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Anxiety disorders are known to be very many. From specific fears of objects or animal phobias, such as fear of spiders, fear of failure to fear of people and social events, the forms of anxiety disorder are very diverse, but can at least be named quite precisely in their character. The situation is different with generalized anxiety disorder (GAS). It is relatively complicated and is not particularly targeted at a particular trigger, but rather rather unspecifically directed against all sorts of things.
Accordingly, it is extremely difficult for those affected to avoid corresponding conflict situations, since practically every everyday situation fuels their fear. In our article on the topic, we explain how generalized anxiety disorder develops and what treatment options are available.
What are anxiety disorders?
The term "anxiety disorder" is a collective term for a variety of different mental disorders that have in common that they are associated with a deep-seated fear of something or someone. There are two main types: the specific anxiety disorder or phobia and the generalized anxiety disorder.
Specific anxiety disorder - phobia
The first form is the specific or specific anxiety disorder (phobic disorder). The fear is aimed specifically at certain objects, people, groups of people or situations and only occurs when the person concerned is confronted with said fear trigger ("trigger") or at least with thoughts about it. Typical examples of corresponding triggers are:
Animals (with animal phobias) such as with
- Fear of bees (apiphobia),
- Fear of dogs (cynophobia),
- Fear of insects (entomophobia),
- Fear of snakes (ophidiophobia)
- and fear of spiders (arachnophobia).
Situations (situational phobias) such as in
- Fear of flying (aviophobia),
- Fear of heights (acrophobia)
- and claustrophobia (agoraphobia).
Social interactions (social phobias) such as
- Fear of blushing in public (erythrophobia),
- Fear of speaking in public (logophobia)
- and fear of urinating in public (paruresis).
Unspecific anxiety disorder
This form of anxiety disorder occurs spontaneously (floating freely) and therefore has no specific trigger factor. For this reason, finding the cause of unspecific anxiety disorders is often very complicated. In contrast to specific phobias, there is no trigger that triggers fear, which may indicate a concrete traumatic experience in the past. Diffuse anxiety disorders can be divided into three sub-forms:
Panic disorder: Panic disorders are anxiety attacks that occur spontaneously and end as suddenly as they started. The duration of a single panic attack is rather short with a few minutes.
Depressive anxiety disorder: Unspecific as well as unfounded fears often occur in the context of depression. The fears are mostly due to a disproportionate, emotional upset or a depressive tendency to brood. The anxiety disorder usually resolves here after an acute depressive episode.
Generalized anxiety disorder: Probably the worst of all non-specific anxiety disorders can span a period of several months to years if it is not treated in time. This means that those affected live permanently in a state of fear, which can be very stressful not only mentally but also physically.
It becomes apparent that generalized fear is not to be trifled with. Affected people have little control over the appearance of their fears, which are associated with constant tension, worry and panic. This can not only be manifested by psychological symptoms such as fearfulness, chronic inner restlessness or disturbed sleep or sleep problems.
Generalized fear also means enormous physical strain, which affects the nerves and the heart in particular, for example in the form of tremors, high blood pressure or rapid heartbeat. The health of those affected is massively endangered. In the worst case, this can even lead to a circulatory collapse or heart attack. It is therefore all the more important to treat the generalized anxiety disorder in a timely manner. This, in turn, requires careful research into the causes, which is not always easy to do.
Generalized Anxiety Disorder - Causes
Even though generalized anxiety disorder can be clearly distinguished from phobic disorders such as social phobia due to its unspecific character, it has something in common with the latter, at least in the area of causes. In both cases, social stress factors and traumatic everyday experiences in the social environment very often contribute to the manifestation of the anxiety disorder. While such experiences often appear as the sole cause of social phobias, they only form one of several influencing factors in generalized anxiety disorder, the interaction of which results in the disorder.
Fear is actually a completely natural sensation that has accompanied people since the beginning of its evolutionary history. It has a more than important function because it can save us from dangerous situations and avert life-threatening threats. So fear is an essential part of our body's survival instinct. However, it is important that this is created in a well-balanced manner. For this purpose, there are special regulatory mechanisms in the brain that are controlled by certain hormones.
