Doc’s Corner

Generalized Anxiety Disorder

Many of us have stressful situations that make us feel anxious. Some of us tend to worry and feel tense and anxious most of the time, most days. When these feelings become chronic, ie. lastsfor 6 months or more and interfere with activities of daily living, it may be due to “generalized anxiety disorder, GAD.  Often people that have chronic or persistent worrying and feelings of anxiety are not aware that something is wrong with them and tend to project their ill feelings on the situation. This may cause them to miss out on treatments and approaches that could help them cope with their situation and lead to a better, happier life. General anxiety disorder, GAD, manifests to various degrees. Since the Elite Fitness family most likely to read this tend to function well in society, our discussion will be limited to the more mild and moderate manifestations and refrain from discussing the most severe forms.

The main symptom is a constant and exaggerated sense of tension and anxiety. You may not be able to pinpoint a reason why you feel tense. Or you may worry too much about ordinary things, such as bills, relationships, or your health. It can upset your sleep and cloud your thinking. You may also feel irritable due to poor sleep or the anxiety itself.

 

Physical symptoms often manifest as muscle tension or pain, headaches, nausea or diarrhea, trembling or twitching, irritability, becoming easily upset and difficulty relaxing.

Your troubles will naturally concern you. What sets generalized anxiety disorder apart is the feeling that you can’t stop worrying. You may find it very hard to relax, even when you do something you enjoy. Severe cases can hamper work, relationships, and daily activities.

 

People of any age can develop generalized anxiety disorder, even children. It tends to appear gradually, with the first symptoms most likely to happen between childhood and middle age. Twice as many women as men say they have it.

 

Why does it happen?

The genes passed down through a family may put some people at a higher risk for anxiety, but that’s not the whole picture. Your background and experiences also matter. Brain chemicals called neurotransmitters, as well as a pair of structures inside the brain called the amygdalae, seem to be involved.

How It’s Diagnosed?

There’s no lab test, so the diagnosis is based on your description of your symptoms. Your doctor may ask, Whatdo you worry about? How often? Does your anxiety interfere with any activities? It may be generalized anxiety disorder if you have felt anxious or worried too much for at least 6 months.

 

What can be done about it?

As with most “chronic” health issues, life-style is an important component to enhance wellness and mitigate against dysfunction and illness. Although it is often very difficult to change feelings, each of us have volition over our behavior. Feelings should be acknowledged and accepted as they arewithout effort to change them. When we have a desire to wish our feelings were different, we can make changes in our behavior that in time will affect our feelings. A priority is to place emphasis on bringing order into our life to replace chaos. Although it may seem trivial, the simple routine of making your bed each morning can help start your day with something that is very “controllable” with little effort. Start to incorporate other routines into your daily life that contribute to a sense of “order”. These acts reduce worry (focus on the unknown) and in turn help to lower general anxiety. What we think about and focus on is a major contributor to anxiety. Rather than feeling overwhelmed by a complex problematic situation that seems unsolvable, break it up into smaller components and then identify which of those you can manage (control) and do not spend much effort on the parts that can not be controlled. Example: None of us can control another individual, but if we focus on controlling ourselves, we can influence others. “Most of us do not control what we could control to the extent we could control it because we are so distracted by all that we can not control”. When possible prioritize taking care of yourself first so that you can then be more helpful to others. Neglecting your own needs to help others in need, other than in acute circumstances, will compromise your ability to meet those needs and result in frustration that contributes to anxiety.

How Psychotherapy Helps

One kind of talk therapy is very effective in treating anxiety. It’s called cognitive behavioral therapy. A counselor helps you identify your negative thoughts and actions. You may do homework, such as writing down the thoughts that lead to excess worry. You will also learn how to calm yourself.

Anti-Anxiety Medicine

Medicines may be part of your treatment plan. Some newer antidepressant drugs work well to lower anxiety. It may take about 4 weeks to feel better. Your doctormight prescribe a benzodiazepine during this time or for a short while. Some of these drugs carry a risk of dependence. Sometimes, older types of antidepressants can treat generalized anxiety disorder if your symptoms include depression or panic. Talk with your doctor about pros and cons.

Taking Care of Yourself

Some rather simple changes can help. Avoid caffeine, mind alternating drugsincluding limited alcholol, and even some cold medicines, which can boost anxiety symptoms. Try to get enough rest and discipline yourself to get up at about the same time each day.  Eat nutritious foods. Use relaxation techniques, such as taking a walk out doors or meditation. Also, exercise! Research shows that moderate physical activity on a regular basis can be calming. The programs available at Elite Fitness Plus are an excellent way to accomplish this component with exceptional coaches and a warm friendly atmosphere.

Herbal Remedies: Caution

If you are thinking about trying a supplement, talk to your doctor first to find out if it’s safe and discuss relative risk benefits. Kava, for instance, has been reported to cause liver damage. St. John’s wort can interact with other medicines and affect mood adversely. What seemingly works wonders for someone, may affect someone else very differently. Be careful when learning of a “miracle remedy” from a friend or online.

When It’s More Than Anxiety

People who have generalized anxiety disorder may also develop depression, alcoholism, or drug addiction. It’s also common for people with GAD to have another anxiety disorder. These can include panic disorder, posttraumatic stress disorder, obsessive-compulsive disorder, and social phobia.

Panic Disorder

People with panic disorder have sudden attacks of terror. Symptoms can include a pounding heart, sweating, dizziness, nausea, or chest pain. You may think you’re having a heart attack, dying, or losing your mind. It’s one of the most treatable of all anxiety disorders.

Posttraumatic Stress Disorder

Some people develop posttraumatic stress disorder (PTSD) after living through a terrifying event. The symptoms include vivid flashbacks and a loss of interest in activities that were once enjoyable. People may also have trouble being affectionate. They may feel irritable or even become violent. Treatments include medicine and counseling. 

Obsessive-Compulsive Disorder

People with obsessive-compulsive disorder (OCD) have troubling thoughts they can’t control. They may feel that they need to repeat rituals, such as washing their hands or checking that the door is locked. They may get dressed in a certain order or count objects for no good reason. It’s often treated with medication and psychotherapy.

Social Anxiety Disorder

People with social phobia feel panicky and self-conscious in ordinary social situations. Symptoms include a sense of dread before social events and sweating, blushing, nausea, or trouble talking during the events. In severe cases, they may avoid school or work. It can be treated with psychotherapy and medicine.

Other Phobias

A phobia is an intense fear of something that is not likely to cause you any harm. Common ones include heights, closed-in spaces like elevators, dogs, flying, and water. Many people don’t seek help because it’s easy to avoid whatever they fear. But phobias can and should be treated.

Where to Get Help 

Start by talking with your family doctor. If an anxiety disorder seems likely, he/shewill probably refer you to a mental health specialist who is trained in psychotherapy. It’s important to choose someone you’re comfortable talking toand working with. Many books are available to add insight and guidance. For an in depth review of a healthy approach to life, read: 12 Rules For Life: An Antidote to Chaos by Jordan B. Peterson.

 

Paul R. Block, MD. FACP, FCCP

 


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