Lecture
Generalized Anxiety Disorder
The leading symptom of this disorder is generalized, free-floating anxiety not linked to a specific situation, which, unlike panic attacks, does not arise suddenly and paroxysmally but exists as a persistent background state accompanied by various somatic complaints (muscle tension, sweating, trembling, constant nervousness, palpitations, a feeling of dizziness, epigastric pain). Fears are expressed about the future (the possibility of becoming ill or the likelihood of an accident happening to oneself and/or relatives).
The lifetime prevalence of GAD is 5.1%, more common in women, with onset in adulthood (after age 18).
ICD-10 criteria:
apprehension about possible misfortune in the future, a feeling of being on edge, difficulty concentrating;
motor tension in the form of physical restlessness, headaches, tension, tremor, inability to relax;
autonomic overactivity, manifested by sweating, tachycardia, tachypnea, dry mouth, and mild lightheadedness.
That is, anxiety + a feeling of impending (inevitable) misfortune. The anxious apprehension concerns everyday situations and problems and is recognized as excessive and inappropriate, yet uncontrollable.
It most often arises for reasons unclear to the patient and is not linked to any specific situations.
Without treatment, avoidant behavior develops, which restricts the person's way of life.
Typical accompanying phenomena
demoralization and the development of secondary depression,
abuse of sedative substances and dependence on them (alcohol, hypnotics, tranquilizers)
Psychological models.
These models are functional rather than etiological in nature, i.e. they explain the determinants that maintain GAD but cannot explain the specific factors of its onset.
And within this group of disorders, psychological approaches are essentially diathesis-stress models.
Depending on the model chosen, different types of predisposition are postulated – neurobiological, psychophysiological, or cognitive
Model of anxious anticipation
Against a background of innate or acquired vulnerability, anxious anticipation develops, characterized by
a) heightened arousal,
b) the assumption that future events will be uncontrollable and unpredictable,
c) a shift in the focus of attention toward internal events due to learning processes (modeling, generalization).
Through these shifting processes of attention and appraisal (cognitive processes), a «vicious circle» mechanism is triggered: autonomic arousal continues to grow, attention narrows, and the individual becomes especially sensitive to possible sources of danger.
Against a background of diffuse anxious anticipation, normal everyday concentration of attention is disrupted, the individual cannot respond adequately to everyday demands and avoids various situations just in case.
Constant worry (mental avoidance) serves to avoid vivid mental imagery and to suppress the corresponding autonomic reactions.
Distinction: the worry is directed at a broad, ill-defined range of stimuli. Experiencing 4 or more stressful life events in a year increases the likelihood of GAD in men.
Traumatic or stressful experiences lead to perceiving the surrounding world as dangerous and threatening.
+Vulnerability – stress
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