Hey everybody, today we're going to talk
about Generalized Anxiety Disorder (GAD).
How do we diagnose it?
And how do we treat it?
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Now, as always whenever I do a diagnosis video,
ya know, I have my handy dandy DSM.
So I'm gonna read from this and I know
that a lot of you are like "Why do you
always read from it?" but this is the
criteria, this is how we diagnose, and I
know that it's not the end all, be all
and I know different countries have
different, you know, types of DSMs and
call them different things, but this just
gives you an idea, as a clinician, what
I'm looking for when someone is
struggling with anxiety and I think it
might be GAD, or Generalized Anxiety
Disorder. Now, the first portion of the
criteria, I think, is the most important.
And that is, that someone who has GAD
struggles with excessive anxiety and
worry, apprehensive expectation, occuring
more days than not, for at least six
months. And that's always important.
How long has it been going on?
For at least six months. About a number
of events or activities such as work or
school performance, and (we're moving onto
the next portion) it says the individual
finds it difficult to control the worry,
and this is what I'll hear in my office a
lot. Is that "I just, I worry about this
and I wake up in a panic and I'm thinking
about this other thing" and it'll be a
bunch of different types of things, and
I'll say, "What have you tried to help?
Have you done anything to try to help
yourself?" "It just comes out of nowhere,
I can't even control it. I try to do
breathing and that's just bullshit."
And so I hear a lot of complaints about
this because we're unable to control it.
It can feel like it controls us.
It comes out of nowhere.
The next criteria is, that the anxiety
and worry are associated with three or
more of the following six symptoms,
with at least some symptoms having been
present for at least more days than not in
the past six months. Now, there are six
of these and they're gonna have to have
three or more. An important note is that
while we need three or more of the
following six symptoms as adults, children
only need one. Okay, the first is
restlessness or feeling keyed up or on
edge, next is being easily fatigued, third
is difficulty concentrating or mind going
blank. Remember, I've talked about that
with a lot of things, like with
depression, and with anxiety we can
struggle to concentrate. The fourth is
irritability, five is muscle tension,
which can look like trembling, twitching,
having the shakes, feeling achey or sore.
And the last, number six, is sleep
disturbance. This can be difficulty
falling or staying asleep, restless or
unsatisfied sleep. Like I've said, I've
had clients who
and then they look around and everything
is fine. Now, there are three more
components to this diagnosis. And the
next is that the anxiety, worry, or
physical symptoms cause clinically
significant distress or impairment. This
is what makes anything a diagnosis. It
has to impair our level of functioning,
it has to stop us from doing the things
that we normally would want to do. And the
next is, that the disturbance is not
attributable to the psychological effects
of substance. So it's like, we can't be
high, or drunk, or anything like that.
This can't be coming from anything like
that, it has to be coming from a natural
origin, like our body just creating this
worry and we don't know why. And the
final is that the disturbance is not
better explained by another mental
disorder. And so there's a lot of
different, we call is differential
diagnosis, when we have to make sure that
this is the proper diagnosis. And it says
that we have to rule out social anxiety,
social phobia, panic disorder, anxiety or
worry, PTSD, gaining weight and anorexia
and nervosa. There can be a lot of
different things, the list goes on and on
and on. So before we diagnose GAD, we need
to make sure it's not coming from some
place else, that it's not part of another
diagnosis. I like that the DSM also
mentions the way that GAD can look in
adults versus children, because I've heard
from many of you that when it comes to
diagnoses, since you're an adult or a
child of that disorder, you feel like the
symptoms that they talk about don't quite
fit you. And so I want to read what they
talk about the difference being when it
comes to GAD. They talk about adults who
have GAD often worry about every day,
routine life circumstances, such as
possible job responsibilities, health and
finances, health of family members,
misfortune of their children, or minor
matters like doing household chores, being
late for appointments, etc. In children,
they tend to worry about their competence
or the quality of their performance. So
it tends to be more focused around how
they're performing in sports or in other
art activities, how they're performing in
school, or their competence overall in
school, like "I don't want to look stupid"
or "I'm doing my best and I'm worrying
about how I'm going to perform on that
test". Now, the median age of onset for
GAD is the age of thirty, which was really
surprising to me, but those that they
talked to and interviewed for that
information, stated that they had felt
nervous their entire life. The DSM also
talks about how GAD in children is often
over-diagnosed and it needs to be
diagnosed with extreme caution because
there are a lot of other disorders that
could better explain the symptoms, and
they talk about Separation Anxiety
Disorder, Social Anxiety Disorder
(social phobia), or OCD are often
accompanied by worries that can mimic the
feelings in the diagnostic criteria of
GAD. Okay, so what if we've been diagnosed
with GAD, then what? Let's get into the
treatment options, and the first is talk
therapy, hooray! But more specifically,
CBT. And I'm looking at my notes here
because they say that CBT is the best
because it focuses on teaching us specific
skills to get back to doing the things
that we love. And often, when we struggle
with GAD, we avoid situations due to our
anxiety, and CBT can help us better slowly
get back into doing those things so that
our whole life isn't spent trying to avoid
anything that can give us anxiety. CBT is
also the best because it helps us
challenge those excessive worries, and
then we can actually realize that they're
not based in fact at all that maybe we got
really anxious that one time and we had no
control, it came out of nowhere, it helps
us challenge it so we can realize that
that actually isn't something we need to
be afraid of. The second treatment option
is medication, and I know not all of you
want to be on medication, but I like to
give you all the information so you can
make the most educated decision for you,
for the treatment that's best for you. And
SSRIs and NSRIs are the first line, and
those are otherwise known as
anti-depressants, and I talked also how
benzodiazepines are used as well, but it's
more and more on a limited basis because
they should only be used for acute
stress/anxiety situations. These aren't,
benzodiazepines aren't something that we
should be using ever day, all day, because
they are habit forming, it could be very
dangerous. Benzodiazepines also aren't a
good idea if you have a history of any
kind of substance abuse, just because they
are so habit forming. But don't worry,
there are other things we can do to help
ourselves. I wrote down some other
relaxations techniques like progressive
relaxation, breathing techniques,
listening to relaxing music, you can also
go for a walk, eat healthfully and
regularly can help a lot, getting enough
sleep and making sure that it's actual
restful sleep, remember back when I was
reading the diagnostic criteria? Sleep
disturbance is one of those, and so if
we're not getting proper sleep that can
make everything else feel a lot worse, so
working with your doctor or therapist on
that could help also. Also avoiding
coffee, obviously it's an upper, it's
gonna maybe make us feel more anxious and
it could even stimulate some of the
physical feelings we have when we feel
anxiety as a whole. And lastly, they say
avoid alcohol because it can lead to
racing heart, when we wake up in the
middle of the night when our body's
processing the alcohol, it feels to some
people like a panic attack. So just being
aware of the things you can maybe change,
lifestyle choices that you can change, to
better help you with your GAD. I hope you
found this helpful. I think it's important
to note, that if you struggle with this,
there are treatment options available,
like I said, there are things we can do
on our own, there are medications that
help, we can talk to a therapist, seeing
someone who specializes in CBT can be so
beneficial. So know that if you are
struggling, help is out there and it can
and will get better. If you're new to my
channel, and you like videos like this,
give it a thumbs up and don't forget to
subscribe. I put out videos twice a week
and you don't want to miss them. And I
will see you next time. Bye!
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