Generalized anxiety disorder

The Generalized Anxiety Disorder (GAD ) is according to ICD -10 ( F41.1 ) a form of "other anxiety disorders ". Here, the fear becomes independent and loses its relevance and relation.

Symptoms

The patient experienced a generalized and persistent fear that is not (as in the phobic disorders ) limited to specific environmental conditions, but rather floats freely.

Content of fear is in most cases an unfounded concern and fears of future accidents or diseases that affect yourself or family members, as well as a large number of other worries and premonitions. The patient is barely or not to deal with the everyday tasks in the situation. He has anxiety, which can hardly force for a normal lifestyle. The anxiety occur in many situations. The person gets panic of crowds, elevators, public transportation, in simple and everyday situations in which the fear of the person concerned for the common man is not to understand. The lifetime prevalence is 4-5%, the disease usually begins between 20 and 30 years of age, women are affected more often than men, often associated with stressful life circumstances. The course is variable, but tends to vary and chronicity. Concerns are:

• Familial / social relationships
• Work and Power
• Health concerns
• Finances
• Daily

The fear manifests itself in patients by physical symptoms such as tremor, palpitations, dizziness, derealization and depersonalization, nausea, restlessness, inability to relax, hot flashes, muscle tension, difficulty concentrating, nervousness, insomnia, tension headache, dizziness, tingling.

According to the ICD -10 criteria following symptoms must be at least 6 months met on most days:

• Fear ( worry about future misfortune, nervousness, concentration problems, etc.)
• Motor voltage ( agitation, tension headache, tremors, inability to relax )
• Vegetative symptoms ( dizziness, sweating, chills, tachycardia and tachypnoea, abdominal pain, dizziness, dry mouth, etc.)
• Mental symptoms ( feeling of dizziness, unsteadiness and dizziness, derealization and depersonalization, fear of losing control, fear of dying )
• Symptoms in the chest or abdomen (difficulty breathing, anxiety, pain, nausea )

There must be no organic cause or apply the criteria for a depressive episode, phobic disorder, obsessive compulsive disorder or panic disorder, although depressive symptoms in generalized anxiety disorder can occur temporarily. According to the ICD -10 research criteria generalized anxiety disorder may therefore occur simultaneously with a major depressive episode. In this case, only the criteria for panic disorder, phobia, obsessive-compulsive disorder or a hypochondriacal disorder may no longer be met.

People suffering from a generalized anxiety disorder, addiction mostly because of his physical complaints to the doctor. Often it takes many years before it is recognized that behind his physical ailments hides chronic anxiety. The physical symptoms of those affected are usually the result of their negative thoughts, their worries and ruminations. The disease has been underestimated in the past. Today we know that it is accompanied by severe impairment of quality of life.

Development and maintenance of

As a cause for the development of generalized anxiety disorder genetic and social factors are assumed. The GAS is not specifically bequeathed; it seems rather to exist an inherited biological vulnerability to the development of pathological anxiety. This biological vulnerability to the experience of anxiety can lead to stress, which is caused by social factors. Stress -generating social factors are most critical life events. The experienced stress can lead to the characteristic of the GAS anticipatory anxiety ( worry ). This anticipatory anxiety is characterized by negative feelings that " related to the perceived inability to predict desired results in upcoming events or situations, control, or be able to achieve " with. This mainly leads to a shift of attention to internal locus, even evaluative content and excessive vigilance against anxiety-provoking stimuli. The vigilance leads in turn to many different life circumstances are perceived as threatening. The GAS seems to be maintained by the worries: After Borkovec and colleagues worries are a form of mental avoidance. The process of caring dampens the emotional processing of fear -inducing stimuli and also leads to somatic suppressor effects: the anxiety-provoking stimuli (due to cognitive processing ) streamlines and the people be quiet by the self- concern. This short-term improvement of the emotional and physical being has a negative reinforcing: The fear is maintained.

More discuss cognitive factors are inter- dimensional and external signals misperceptions arising from the observed by the patient to itself changes as a lower concentration and disturbance of working memory: I'm not up to the task, possess little control or ability to master difficult situations that are harmful to worry mine. Due to the negative Metasorgen to control experiments may arise, which still increase the frequency of worry and trigger avoidance and reinsurance behavior. But even positive Metasorgen as: "Worry is the same provision" can reinforce the concerns process. Through the control, prevention and Reinsurance no habituation and thus no end to the worry process can take place, and the vicious rocks up.

Therapy

In psychodynamic psychotherapy, both the psychic structure as well as the fears and the associated anxiety-provoking situations are handled. Here a just a lot of attention is the " fear- preserving conditions " given as the contents of the fears or the triggering conditions in the life of the person concerned. Also biographical contexts can be taught in the course of therapy, these are, unlike other anxiety disorders, but never in the foreground. In the transfer, the amount of the security needs of the person concerned is at the center. This is followed by the interventions of the therapist true. Also bond themes can come into play in therapy. There are also short-term psychodynamic psychotherapies, which have been found in the treatment of GAS as effective as cognitive-behavioral programs.

In a cognitive-behavioral therapy, the first objective is that the patient experienced through a behavioral analysis and the mediation of his individual fault model, an understanding of his disorder and thus the willingness arises to behavioral interventions, such as the confrontation with the fear in sensu ( mentally ) or in vivo ( in real life, ie, in the concrete situation ) participate. This enables it to learn new patterns of behavior by his fear arises and practical experience that the feared consequences of it fail. Through cognitive therapy elements such as cognitive restructuring, reality testing, the Entkatastrophisieren or edit the Metasorgen the patient is to acquire a new outlook on life and a new perspective on their own abilities. The effectiveness of cognitive behavioral therapy has greatly increased since clinical researchers have improved the techniques used therein.

Another important element is the Applied Relaxation therapy is only intended for severe cases that are not otherwise be able to benefit from psychotherapy, as their fears and tensions are too large, offers a drug therapy with antidepressants, especially SSRIs or SNRI, in order to generate a treatment ability at all. However, this is also a negative expected additional fears and discontinuations due to side effects or the fear of discontinuation of the drug.

Many clients with generalized anxiety disorder search on GPs to seek treatment for their anxiety and somatic complaints. In this case, often mistakenly benzodiazepines prescribed to alleviate the nervousness. However, there are fast habituation effects. Benzodiazepines also quickly create a dependency, which makes the withdrawal of the medication difficult.