What is generalized anxiety disorder?
Generalized anxiety disorder
When I look back on all these worries, I remember the story of the old man who said on his deathbed that he had had a lot of trouble in his life, most of which had never happened.
Parents in Guatemala employ an unusual technique for helping children to overcome their worries. They give the child a small bag containing six tiny dolls fashioned from cloth and wood. Each night, the child tells one of the dolls a particular worry, and then places the doll under their pillow. The doll’s job is to take on — and take away — the worry, thereby allowing the child to sleep soundly. During the night, the parent may remove the doll. When the child wakes up in the morning, their worry has disappeared along with the doll.
Muñecas quitapenas — literally, ’dolls that remove worries’ — are generally given to children by their parents, but adults use them too. And there’s a reason why their use has persisted since Mayan times: they really do seem to work. This is because simply expressing your worries is often enough to neutralize them. If you, or your child, are struggling with night-time worries, you might like to make your own muñecas quitapenas.
What is generalized anxiety disorder?
The term ’generalized anxiety disorder’ may be new to you, but you’ll certainly be familiar with the concept of worry. Here’s a definition of worry:
a chain of thoughts and images, negatively affect-laden [i.e. unpleasant emotionally] and relatively uncontrollable; it represents an attempt to engage in mental problem-solving on an issue whose outcome is uncertain but contains the possibility of one or more negative outcomes.
Despite the jargon, you’ll probably recognize in this description your own experience of worry. When we worry, we become preoccupied with an aspect of our lives, trying to anticipate what might go wrong and, if it does, what consequences may follow. (This is why some psychologists have called worrying ’what if?’ thinking.) While we may imagine that worrying helps us to solve our problems, this is often an illusion. Worrying is rarely constructive. Rather than improving our mood, it generally makes us feel worse. And once we start worrying, it can be difficult to stop.
A certain level of worry is normal — as the doctor and writer Lewis Thomas put it: ’We are, perhaps, uniquely among the earth’s creatures, the worrying animal. We worry away our lives.’ But for some people, worry can get out of hand. Virtually all the anxiety disorders we cover in this book involve a lot of worrying — as do many other types of psychological problems, particularly depression. (Technically, worry concerns problems in the future, whereas the rumination characteristic of depression focuses on past events. However, both are repetitive styles of thinking and are probably caused by the same processes.)
Moreover, worry is the cardinal characteristic of generalized anxiety disorder (GAD), which the American Psychiatric Association’s Diagnostic and Statistical Manual defines as marked by:
• Excessive, unrealistic, and uncontrollable worry.
• Worry that has lasted for at least six months.
• At least three of the following: restlessness, feeling on edge, fatigue, difficulty concentrating, irritability, muscle tension, sleep problems.
• High levels of distress and/or major disruption to the affected person’s day-to-day life.
As you’ll gather from this list of symptoms, GAD can be a highly debilitating illness, with profound effects on a person’s career, relationships, and overall wellbeing. As Stanley Rachman, a leading psychologist of anxiety, has written:
Affected people go to great lengths to avoid risks, engage in repeated checking, pursue and recommend cautious behaviour, regulate their diet carefully, practice the most hygienic habits, and generally engage in overprotective behaviour. Despite all these attempts they seldom achieve a sense of safety or of contentment.