s daily routine significantly. For example an office secretary suffering from SAD may not be able to function well as her work will require her to meet and greet strangers visiting the office. Her fear of meeting new people may lead to calling in sick when there would be guests coming to office or to meet with her boss. This disorder has debilitating effects on the person’s social and performance responsibilities.

Social anxiety disorder causes both emotional and physical symptoms including:

• Being excessively self-conscious and anxious in daily social activities
• Worrying about a feared social event or situation for weeks or months in advance before the event
• Worrying about other people’s opinions and judgments about himself
• Being scared that one’s actions will cause severe embarrassment or humiliation
• Being anxious that other people would notice the anxiety and fear
• Blushing or face turning red in social situations
• Trembling or shaking in voice or body when in feared situations
• Breathing problems, , shortness of breath, chest tightness, or racing heart beat
• Upset stomach or feeling ‘butterflies’ in your stomach
• Nausea, dizziness, feeling of passing out/fainting

Diagnosis

Like most psychiatric conditions, there are no specific tests to diagnose social anxiety disorder. A comprehensive psychiatric evaluation should be conducted by a psychiatrist or licensed mental health provider to establish a formal diagnosis. Information booklets, websites, clinical guidelines, and self assessment tests can help to learn about one’s emotional and psychological state.

To be diagnosed with social anxiety disorder (SAD), one must meet the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). DSM 5 will be published by the American Psychiatric Association in 2013 and will make some changes to criteria listed in DSM-IV.

People exhibiting any of the following may meet criteria for SAD:

• Constant fear of being embarrassed or humiliated in social situations especially when feeling that other people are scrutinizing you
• Social situations causing a high level of fear and anxiety
• Recognition of the fact that the anxiety is rather unreasonable and irrational
• Avoidance of social situations which trigger anxiety or fear
• The level of fear or anxiety is interfering with normal daily functions and activities
• For individuals under 18 years of age, symptoms lasting for at least six months
• The fear or anxiety is not caused by other health problems or medical or mental conditions or disorders

Treatment

Like many other mental health conditions, treatment options include various medications and  psychotherapy. Any of the two used individually or in combination may prove to be beneficial and effective.

• Medications

There are several types of medications that are proven to be effective in treatment for social anxiety disorder. Selective serotonin reuptake inhibitors (SSRI) are usually the first line of treatment prescribed to persons suffering from symptoms of social anxiety disorder. Some of the commonly prescribed SSRIs are:

• Sertraline or Zoloft
• Fluoxetine or Prozac, Sarafem or others
• Citalopram, Escitalopram or Celexa, Lexapro
• Paroxetine or Paxil
• Fluvoxamine or Luvox

Another medication group is serotonin and norepinephrine reuptake inhibitors (SNRI), which may be prescribed by doctors to persons suffering from SAD. Venlafaxine (Effexor), Desvenlafaxine (Pristiq), and Duloxetine (Cymbalta) are among the SNRIs.

If any of the medications from the mentioned groups do not help in reducing the symptoms or improving quality of life, clinicians may recommend medications from other groups such as:

• Other antidepressants (such as mirtazapine, bupropion, etc.)
• Anti-anxiety medications or benzodiazepines
• Beta blockers, etc.

The prescribing doctor monitors the response and adverse or side effects of medications to determine if the medication is suitable, the dose is adequate or adjustments should be made. The patient and doctor should work closely to achieve good response to treatment, relief, and ideally full recovery from symptoms.

• Psychotherapy

Also known as psychological counselling or talk therapy, this treatment modality also helps to improve the symptoms of social anxiety disorder. Therapy will allow the person to learn, recognize and alter or manage negative thoughts, feelings and behavioural patterns.

There are different types of psychotherapy used by clinicians and mental health providers to treat SAD. Cognitive behavioural therapy (CBT) is probably the most commonly used method. This therapy dwells on the idea that a person’s own thoughts determine his/her feelings, behaviours and reactions in certain situations. It is not the other people or situation dictating how a person will behave or react. In that sense, a person can choose, control, and change the way he/she feels and acts.

Cognitive behavioral therapy may also include exposure therapy or gradual exposure desensitization therapy, where the person is gradually prepared to face or confront the causes of fear in a controlled environment. This type of therapy allows a person to learn various coping mechanisms and techniques which will help in reducing the degree of fear and anxiety felt in certain situations.

Interpersonal, supportive, psychodynamic, dialectical, behavioral, mindfulness, and relaxation-based therapies are some other therapy types that can be used in the treatment of SAD.