The “Diagnostic and statistical manual” (2013) specifies that an individual must exhibit excessive anxiety or worry toward certain events or activities in order to have General Anxiety Disorder (GAD). Adrian demonstrates excessive anxiety and worry for a number of events and activities such as job performance, her children’s well being, and her relationships with men. With regard to her children, Adrian often became very anxious that they might have been harmed or killed if they were out in the neighbourhood playing, and she had not heard from them in a while. This level of worrying is excessive as it is irrational to assume they have been killed in this situation, therefore this study meets the first requirement in the diagnostic criteria. As stated in the case study, “Her worries were also uncontrollable: when a worry came into her mind, she was unable to dismiss it.” This satisfies the diagnostic requirement that the individual must find it difficult to control the worry. (“Diagnostic and statistical manual”, 2013) Additionally, Adrian’s anxiety and worry were accompanied by other symptoms including irritability, problems in getting and staying asleep, frequent muscle tension and headaches, and a feeling of being keyed up or on edge.
She also displayed lapses in concentration and memory. Amid periods of increased worry, Adrian would be more forgetful because her mind had not been focused on her work (e.g., she would often forget what her supervisor had told her). Therefore, Adrian’s symptoms meet the diagnostic criteria, as Adrian’s anxiety and worry are associated with 3 or more of the symptoms listed for Generalized Anxiety Disorder in the DSM-5. The DSM-5 states that the symptoms must cause clinically significant distress in social, occupational or other important areas of functioning. (“Diagnostic and statistical manual”, 2013) Adrian reported distress in her social life by claiming that her children often complained that she was always in a bad mood. She knew that she was spending little time with her friends and had noticed that the men she dated never seem to call her back. Adrian affirmed that being assertive, participating in meetings, dating and public speaking were situations that she tended to endure with moderately high levels of anxiety and distress. Likewise, the symptoms also display clinically significant distress in occupational areas of functioning. She spent many extra hours at the office, arriving 30 minutes early every day to plan out her day to the best of her ability. It took her a relatively long time to complete tasks or make decisions. Adrian would become more anxious and worried at work when her supervisor was around because she feared that her job performance would be negatively evaluated. Her preoccupation with the possibility of being negatively evaluated made her less attentive, leaving her susceptible to make mistakes. There is insufficient evidence suggesting that the disturbance is attributable to the physiological effects of a substance or other medical condition. (“Diagnostic and statistical manual”, 2013) Furthermore, the disturbance doesn’t appear to be better explained by another disorder. (“Diagnostic and statistical manual”, 2013) Therefore, this case study meets all the diagnostic criteria and Generalized Anxiety Disorder appears to be the most plausible diagnosis.
I believe that there is insufficient information provided in this case study to validate the diagnosis of an additional disorder. Research suggests that family history increases the possibility that a person will develop GAD. (“Learn More About General Anxiety”, n.d.) The first-degree relatives of someone with GAD are more vulnerable to develop anxiety and mood disorders, specifically GAD. (Meek, n.d.) Certain patterns of brain function and structure have been found consistently in patients with GAD. GAD patients display elevated amygdala (structure in the brain that processes emotions) activity when processing negative emotions. This heightened amygdala activity can instigate inaccurate perceptions that lead people with GAD to believe a non-threatening interaction or social cue is threatening. (Meek, n.d.) Therefore, it is likely that the disruption in the function or activation of certain parts of the amygdala may be a factor that causes the development of Generalized Anxiety Disorder. (Gregory, 2018) Moreover, an increased quantity of grey matter in specific regions of the brain has been repeatedly found in GAD patients. (Meek, n.d.) The right putamen of the brain shows consistent growth in the volume of grey matter in patients with GAD. Researchers found that an extensive volume of grey matter in the right putamen was positively correlated with mistreatment during childhood. Although correlation doesn’t prove causality, there appears to be a relationship between childhood trauma and the large volume of grey matter seen in many patients with GAD. (Meek, n.d.) Furthermore, an imbalance in neurotransmitters such as dopamine, norepinephrine, and serotonin can have a burden on well-being and stability and is seen in a wide array of GAD patients. (Zimmerman, 2018)
