Generalized Anxiety Disorder Based on DSM-V

Abstract

Generalized anxiety disorder (GAD) is a mental condition that makes a person worry too much. This condition can be diagnosed when the patient is seen to be exhibiting some symptoms as highlighted in DSM-V. Treatments for GAD include medication and psychotherapy sessions. Children and adolescents are normally affected by the condition the most due to their developing personality and young brains. Therefore, they need maximum support from family members during intervention in order to cope or overcome this situation.

Keywords: generalized anxiety disorder, disorder diagnostics, psychiatric treatment

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Generalized anxiety disorder (GAD) can be described as an excessive fear that is not caused by any specific event or problem. This kind of fear is commonly associated with persistent worry that is considered unrealistic (Friedman et al., 2011). GAD is common in children and normally becomes more severe as they grow up. More often than not, as the afflicted children start attending school and participating in various activities, such as sports or academic work, alongside their peers, the worry intensifies and makes their situations worse. Children with GAD tend to have a lot of factors influence their fears. Research has proved that they are more worried about many things as opposed to other children who do not have the disorder (American Psychiatric Association, 2013). The excessive and unrealistic worry for children and adolescents is often associated with increased concerns over the patients’ own safety and security, persistent worry over the security of their loved ones, including their parents and siblings, fear of failure at school or nonperformance in sporting activities, and fear of attack or occurrence of a catastrophe such a natural disaster.

All the listed precipitating factors for fear may change at one point, however, the patients are unlikely to be able to control these worries. This means the anxiety tends to persist with time. GAD affects children and adolescents because it interferes with the mental capability of these young people. Children and adolescents, in particular, have young brains that are still developing, and their minds are expected to process and learn new information. This, however, is not the case with the young people affected by GAD (Friedman et al., 2011).  Since these children are unable to control the problem of excessive worrying, they cannot process information. They also lack concentration and, therefore, are unable to take part in many crucial activities that they should be involved in at their age (American Psychiatric Association, 2013).

Children with this disorder normally tend to seek reassurance of their security due to safety-related worries, which is likely to interfere with their personal growth and eventually their social relationships as they grow into adolescence. There is also a tendency by most of those who are affected by GAD to be perfectionists, excessively conforming, and extremely self-critical. This is made evident by the tendency to perform even insignificant activities several times to ensure that they are perfectly done (Friedman et al., 2011). The GAD patients normally do this due to the fear of failing or disappointing their parents, which is one of the worries associated with GAD. This paper explores the prevalence, diagnosis, treatment, and recovery options for adolescents and children, as well as the role family support plays in the recovery from GAD.

Prevalence

GAD is common in children and adolescents. The prevalence among them is high, and the impact of the condition is likely to persist into adulthood. Statistics show that about 3.1% of the U.S. Citizens or 6.8 million people are affected by GAD. Further, it affects more females than males both in childhood as well as in adulthood. Some of the factors that precipitate GAD include extraordinary occurrences such as natural disasters. Young people are more at risk of being diagnosed with the disorder.

Diagnostic Criteria for Generalized Anxiety Disorder

GAD affects children, adolescents, and adults. Whenever one suspect that they have the condition, it is important to immediately seek help from an expert. According to American Psychiatric Association (2013) the criteria for GAD diagnosis based to DSM-V are as follows:

1. Excessive worry and anxiety lasting more than six months (can be associated with school-related activities).
2. Inability or difficulty to control the anxiety.
3. Children and adolescents must exhibit at least one of the following symptoms: restlessness, irritability, getting easily fatigued, difficulty in sleeping, difficulty in concentrating (mind going blank), and muscle tension (American Psychiatric Association, 2013).
4. The symptoms cause distress or impairment of social functioning.
5. The anxiety is not caused by consumption of drugs or other substances and is not associated with another illness (i.e. hyperthyroidism).
6. Anxiety is not linked to another mental disorder.

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Common co-occurring disorders

Depression is a common disorder associated with GAD.  The excessive worries can lead to high levels of depression as one engages more in worrying about the future, safety, and other issues related to their lives. Depression can push children affected by GAD to distrust other people and internalize their problems. One of the common ways of doing so is through withdrawal from age-appropriate activities that are performed by their peers (Friedman et al., 2011b).  This means that such a child lacks a normal childhood. The withdrawal in many cases manifests through truancy whereby children affected by the disorder miss school. GAD is also associated with drug and substance abuse, which typically occur through self-medication.

Social anxiety disorder (SAD) is also likely to occur alongside GAD. For children and adolescents, SAD tends to occur especially in the situations that the worry is related to and in places where social interactions are required such as school. If the patients feel that they have not done enough to feel appreciated despite their effort to do things perfectly, they may move into social isolation due to the fear of being ridiculed or laughed at by peers (Friedman et al., 2011b).

Post-traumatic stress disorder (PTSD) is likely to occur in children and adolescents in the even that their worry comes from an occurrence that threatened their safety or the safety of their loved ones. Such events may include natural disasters or accidents. PTSD may aggravate GAD if the patient associates specific events with the general fear that he or she has and, thus, make the condition more complex (Friedman et al., 2011a).