As soon as a person finds himself in an acute situation that triggers stress or fear, for example perceives unexpected noises or smells, the body releases more adrenaline. The stress hormone increases the attention of those affected. In order to be able to better perceive possible dangers in the vicinity, the pupils dilate and the hearing becomes more sensitive. It also happens among other things
- accelerated heartbeat,
- shallow breathing aimed at rapid body reactions,
- increased muscle tension, which allows quick escape or defense reflexes,
- increased energy supply for the muscles
- and the secretion of sweat, the smell of which alarms fellow species.
If the brain subsequently classifies an apparently dangerous situation as harmless, the adrenaline output drops again. If, on the other hand, the fear-triggering situation persists, the release of another stress hormone begins at a certain point in time, namely cortisol. It is responsible in particular for the long-term conversion of the metabolism to a chronic danger or stress situation, but at the same time has an anti-inflammatory effect because it dampens the immune system. An effect that is often used in medicine to suppress excessive immune reactions, such as those typical for allergies.
It is easy to guess that the release of stress hormones is massively disrupted in people with anxiety disorders. Above all, a constant release of adrenaline or noradrenaline can escalate the feeling of fear enormously. Doctors assume that said imbalance in the hormone balance is associated with a particular, hereditary biological susceptibility to the development of pathological anxiety (so-called pathological anxiety).
A reduced activity of brain neurotransmitters to inhibit stress hormones causes a disproportionate release. The result is sustained arousal of the brain that promotes generalized anxiety.
The neurotransmitter y-aminobutyric acid seems to play a special role here. What is interesting here is that the “gamma-aminobutyric acid” (GABA) in English has an inhibitory effect in adulthood, but fetal maturation in the womb has a rather exciting effect on the development of the brain's own synapses. To what extent genetic disorders during these maturation processes also influence the development of anxiety disorders remains to be researched.
In principle, fear can only be sustained permanently if it is fed by perceived psychological stress. Here too, patients with generalized anxiety disorder seem to be susceptible to particular stress sensitivity. Certain everyday situations are perceived as stressful beyond the usual measure in the context of the disease, which is why the pathological fear usually arises in situations that are rather banal for outsiders.
Now, however, this hypersensitivity to stress is mostly provoked externally by social factors. This means that social confrontations with critical stress potential contribute to the manifestation of generalized anxiety disorder. Corresponding social events can be, for example:
- Appearances in front of an audience,
- Relationship disputes,
- family conflicts,
- new social contacts,
- Exam situations,
- Deaths in the family or among friends
- or physical disputes.
Particular attention should be paid to social situations that mean a loss of control for those affected. A good example is an insecure bond with close caregivers (e.g. parents) in childhood. It arises especially when the caregiver was unable to instill sufficient basic trust in the child, for example due to an emotional absence or as part of domestic violence. The child experiences the behavior of the caregiver increasingly as uncontrollable or unpredictable, which increases the fear of losing control in social situations.
In addition to other psychological disorders such as fear of attachment, this can also lead to a generalized fear of events that harbor the risk of losing control. These can be banal activities such as swimming, in which those affected literally lose their feet and have no way of gaining control of the situation by holding onto a fixed point. Situations such as applying for a job are also conceivable, in which those affected have no or only limited influence on the result of the application.
It becomes apparent that generalized anxiety disorders are associated with enormous impairments in everyday social life because numerous activities cannot be carried out due to the constant and disproportionate fear.
Important: Generalized anxiety usually manifests between the ages of 20 and 30, whereby women are affected much more often than men. Doctors suspect that a particular suffering of the female gender, for example through social inequality, discrimination or the sometimes very stressful female cycle, is responsible for this gender.
Normally our brains are able to objectively assess the potential danger of a situation and consequently to justify or refute fear. For people with generalized anxiety, however, there is a misjudgment, which is largely due to the fact that the person concerned does not assess the situation itself, but the changes in their own body.
