Genetics[edit] => Genes are attributed about a third of general anxiety disorder's variance.[13] Individuals with a genetic predisposition for GAD are more likely to develop GAD, especially in response to a life stressor.[14]
Substance-induced[edit] => Long-term use of benzodiazepines can worsen underlying anxiety,[15][16] with evidence that reduction of benzodiazepines can lead to a lessening of anxiety symptoms.[17] Similarly, long-term alcohol use is associated with anxiety disorders,[18] with evidence that prolonged abstinence can result in a disappearance of anxiety symptoms.[19] However, it can take up to two years for anxiety symptoms to return to baseline in about a quarter of people recovering from alcoholism.[20]
In one study in 1988–90, illness in approximately half of patients attending mental health services at British hospital psychiatric clinic, for conditions including anxiety disorders such as panic disorder or social phobia, was determined to be the result of alcohol or benzodiazepine dependence. In these patients, anxiety symptoms, while worsening initially during the withdrawal phase, disappeared with abstinence from benzodiazepines or alcohol. Sometimes anxiety pre-existed alcohol or benzodiazepine dependence, but the dependence was acting to keep the anxiety disorders going and often progressively making them worse. Recovery from benzodiazepines tends to take a lot longer than recovery from alcohol, but people can regain their previous good health.[20]
Tobacco smoking has been established as a risk factor for developing anxiety disorders.[21] Excessive caffeine usage has been linked to anxiety.[22]
DSM-5 criteria[edit] => The diagnostic criteria for GAD as defined by the Diagnostic and Statistical Manual of Mental Disorders DSM-5 (2013),[2] published by the American Psychiatric Association, are paraphrased as follows:[2]
Too much anxiety or worry over more than six months. This is present most of the time in regards to many activities.&Inability to manage these symptoms&At least three of the following occur: Note: Only one item is required in children. Restlessness Tires easily Problems concentrating Irritability Muscle tension. Problems with sleep&Restlessness&Tires easily&Problems concentrating&Irritability&Muscle tension.&Problems with sleep&Symptoms result in problems with functioning.&Symptoms are not due to medications, drugs, other physical health problems&Symptoms do not fit better with another psychiatric problem such as panic disorde
No major changes to GAD have occurred since publication of the Diagnostic and Statistical Manual of Mental Disorders (2004); minor changes include wording of diagnostic criteria.[24]
ICD-10 criteria[edit] => ICD-10 Generalized anxiety disorder "F41.1"[25] Note: For children different criteria may be applied (see F93.80).
A period of at least six months with prominent tension, worry, and feelings of apprehension, about everyday events and problems.&At least four symptoms out of the following list of items must be present, of which at least one from items (1) to (4). Autonomic arousal symptoms (1) Palpitations or pounding heart, or accelerated heart rate. (2) Sweating. (3) Trembling or shaking. (4) Dry mouth (not due to medication or dehydration). Symptoms concerning chest and abdomen (5) Difficulty breathing. (6) Feeling of choking. (7) Chest pain or discomfort. (8) Nausea or abdominal distress (e.g. churning in the stomach). Symptoms concerning brain and mind (9) Feeling dizzy, unsteady, faint or light-headed. (10) Feelings that objects are unreal (derealization), or that one's self is distant or "not really here" (depersonalization). (11) Fear of losing control, going crazy, or passing out. (12) Fear of dying. General symptoms (13) Hot flashes or cold chills. (14) Numbness or tingling sensations. Symptoms of tension (15) Muscle tension or aches and pains. (16) Restlessness and inability to relax. (17) Feeling keyed up, or on edge, or of mental tension. (18) A sensation of a lump in the throat or difficulty with swallowing. Other non-specific symptoms (19) Exaggerated response to minor surprises or being startled. (20) Difficulty in concentrating or mind going blank, because of worrying or anxiety. (21) Persistent irritability. (22) Difficulty getting to sleep because of worrying.&The disorder does not meet the criteria for panic disorder (F41.0), phobic anxiety disorders (F40.-), obsessive-compulsive disorder (F42.-) or hypochondriacal disorder (F45.2).&Most commonly used exclusion criteria: not sustained by a physical disorder, such as hyperthyroidism, an organic mental disorder (F0) or psychoactive substance-related disorder (F1), such as excess consumption of amphetamine-like substances, or withdrawal from benzodiazepines.[5
History of diagnosis[edit] => The American Psychiatric Association introduced GAD as a diagnosis in the DSM-III in 1980, when anxiety neurosis was split into GAD and panic disorder. [26] The definition in the DSM-III required uncontrollable and diffuse anxiety or worry that is excessive and unrealistic and persists for 1 month or longer. High rates in comorbidity of GAD and major depression led many commentators to suggest that GAD would be better conceptualized as an aspect of major depression instead of an independent disorder.[27] Many critics stated that the diagnostic features of this disorder were not well established until the DSM-III-R.[28] Since comorbidity of GAD and other disorders decreased with time, the DSM-III-R changed the time requirement for a GAD diagnosis to 6 months or longer.[29] The DSM-IV changed the definition of excessive worry and the number of associated psychophysiological symptoms required for a diagnosis.[27] Another aspect of the diagnosis the DSM-IV clarified was what constitutes a symptom as occurring "often".[30] The DSM-IV also required difficulty controlling the worry to be diagnosed with GAD. The DSM-5 emphasized that excessive worrying had to occur more days than not and on a number of different topics.[28] It has been stated that the constant changes in the diagnostic features of the disorder have made assessing epidemiological statistics such as prevalence and incidence difficult, as well as increasing the difficulty for researchers in identifying the biological and psychological underpinnings of the disorder. Consequently, making specialized medications for the disorder is more difficult as well. This has led to the continuation of GAD being medicated heavily with SSRIs.[28]