When Worry Gets in the Way of Life

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To be human is to worry—about finances, your children’s health, work, even whether you remembered to unplug the iron when you go on vacation.

But if you find that worry seems to consume your life, that you barely finish ruminating about one thing before something else begins to trouble you, even to the point of feeling physically ill, you may suffer from the often-undiagnosed but treatable illness called General Anxiety Disorder (GAD).

“It’s normal to worry about things,” said Dr. Boadie Dunlop, an assistant professor of psychiatry at Emory University’s School of Medicine in Atlanta, who works with patients suffering from GAD.

"People with GAD, however, are chronically concerned about future events. They feel powerless in the face of the worry,” he said. And, their distress is often accompanied by physical symptoms, like muscle tension, a racing heart, sweating and trembling, he added.

Unfortunately, because everyone worries to some degree, people with GAD sometimes don’t recognize they’re struggling with a treatable illness, said Dr. Eric Hollander, director of the Compulsive, Impulsive and Anxiety Disorders Program at Mount Sinai School of Medicine in New York City.

The result, he said, “is that their problems often can go undetected for many years.”

GAD affects approximately 5 percent of the U.S. population, with more women than men diagnosed with the ailment—perhaps because they’re more likely to seek help, Hollander said.

A common obstacle to timely GAD diagnosis, said Dunlop, is that a sufferer is reluctant to talk to a doctor about it.

“People with GAD are known to go to the doctor more frequently, but they report medical problems,” he said, often ailments such as stomach pains or heart palpitations. So the doctor will look for physical causes for the patient’s discomfort, rather than ask about anxiety.

However, most primary care physicians know about GAD, so patients can get the help they need, Dunlop said. “If a patient is able to express his concerns, the doctor will pay attention,” he said.

Teasing out a diagnosis of GAD can be tricky, both doctors said, because you always have to evaluate a patient for physical problems first, including potential difficulty with the heart, blood sugar and thyroid. Also, anxiety can be part of other ailments as well.

“Frequently anxiety disorders can accompany other things, like depression,” said Hollander, who is also the author of Coping with Social Anxiety: A Guide to Effective Treatment Options. Social anxiety disorder is another potentially crippling ailment that inhibits people from normal social interaction.

But with the proper diagnosis, he said, doctors can help patients significantly reduce their GAD symptoms by either drug therapy, psychotherapy or both.

“Many people with mild-to-moderate illness are treated with drugs and do well,” Dunlop said.

Selective serotonin re-uptake inhibitor antidepressants (SSRIs) like Zoloft and Paxil are commonly prescribed, although relapse rates are high for GAD if people stop taking them, he said.

Cognitive behavior therapy, often in conjunction with SSRIs, is another treatment option, enabling patients to learn to control their anxiety, Hollander said.

The best news for GAD sufferers, and those who have other anxiety disorders, is the increased understanding that anxiety is rooted in a physiological, rather than a psychological, condition. The brain, like the other organs of the body, sometimes malfunctions, and excessive anxiety can result, Dunlop said.

“The biggest single thing [for GAD sufferers] is the reduction of stigma in society about anxiety,” he said. “People don’t feel stigmatized by others and that enables them to seek help.”

SOURCES: Boadie Dunlop, M.D., assistant professor of psychiatry, Emory University School of Medicine, Atlanta; Eric Hollander, M.D., director of Compulsive, Impulsive and Anxiety Disorders Program, Mount Sinai School of Medicine, New York City

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