Tutorial 7 Anxiety Disorders – Generalized anxiety disorder
Problem statement: What is a generalized anxiety disorder?
Learning goals
DSM lV criteria en difference DSM 5
Epidimiologie
Comorbide
Differential diagnostic
Cognitive model of Borkovec en Wells
2 factor model of Mowrer
What is the function of worry? According to the theory and according to GAD
patients.
What is the difference in physiological response between a normal anxiety reaction
and an anxiety reaction in GAD?
Normal anxiety is triggered at the moment by something specific like a snake. Ths
elicits a clear fear reaction ans arousal.
Pathological: usual fight and flight reactions are inhibited because the trigger of the
anxiety is unclear and usually future oriented.
Treatment
GAD according to DSM IV
The essential feature of Generalized Anxiety Disorder is excessive anxiety and worry
(apprehensive expectation), occurring more days than not for a period of at least 6 months,
about a number of events or activities (Criterion A). The individual finds it difficult to control
the worry (Criterion B). The anxiety and worry are accompanied by at least three additional
symptoms from a list that includes restlessness, being easily fatigued, difficulty concentrating,
irritability, muscle tension, and disturbed sleep (only one additional symptom is required in
children) (Criterion C).
The focus of the anxiety and worry is not confined to features of another Axis I disorder:
Having a Panic Attack (as in Panic Disorder)
being embarrassed in public (as in Social Phobia)
being contaminated (as in Obsessive-Compulsive Disorder)
being away from home or close relatives (as in Separation Anxiety Disorder)
Gaining weight (as in Anorexia Nervosa)
Having multiple physical complaints (as in Somatization Disorder)
Having a serious illness (as in Hypochondriasis)
The anxiety and worry do not occur exclusively during Posttraumatic Stress Disorder
(Criterion D).
Although individuals with Generalized Anxiety Disorder may not always identify the worries as
"excessive," they report subjective distress due to constant worry, have difficulty controlling
the worry, or experience related impairment in social, occupational, or other important areas
of functioning (Criterion E). The disturbance is not due to the direct physiological effects of a
substance (i.e., a drug of abuse, a medication, or toxin exposure) or a general medical
condition and does not occur exclusively during a Mood Disorder, a Psychotic Disorder, or a
Pervasive Developmental Disorder (Criterion F).
The intensity, duration, or frequency of the anxiety and worry is far out of proportion to the
actual likelihood or impact of the feared event. The person finds it difficult to keep worrisome
thoughts from interfering with attention to tasks at hand and has difficulty stopping the worry.
Adults with Generalized Anxiety Disorder often worry about everyday, routine life
circumstances such as possible job responsibilities, finances, the health of family members,
misfortune to their children, or minor matters (such as household chores, car repairs, or being
late for appointments).
Children with Generalized Anxiety Disorder tend to worry excessively about their competence
or the quality of their performance. During the course of the disorder, the focus of worry many
shift from one concern to another.
Problem statement: What is a generalized anxiety disorder?
Learning goals
DSM lV criteria en difference DSM 5
Epidimiologie
Comorbide
Differential diagnostic
Cognitive model of Borkovec en Wells
2 factor model of Mowrer
What is the function of worry? According to the theory and according to GAD
patients.
What is the difference in physiological response between a normal anxiety reaction
and an anxiety reaction in GAD?
Normal anxiety is triggered at the moment by something specific like a snake. Ths
elicits a clear fear reaction ans arousal.
Pathological: usual fight and flight reactions are inhibited because the trigger of the
anxiety is unclear and usually future oriented.
Treatment
GAD according to DSM IV
The essential feature of Generalized Anxiety Disorder is excessive anxiety and worry
(apprehensive expectation), occurring more days than not for a period of at least 6 months,
about a number of events or activities (Criterion A). The individual finds it difficult to control
the worry (Criterion B). The anxiety and worry are accompanied by at least three additional
symptoms from a list that includes restlessness, being easily fatigued, difficulty concentrating,
irritability, muscle tension, and disturbed sleep (only one additional symptom is required in
children) (Criterion C).
The focus of the anxiety and worry is not confined to features of another Axis I disorder:
Having a Panic Attack (as in Panic Disorder)
being embarrassed in public (as in Social Phobia)
being contaminated (as in Obsessive-Compulsive Disorder)
being away from home or close relatives (as in Separation Anxiety Disorder)
Gaining weight (as in Anorexia Nervosa)
Having multiple physical complaints (as in Somatization Disorder)
Having a serious illness (as in Hypochondriasis)
The anxiety and worry do not occur exclusively during Posttraumatic Stress Disorder
(Criterion D).
Although individuals with Generalized Anxiety Disorder may not always identify the worries as
"excessive," they report subjective distress due to constant worry, have difficulty controlling
the worry, or experience related impairment in social, occupational, or other important areas
of functioning (Criterion E). The disturbance is not due to the direct physiological effects of a
substance (i.e., a drug of abuse, a medication, or toxin exposure) or a general medical
condition and does not occur exclusively during a Mood Disorder, a Psychotic Disorder, or a
Pervasive Developmental Disorder (Criterion F).
The intensity, duration, or frequency of the anxiety and worry is far out of proportion to the
actual likelihood or impact of the feared event. The person finds it difficult to keep worrisome
thoughts from interfering with attention to tasks at hand and has difficulty stopping the worry.
Adults with Generalized Anxiety Disorder often worry about everyday, routine life
circumstances such as possible job responsibilities, finances, the health of family members,
misfortune to their children, or minor matters (such as household chores, car repairs, or being
late for appointments).
Children with Generalized Anxiety Disorder tend to worry excessively about their competence
or the quality of their performance. During the course of the disorder, the focus of worry many
shift from one concern to another.
