Fear and anxiety are a natural part of life, even adaptive in many situations. Not only is anxiety a common human emotion, but moderate amounts of anxiety can be helpful by motivating people to prepare for an exam, complete a work assignment, or deliver a speech. Mental health professionals are not concerned with normal anxiety. Rather, they attend to fear and anxiety that has somehow gone astray and that has reached an inexplicably irrepressible level. Fear and anxiety that significantly reduces or eliminates productivity and dramatically intrudes on an individual's quality of life and for which, friends, family and even the patient can find no obvious cause is of great concern to mental health professionals.
Excessive anxiety is more than butterflies in your stomach. It is a real, medical illness that can disrupt people's lives, interfere with performance, and trigger physical discomforts. Very often those suffering from persistent anxiety seem unable to relax, and frequently have trouble staying or falling asleep. When continual and unrealistic worry becomes a customary way of approaching daily life, an individual may be suffering from Generalised Anxiety Disorder (G.A.D.). Dr Stuart Lund, a prominent Pietermaritzburg psychiatrist, describes this illness as “widespread and debilitating”, while Dr Franco Colin, an eminent Pretoria psychiatrist, believes that “the condition is common, however it has severe consequences for those suffering from it”. Recognising the need for more awareness in order to improve the diagnosis of G.A.D., the Depression and Anxiety Support Group provide a telephonic counselling service for potential sufferers. Counsellors can be contacted Monday to Friday (8 a.m. to 7 p.m.) and Saturdays (8 a.m. to 5 p.m.) on (011) 783-1474/6 or 884-1797.
Although many people will consult a doctor or pharmacist about the symptoms they may be suffering from, the underlying cause may not be immediately apparent. Dr Catherine Maud, a Durban psychiatrist, acknowledges that “G.A.D. is an illness that hides beneath many other conditions and therefore won’t be initially obvious, but will emerge once the presenting problem is treated”. The result of this approach is often a lot of wasted time and money, and no real, sustainable relief for the sufferer. Correct diagnosis is therefore of great importance in the successful treatment of the disorder. The key symptom of the disorder is persistent worry that is unrelated to another illness. The excessive or unrealistic worry characteristically involves two distinct areas of a person's life, such as health, money, relationships, career prospects, etc., which has been present for at least six months or more. Realistic concerns such as financial worry after losing a job, is not a sign of G.A.D. However, consistent and chronic anxiety about events that are not likely to occur is cause for concern. G.A.D. is often accompanied by physical symptoms, including trembling, muscular aches or soreness, restlessness, difficulty sleeping, sweating, dizziness, problems with concentrating and irritability. Although these symptoms will vary across individuals, in order for a diagnosis of G.A.D. to be made, at least six must be present.
G.A.D.'s physical symptoms are typical of many other disorders, such as panic disorder, depression and substance abuse. However, it lacks the dramatic and chronic symptoms, such as unprovoked panic attacks, that are distinctive of other anxiety disorders. There is no traceable traumatic experience involved, as is the case with post-traumatic stress disorder, nor is the anxiety a response to a specific stimulus, as is generally true of phobias. This makes the diagnosis of G.A.D. hard to make. It often coexists with other anxiety and depressive disorders, and is therefore not the primary area of treatment. In many cases, G.A.D. will disappear when comorbid disorders are under control.
Statistically, more than five out of every 100 people will develop G.A.D. at some point in their lives. The disorder comes on gradually and most often affects people in childhood or adolescence, but can begin in adulthood. Researchers have as yet not identified a cause of the disorder. As is the case with other disorders of this type, there are most probably a number of interrelated causative factors, that each play a specific role. To date, the best evidence suggests that biological factors, family background and life experiences are important contributors to the onset of the disorder. The evidence proposes that individuals are genetically predisposed to develop G.A.D., while at the same time, people who grew up with particularly anxious role models, have learned that the world is a uncontrollable and dangerous place. Increased stress levels are indicated as a possible trigger for the development of the disorder. In the months or years prior to the onset of the disorder, many G.A.D. victims report an increase in stressful events, such as death in the family, illness, job less, or divorce. Positive events that cause stress, such as marriage, a new baby, or a new job can also trigger the onset of G.A.D. It is important to note however, that stress is only a catalyst for onset, and not a cause of the disorder.
Fortunately, G.A.D. is a highly treatable disorder, with most sufferers significantly recovering due to intervention. In general, the symptoms of G.A.D. seem to diminish with age. Successful treatment usually takes the combined form of medication and psychotherapy. Anti-depressants and benzodiazepines are used to treat the G.A.D. victim medically, whilst cognitive-behavioural therapy, relaxation techniques and biofeedback to control muscle tension, form a part of the psychotherapeutic approach to the illness. Cognitive-behavioural therapy seeks to alter the way G.A.D. sufferers think about, and respond to troubling events. Therapy treatments must be tailored to the individual.