Treatment for General Anxiety Disorder

Psychotherapy

Psychotherapy is one of the most common treatment methods for GAD. Different categories of professionals can perform psychotherapy through what is typically known as “talk therapies” (Weisz & Kazdin, 2010). Some of the most commonly used therapeutic approaches include cognitive behavioral therapy (CBT), acceptance commitment therapy (ACT), psychodynamic psychotherapy, and interpersonal psychotherapy.

Cognitive behavioral therapy. CBT is critical in treatment of anxiety disorders, including eating disorders and mood swings. CBT is focused on dealing with feelings, emotions, thoughts, and behaviors. CBT is a short-term treatment that is frequently aimed at ensuring that the patient learns how to have personal therapy. In as much as CBT treatment tends to work towards ensuring individual therapy for patients, there are frequent cases of refresher treatment. CBT is usually present-focused, i.e. it deals with the current issues affecting the patient (Friedman et al., 2011b).

Acceptance commitment therapy. Just like the name suggests, ACT is about the patients accepting their situation by gaining more insight into their thinking and committing to improving the situation (Friedman et al., 2011a). The major focus of this kind of therapy is not to struggle to change the situation but rather to help the patient get more involved in meaningful and beneficial activities (Weisz & Kazdin, 2010). These activities help the patients solve the problems that they are involved in by dealing with the situation in more creative ways.

Psychodynamic psychotherapy. This kind of therapy is based on the belief or thought that in many cases, things that people are not conscious of can lead to inner conflicts that eventually results in anxiety and worries that affect the person’s mood. This kind of therapy is a long-term option, and it has helped the affected people to deal with anxiety in many ways (Friedman et al., 2011b).

Interpersonal psychotherapy. It was initially meant to deal with depression. The major belief in this form of therapy is that worries normally emanate from problems in interpersonal relationships, and, therefore, dealing with these interpersonal challenges is likely to help in reducing the GAD symptoms. Some of the skills acquired during interpersonal psychotherapy sessions include communication skills which can help children and adolescents improve their relationships with others and, hence, overcome the problems of anxiety (Reinholt & Krogh, 2014).

Medication

Antidepressants. They are considered among the most tolerated and accepted forms of medication, because they are accepted by most individuals. Antidepressants are not only meant for the treatment of depression but rather have the capacity to treat GAD and other anxiety disorders. Examples of antidepressants include SSRIs and SNRIs (Friedman et al., 2011a; Weisz & Kazdin, 2010).

Anxiolytics. Another group of medications used for the GAD treatment is anxiolytics, sometimes referred to as anti-anxiety medicines. Examples if anxiolytics include azipirones, buspirone, and benzodiazepines, such as alprazolam, clonazepam, and lorazepam (Weisz & Kazdin, 2010). Most of the medication in this category is normally preferred for short-term use, since they are habit forming and are in many cases the most effective within short time. In some instances, these medicines are used for symptom relief. A combination of psychotherapy and medication is always considered to be important in dealing with problems emanating from GAD, and in the long term, a combination of both methods can help in dealing with this problem permanently (Reinholt & Krogh, 2014).

How to Use the Intervention in Both Child and Family Sessions

Since GAD has more impact on children and adolescents, it is important to emphasize the treatment administered to patients in family sessions as well as on individual level. As evident from the preceding facts, this condition interferes with a person’s confidence in their abilities to perform and succeed. Consequently, patients, especially children, require reassurances, which means that the therapy sessions must be done with support from close family members (Reinholt & Krogh, 2014). The close family members must be actively involved because of the need to monitor the patients and identify whether or not the interventions are having positive or negative effects. For instance, antidepressants have been said to bring suicidal thoughts to children, and, therefore, close monitoring of the patients is necessary.

During child sessions, there is need to ensure that the children understand that the therapy sessions are not a form of punishment and that their condition is not abnormal but rather something that they can overcome (Weisz & Kazdin, 2010). The therapist has to create an environment that allows the child to embrace what is going on and feel like it is good for him or her. In many cases, children may not understand why they have to go to psychotherapy sessions, or some of their friends at school may tease them about these sessions and, hence, make them feel inferior or develop dislike for psychotherapy. The child has to be reassured every time that he or she is doing a thing that he should be proud of. He or she should see the therapists as friends who mean well (Reinholt & Krogh, 2014).

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Conclusions

Generalized anxiety disorder is one of the mental disorders that may have a grave toll on children and adolescents considering that these young people are still at a stage where their minds are developing. Since GAD affects the confidence of children, these young people need a lot of support from their parents, friends, and close relatives. GAD also affects interpersonal relationships whereby the adolescents affected may not have normal social relationships which are an important stage of their development. It is, therefore, important that therapy sessions take into account the aspects of development with regard to interpersonal relationships so that, at the end of the day, these young people could be more confident about themselves and, thus, have more vibrant relationships with others.