Everyone Worries, but When Does Worry Constitute a Disease?

Everyone worries or feels anxious from time to time.  Financial issues, conflicts faced at work, problems with relationships--- these are just a few of the events that can bring about anxiety.  In prehistoric humans worry, or its more exaggerated counterpart, fear, may have even provided some benefits. Triggering the “fight or flight” response activated mental and physical responses developed to address threats to survival.
   
Most people experience what could be called “normal worry”.  This type of worry is relatively brief and doesn’t interfere with work, relationships, or other activities of life.  One study found that people may experience this type of worry for up to 55 minutes a day. This is in contrast to someone who has an anxiety disorder in which worry can be present for several hours a day.  Anxiety disorders are characterized by excessive or irrational worry, usually present for several months or years.  Millions of people in the United States are estimated to be affected by an anxiety disorder.

One of the most common anxiety disorders is called Generalized Anxiety Disorder (GAD).  People with GAD obsess over their concerns, even though they may recognize that these concerns are out of proportion to reality.  GAD may also be associated with physical symptoms such as rapid heart rate, sweating, dizziness, headaches, shaking, shortness of breath, lightheadedness, and difficulty swallowing.

The exact cause of GAD is not fully known, but has been linked to a number of factors including brain chemistry, heredity, and precipitating stressful events.  Additionally, using or withdrawing from addictive substances such as alcohol, nicotine or opiates can contribute to the development of GAD.

There is no specific test to diagnose GAD.  Health providers make the diagnosis based on symptoms and physical manifestations.  Often, a physical exam or laboratory tests are required to rule out other conditions that can cause anxiety-like symptoms. Excessive thyroid hormone (hyperthyroidism), asthma, and the heart condition supraventricular tachycardia are three medical conditions that can produce similar symptoms as those seen in GAD.
 
Treatment for GAD most often includes a combination of medication and cognitive-behavioral therapy, also known as “talk” therapy.  The most common drugs used to treat GAD are in the anti-depressant or anti-anxiety classes of medications.  Anti-anxiety medications (e.g. Xanax, Valium, Ativan, others) are typically only used short-term because of their potential for causing sedation, adverse side effects when mixed with other drugs, and addiction.

Cognitive-behavioral therapy (CBT) is delivered by a mental health professional over several sessions. Major goals of CBT are to help someone with GAD to understand the relationship between thoughts, behaviors, and symptoms as well as to gain control of distorted views of stress-provoking events.  Many people with GAD also benefit from joining a self-help or support group in which problems and successes are shared with others.

Factors that should steer someone toward receiving professional help are when excessive anxiety or worry:

• Interferes with work, relationships or social activities
  
• Lasts for several months,  seems overwhelming or uncontrollable
  
• Causes physical symptoms such as dizziness, rapid breathing or racing heartbeat
  
• Produces psychological symptoms such as sleep disturbance, irritability, or problems concentrating.
  
• Begins without an obvious cause  

“Do not anticipate trouble, or worry about what may never happen. Keep in the sunlight.” ― Benjamin Franklin