Doctor’s Corner
IN this final article on anxiety disorders, we will briefly discuss generalised anxiety disorder (GAD), obsessive-compulsive disorder (OCD) and acute stress disorder.
We have already covered panic and phobias.
GAD is all about excessive worry and the tension that results from that. Treatment is therefore about teaching people to worry appropriately (structured problem solving is good for this) and enabling them to be less tense.
GAD is characterised by persistent, generalised and excessive feelings of anxiety that are not associated with any particular environmental circumstances but are caused by a general tendency to worry excessively.
Typical worries may include such things as: the possibility of the individual or a relative becoming ill or having an accident, exaggerated concern about finances, or excessive worries about work or social performance.
The anxiety symptoms experienced by individuals with GAD are variable but may include any of the following: nervousness or restlessness, muscular tension, trembling, easy fatigue, trouble falling or staying asleep, irritable mood, sweating, light-headedness or dizziness, poor concentration, increased vigilance, shortness of breath, frequent urination and depressed mood.
GAD is defined by a protracted (six-month duration) period of anxiety and worry, accompanied by the multiple associated symptoms. In youth, the condition is known as overanxious disorder of childhood.
An essential feature of GAD is that the anxiety and worry cannot be attributable to the more focal distress of panic disorder, social phobia, obsessive-compulsive disorder, or other conditions.
Rather, as implied by the name, the excessive worries often pertain to many areas, including work, relationships, finances, the wellbeing of one’s family, potential misfortunes and impending deadlines.
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GAD occurs more often in women, with a sex ratio of about 2:1. Approximately 50 percent of cases begin in childhood or adolescence.
OCD is characterised by persistent, intrusive, unwanted thoughts that the individual finds difficult to control.
These obsessional thoughts are usually concerned with contamination, harm to self or others, disasters, blasphemy, violence, sex, or other distressing topics.
These thoughts are recognised as being generated within the individual’s own mind and not inserted from without (as in “thought insertion” in schizophrenia).
The thoughts may also involve images or scenes that enter the individual’s head. Such thoughts and images are very distressing and may result in extreme discomfort.
Many individuals with OCD also experience persistent and uncontrollable compulsions or urges to perform certain behaviours (rituals). If the compulsions are strong the individual may experience anxiety and extreme discomfort.
This discomfort can be temporarily relieved by the performance of the specific rituals. The rituals are usually associated with obsessional thoughts.
For example, an individual may have the thought “my hands are dirty” thus triggering washing rituals.
Or another individual may repeatedly imagine his or her house burning down thus triggering checking rituals of all electrical or gas appliances.
While the most common rituals are washing or checking, other rituals may include such things as counting, arranging, or doing things in a specific and rigid order.
Although rituals are performed so as to alleviate anxiety or discomfort, the anxiety relief is usually short-lived.
Also, unless the ritual has been performed perfectly, the individual may find it necessary to keep repeating the ritual many times over.
Since many individuals with OCD have more than one type of obsession and associated ritual, much of the day may be taken up by the performance of such rituals.
Additionally, OCD may lead to avoidance of certain objects or situations (eg, dirt, leaving the house so as to avoid locking doors), thereby adding to life disruption.
The symptoms of OCD are thus controlling, frustrating and irritating to the individual, family, friends and workmates.
OCD is equally common among men and women and typically begins in adolescence to young adult life (males) or in young adult life.
For most, the course is fluctuating and, like generalised anxiety disorder, symptom exacerbations are usually associated with life stress.
OCD has a clear familial pattern and somewhat greater familial specificity than most other anxiety disorders.
Acute stress disorder refers to the anxiety and behavioral disturbances that develop within the first month after exposure to an extreme trauma.
Generally, the symptoms of an acute stress disorder begin during or shortly following the trauma.
Such extreme traumatic events include rape or other severe physical assault, near-death experiences in accidents, witnessing a murder and combat.