Concomitant symptoms of stressful situations such as an accelerated heartbeat, excitement or a loss of ability to concentrate cause enormous restlessness and intensify the feeling of a loss of control due to their uncontrollable character. Cognitive behaviors that promote fear, such as worry or inner restlessness, also increase in the course of misjudgment, which is why fear becomes a true vicious circle.
By the way: Worrying about generalized fear is seen by psychologists as a targeted avoidance behavior that prevents emotional processing of the actual fear. Such processing is another unknown to many of those affected, which could possibly result in losing control of their own emotions. Avoiding the conscious experience of anxiety-inducing stimuli thus unintentionally maintains anxiety.
General stress factors
In addition to social stress factors, generalized anxiety can also fuel further stress-causing brooding and worries. For example, concerns about your personal financial situation or your own health are conceivable. The latter in particular can also lead to an overlap with conventional triggers of specific phobias, for example when it comes to the fear of germs or poisonous animals.
Nevertheless, a clear differentiation must be made here between generalized fears and phobias, because, as shown, the additional stress factors are only one of many components that come into play in generalized anxiety disorder.
Generalized anxiety disorder - symptoms
As already mentioned, generalized anxiety disorder initially causes exactly those symptoms that also occur in natural cases of anxiety. However, in the event of illness, they last disproportionately long and without normal regulation after the end of an anxiety state. Complaints like
- Racing heart,
- Irregular heartbeat,
- a dry mouth,
- Muscle tension,
- or tremors
thus become a chronic problem. This inevitably has further effects on the health of those affected. Persistent palpitations and irregular heartbeats, for example, increase blood pressure and the risk of a heart attack. A constant tension also favors
- Difficulty breathing,
- inner unrest,
- Difficulty concentrating,
- Loss of performance,
- increased irritability
- and sleep disorders.
All in all, chronic tension due to non-waning fear is an enormous strain on the immune system, which in such a case is also put on permanent alert. An increased risk of infection and excessive immune reactions in the form of an allergy cannot therefore be ruled out.
Muscle and nerve tension can also result, and this can lead to discomfort (for example, tingling in the limbs or feelings of numbness) or damage to posture. The latter are not uncommon in people with generalized anxiety in a crooked posture. Furthermore, certain behavioral problems, such as
- particular fearfulness,
- exaggerated shyness
- or very quiet speech,
observed in patients with generalized anxiety. Social behavior is also increasingly shaped by avoidance behavior, which manifests itself in avoiding public places, social contacts or certain everyday situations (e.g. driving with public transport or shopping). The fear itself can increase in the further course of the disease to such an extent that a completely unfounded fear of death occurs, which then means a particularly great impairment in the everyday life of those affected.
Caution: People with generalized anxiety are prone to depression and an increased risk of suicide due to their often unbearable suffering. In many cases, psychosomatic pain symptoms can also be observed, which further aggravate patient suffering.
If there is a suspicion that a person is suffering from a generalized anxiety disorder, a conversation with a specialist psychotherapist is without options. General practitioners and non-medical practitioners can identify certain abnormalities and later provide some help in therapy, but a reliable diagnosis can only be made within the framework of psychotherapeutic examination criteria.
As with other health complaints for which patients are referred to a doctor, the first step in a diagnosis is a personal patient consultation. On the one hand, the existing symptoms and possible previous illnesses are inquired about. On the other hand, a psychotherapist also examines the family background of the person concerned and any traumatic experiences that may have contributed to the development of the anxiety disorder. In many cases, therapists also use standardized questionnaires that were specially developed to identify anxiety disorders.
It should be noted that long-term psychological complaints often take longer to examine. As a result, it may take several interview sessions for the psychotherapist to complete his diagnosis. This careful examination of mental health is particularly important because it has to be clarified whether there are other psychological complaints besides the actual anxiety disorder. Targeted treatment can only be initiated once the examination has been fully and completely completed.
Generalized Anxiety Disorder - Therapy
Both medicinal and psychotherapeutic measures are used to treat generalized anxiety disorder. In addition, certain alternative medical therapy approaches and the patient's conscious involvement in the design of the therapy can significantly accelerate the recovery process. For details on therapy for generalized anxiety disorder, please see the overview below.
