Definition and Overview
Generalized anxiety disorder (GAD) is an anxiety disorder characterized by excessive and uncontrollable worries about events or activities in various areas, such as work, school, health, family, and money, that last for more than six months. Unlike simple worry, worry permeates all aspects of life, is very difficult to stop, and is accompanied by physical symptoms and functional impairment.
The lifetime prevalence worldwide is approximately 5-6%, and it is a common type of anxiety disorder in Korea. It is about twice more common in women than in men, and occurs widely from adolescence to old age.
Causes and Mechanisms
neurobiological mechanism
The key mechanism is dysregulation between the amygdala and the prefrontal cortex. When the prefrontal cortex cannot sufficiently suppress the fear and threat responses of the amygdala, excessive worry and anxiety persist. Serotonin, norepinephrine, and GABA dysregulation are also involved.
Autonomic dysfunction
In GAD patients, a decrease in the high-frequency component of heart rate variability (HRV) (an index of parasympathetic nerve activity) is consistently confirmed. This reflects chronic sympathetic dominance and is directly related to physical symptoms such as muscle tension, increased heart rate, and gastrointestinal discomfort.
Psychological and environmental factors
Experiences of insecure attachment in childhood, negative life events, perfectionistic personality traits, low tolerance for uncertainty, and chronic stress increase the risk of developing it.
symptoms
mental symptoms
- Excessive and uncontrollable worrying about a variety of topics
- Catastrophizing thinking, imagining the worst outcome
- Extreme discomfort in uncertain situations
- Irritability and irritability
Physical symptoms (3 or more out of 6, 1 or more in children)
- Muscle tension or muscle pain (mainly neck, shoulder, headache)
- Getting tired easily
- Difficulty concentrating or going blank in your mind
- hypersensitivity
- Sleep disorders (difficulty falling asleep, frequent awakenings, non-restorative sleep)
- Feelings of restlessness or tension
Comorbidities
Depressive disorder (comorbidity rate of approximately 60%), panic disorder, somatic symptom disorder, sleep disorder, and irritable bowel syndrome are commonly accompanied.
diagnosis
According to DSM-5 diagnostic criteria, the following conditions must be met:
- Excessive anxiety and worry about multiple events or activities, occurring almost every day for more than 6 months
- Difficulty controlling worries
- Three or more of the following: muscle tension, fatigue, difficulty concentrating, irritability, or sleep disturbance
- Decrease in social and occupational functioning
- Not better explained by a substance, drug, other medical condition, or other mental illness
Exclude organic causes such as hyperthyroidism, excessive caffeine intake, or use of sympathomimetic drugs.
treatment
Cognitive Behavioral Therapy (CBT)
It is the primary non-drug treatment for GAD. Realistic appraisal of worry, worry postponement, and uncertainty tolerance training are key elements. A meta-analysis confirmed that CBT was significantly effective in reducing anxiety symptoms.
medication
- SSRIs (escitalopram, paroxetine, etc.) or SNRIs (venlafaxine, duloxetine) are the first-line drugs.
- Buspirone: Serotonin 1A receptor partial agonist, useful in GAD without dependence.
- Pregabalin: Useful when accompanied by neuropathic pain.
- Benzodiazepines: Used to control short-term symptoms, but avoid long-term use due to concerns about dependence.
autonomic nerve control treatment
Research has shown that HRV biofeedback training helps reduce anxiety and restore autonomic balance. Abdominal breathing training, mindfulness-based cognitive therapy (MBCT), and transcranial magnetic stimulation (TMS) are used as adjunctive treatments.
life management
- Regular aerobic exercise (3-5 times a week, 30 minutes or more) improves anxiety levels and HRV
- Limit caffeine and alcohol intake
- Maintain a regular sleep schedule
- Worry journal: An exercise in writing down your worries and evaluating their realistic possibilities.
- Mindfulness Meditation: A practice that focuses attention on the present moment to reduce rumination about future worries.