Psychological factors such as childhood trauma can increase the risk of developing GAD. (Meek, n.d.) Recent traumatic or negative events such as divorce, the death of a loved one, changing jobs or schools, or abuse may also prompt the development of GAD. (“Learn More About General Anxiety”, n.d.) Going through notably hard experiences can leave us feeling humiliated, uncertain or isolated, which makes it likely that we may become anxious in situations that remind us of these difficult experiences. (Meek, n.d.) Life events that result in feelings of embarrassment, defeat, deception, and danger are reliable predictors of the development and onset of Generalized Anxiety Disorder. (Meek, n.d.) Additionally, studies have found that a person with a shy or pessimistic personality may be more prone to developing GAD than others. (“Generalized anxiety disorder”, 2017)
Social causes of Generalized Anxiety Disorder appear in numerous forms. Early social learning tends to shape how we handle situations throughout our life. (Meek, n.d.) Caregivers and other important people in our lives inadvertently teach us how to handle demanding, stressful situations through their actions. When they model ineffective methods of stressful management, we tend to follow in their footsteps. These early social learning experiences can influence our development of anxiety. (Meek, n.d.) Additionally, feelings of rejection, abandonment, humiliation, or loneliness can stimulate anxious behaviours. Fearful and dangerous experiences within intimate relationships can impact the augmentation of anxiety (more common in women). Career and work-related stress such as losing a job may also increase anxiety levels. (Meek, n.d.) Moreover, lifestyle choices such as alcohol consumption, tobacco use, caffeine, and use of benzodiazepines can all heighten anxiety levels, which can lead to the onset of GAD. (Gregory, 2018)
Worries can be adaptive or maladaptive. High levels of worry can promote adaptive health behaviours in individuals. (Notebaert et. al, 2014) For example, if someone with elevated levels of worry processes a threat as being dangerous or potentially harmful, then they may take the necessary precautions to reduce/inhibit the effect of the apparent threat. (Notebaert et. al, 2014) A study found that worry could serve as a mechanism to regulate the physiological stimulation associated with anxiety. (Ottaviani et. al, 2014) However, worry becomes a liability when it becomes the default and pathological response to a threat, as seen in patients with GAD. (Ottaviani et. al, 2014) Habitual worrying can be adaptive as well, as worrying can make people take action about serious issues in their lives. (Verplanken & Roy, 2013) As stated by Verplanken & Roy (2013), “Habitual ecological worrying was associated with pro-environmental attitudes and behaviours, and with a personality structure characterized by imagination and an appreciation for new ideas.” This indicates that worrying may open up new windows of creativity and receptivity, along with other strong adaptive qualities.
There are various situations and circumstances in which worry can be a disadvantage. Results of a study suggest that worry may lead to a decrease in selective responding to neutral cues in the environment. (Salters-Pedneault et. al, 2008) The outcomes imply that worry may contribute to feelings of anxiety by weakening adaptive responses to neutral cues and interfering with adaptive behaviours. (Salters-Pedneault et. al, 2008) Another study, which utilized experimentally induced worry, found various physiological drawbacks of GAD. (Fisher, 2015) GAD accounted for impairments in cardiovascular, sympathetic, and parasympathetic systems. Additionally, rigidity of cardiovascular reactivity was seen in individuals with GAD. (Fisher, 2015) At times, individuals can worry so excessively that their daily activities revolve around their worry, especially if their worry started at a young age. This can negatively impact their everyday lives in social, psychological, and prominently, emotional contexts. Worrying, especially at the level of GAD can also result in a seemingly everlasting feeling of apprehension and anxiety because the individual is consumed by their worries and does not possess a means of controlling them. (Zimmerman, 2018) Persons with GAD display high amounts of depression, trait anxiety, severe negative thought intrusions, as well as negative thoughts about worry (Hirsch et. al, 2013) The incompetence to control undesirable thought intrusions related to worry (found in people with GAD) is affiliated with a deficiency in attentional control. (Fox et. al, 2015) Since, adaptive behaviour relies on the ability to filter between relevant and irrelevant information, being able to control attention is a vital asset, one that is not effective in individuals with inflated levels of worry. (Fox et. al, 2015)
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- Diagnostic and statistical manual of mental disorders: DSM-5. (2013). doi:https://doi-org.myaccess.library.utoronto.ca/10.1176/appi.books.9780890425596.dsm05
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- Zimmermann, K. A. (2018, November 06). Generalized Anxiety Disorder: Causes, Symptoms & Treatment. Retrieved from https://www.livescience.com/45781-generalized-anxiety-disorder.html