Chapter 33. Generalized Anxiety Disorder

Rudolf Hoehn-Saric, M.D.; Thomas D. Borkovec, Ph.D.; Kenneth Belzer, Ph.D.
DOI: 10.1176/appi.books.9781585622986.258989



Generalized anxiety disorder (GAD) is not as sharply delineated as DSM nomenclature makes it appear to be (Noyes and Hoehn-Saric 1998) but is a heterogeneous disorder; patients differ in onset, the type and intensity of worries, the degree of hyperarousal, and their physical manifestations. Worries may be generalized or focused on certain situations; hyperarousal may lead to insomnia or be only present during certain times of the day. Physical complaints tend to cluster to different degrees around muscular, cardiovascular, or gastrointestinal symptoms. In the presence of medical comorbidity, anxiety may crystallize around the physical state. Personality traits influence patients' behavioral responses and can significantly modify the clinical picture. Finally, GAD has a high comorbidity with affective and other anxiety disorders, which, when present, necessitates the formulation of comprehensive treatment plans. Therefore, each patient must be considered individually, according to the type, severity, and chronicity of symptoms; triggers that elicit or aggravate the symptoms; life stressors; coping ability; learning potentials; specific personality traits; and, above all, motivation to change. In most cases, GAD is a chronic condition, but the severity of symptoms may depend greatly on the present degree of stress.

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