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Chapter 23. Anxiety > Generalized Anxiety Disorder

Generalized Anxiety Disorder

Anxiety comes in many different forms. In generalized anxiety disorder, people experience high levels of anxiety about a wide range of daily activities that pose no real threat. They are continually anxious and worry about whatever they are doing and whatever they are facing. They not only worry about whether they will be fired during a company downsizing, or if the mark on their skin is cancer, but they worry about whether their friends will be satisfied with the meal they are cooking for them or if people will be upset if they are late to dinner. Everything becomes a source of worry and trepidation. This leads to exhaustion as well as continual discomfort.

Generalized Anxiety Disorder

Betty was always worried, always tense. Coworkers often avoided her, since her continual worrying was draining. One day she worried if the division vice president would be upset with her for being late to a meeting; the next day she worried about whether her team would be able to finish its project on time; the following day she was preoccupied with whether her child would get into the right private school.

She also complained a lot about how she was feeling. She often had headaches or felt stiff. By the afternoon, her energy seemed to collapse. It was exhausting to be nervous all of the time. Once and sometimes twice a week she came into work with bags under her eyes after not being able to sleep, since some worry had kept her awake. She was also often distracted in meetings from being preoccupied with whatever was currently worrying her.

The vice president of the division ordered her to see a psychiatrist; he thought she had attention deficit disorder. His son had just been treated for it and had gotten much better. Like his son, Betty was hyper and had a hard time concentrating. The psychiatrist said it wasn’t ADHD, but a generalized anxiety disorder.

The psychiatrist offered her a choice of a 12-course of cognitive behavioral therapy (CBT) or a medication called a serotonin reuptake inhibitor (SSRI). Betty wanted whatever would work fastest and chose the SSRI. In a few days, she was less tense and stopped snapping at people. In the weeks ahead, her whole personality seemed to change. In reality, what changed was that the burden of excess anxiety was lifted from her shoulders, and her real personality was finally able to come out. She was no longer carrying a 50-pound pack on her back, draining her energy and making her feel bad. She was much easier to be with, and her energy and concentration improved, as did the bags under her eyes.

Betty was satisfied and wanted to continue with the medication and come back only for rare medication follow-up visits. Her psychiatrist, however, convinced her to try a period of CBT in the hope that she could then get off of the medication.



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