The primary goal of therapy for generalized anxiety must be to change the patient's way of thinking so that he / she does not consider every potential stressful situation to trigger anxiety. So he or she has to face the inner fears consciously and learn alternative coping strategies. For this purpose, cognitive behavioral therapy is usually first played with possible anxiety situations and theoretical behaviors are discussed. This is followed by confrontations under real conditions.
By creating conflict situations in everyday life as well as successfully coping with them, the patient's unfounded worries and fears can be refuted using concrete examples, whereby the thinking pattern of those affected is restructured in such a way that it remembers successfully mastering a difficult situation and therefore one less fear-triggering factor remains in the memory.
Through constant conditioning, a completely new view of life and its challenges can be obtained in the long term. In addition, the patient is encouraged to carry out a constant reality check, which must be the first response to emerging fears in order to be able to assess whether the fears are justified or unfounded.
Another psychotherapeutic approach is the so-called metacognitive therapy. The aim is to train to consciously reject worries and constant brooding and thus to change the thinking behavior of those affected.
One of two variants in this regard is the thought stop technique. The person concerned should reject or postpone unhealthy thoughts by consciously saying “stop”. The delay in training is usually 15 minutes, which is intended to show the patient that his / her thinking processes are entirely controllable. After the 15 minutes have passed, he / she can then ponder and worry as usual, which ideally leads to those affected realizing how much they themselves motivate their anxiety through unnecessary mind games.
The second variant of metacognitive therapy is attention training. Here training is given to consciously draw attention to another topic in acute cases of worry and brooding. This can happen, for example, through tasks such as focusing on room noises or room colors.
Detached Mindfulness is also a method in which those affected concentrate on different words and then imagine them in pictures. All of the metacognitive measures mentioned have already shown clear success in various studies. The conscious decision to change the focus of attention in moments of acute fear can therefore reduce or at least weaken the occurrence of anxiety.
In support of psychotherapeutic treatment, patients should initiate targeted relaxation measures in order to help themselves to calm down. On the one hand, relaxation methods such as yoga, autogenic training, progressive muscle relaxation or singing bowl therapy can be considered. On the other hand, personal relaxation rituals such as walking, listening to soothing music, stress-free everyday planning and regular bed times can also help to reduce stress.
Aromatherapy is also highly recommended for anxiety disorders. Here, soothing aromas are emitted by means of fragrance oil stands or incense, which should particularly appeal to the senses of those affected. Alternatively, appropriate herbal oils can also be used for massage or rubbed on the skin (for example, under the nose or on the temples). Other possibilities are relaxation baths with herbal additives or drinking soothing herbal teas.
The best herbs for anxiety relief and relaxation are:
- Johannis herbs,
- and passion flower.
Generalized anxiety disorder - medication
To inhibit the anxiety-promoting effects of the stress hormone norepinephrine in the brain, doctors work with so-called serotonin reuptake inhibitors in the case of generalized anxiety. Serotonin reuptake inhibitor, short: SRI). Serotonin is a natural tissue hormone that helps calm and relax. In the brain, the neurotransmitter is therefore considered an opponent of adrenaline and norepinephrine, which can be very beneficial for generalized anxiety disorders.
In addition, serotonin is often referred to in medicine as a happiness hormone because it increases well-being and triggers feelings of happiness. Again an effect that is very desirable with constant anxiety and which also makes the SRI important antidepressants.
In addition to long-term therapy with anxiety-reducing antidepressants, it is possible to administer benzodiazepines at short notice. They also have an anxiolytic, calming and muscle-relaxing effect. However, it is not advisable to use benzodiazepine-containing preparations too often, since the strong habit of getting used to these drugs entails an increased risk of dependency. You should therefore really only be used in extreme emergencies. Herbal sedatives from the medicinal herbs already mentioned are better in the accompanying therapy for symptom treatment. (ma)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
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- Max Planck Institute for Psychiatry: Anxiety Disorders (accessed December 3, 2019), Max Planck Institute
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ICD codes for this disease: F41.1ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.