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Generalized Anxiety Disorder (GAD)

Mental Health Case Study

Introduction

Generalized anxiety disorder (GAD) is a major mental health concern as it is one of the

most common mental disorders amongst individuals.1 Currently, 6.8 million, or 3.1%, of the

United States population is affected by GAD, and sadly only 43.2% of those diagnosed with

GAD are actively receiving treatment.2 Also, out of the 6.8 million Americans with a GAD

diagnosis, a disproportionate number of them are women due to females being twice as likely to

be affected by GAD compared to men. GAD does not discriminate, as both children and adults

are affected.1 According to the National Library of Medicine, one out of four children between

the ages of 13 to 18 will experience GAD at least once. Additionally, the lifetime prevalence of

GAD in those younger than the age of 18 is between 5.7% and 12.8%. Furthermore, adults have

a greater burden of GAD as up to 20% of adults have reported to have GAD each year. With this

evidence, the negative impact of GAD on the U.S. is clearly seen.

GAD is a mental health disorder that can bring about feelings of worry, fear, and being

constantly overwhelmed.1 GAD is often characterized by persistent, excessive, and unrealistic

worry of everyday events or things.1 These worries can be multifocal and for adults include items

such as, health, family, finances, future, and occupation. Likewise, children often suffer from

worries stemming from poor performance at school and other extracurriculars, catastrophic life

events, actual or perceived inability to meet the standards of family members and others, and

homelife.3

Most often those with GAD have a difficult time controlling their worries, thus leading to

numerous nonspecific physical and psychological signs and symptoms.1 These signs and

symptoms include difficulty staying or falling asleep, irritably, sweating, persistent headaches,
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trembling, fatigue, trouble concentrating, inability to relax, lightheadedness, and countless

others.4 With the symptoms of GAD being consistent with various mental and physical health

conditions, this disorder can be difficult to diagnosis.

GAD has numerous reported causes and associated risk factors.3 Well-known causes of

GAD include not being able to properly cope with internal stress and a history of substance

abuse.1 Additionally, having other physical conditions, for example diabetes and

hyperthyroidism, and comorbidities, such as depression, increases one’s chance of developing

GAD.1,3 Furthermore, studies have shown that GAD also has a genetic component, as GAD has

heritability of roughly 30%. 5 Moreover, due to women having a greater chance of developing a

diagnosis of GAD compared to men, research has discovered possible women-specific risk

factors.1,4 These women-specific risk factors include, a higher sensitivity of low corticotropin-

releasing factor (CRF) levels.6 CRF a hormone that is responsible for organizing the stress

response in animals, so having an increased sensitivity to low levels of CFR would mean that a

woman would have a harder time responding and coping to a stressful event, thus leading to

more frequent GAD diagnosis for women.6

Illustrative Case Description

The patient was a 27 year old female that came for an anxiety medication refill, and also

a request for an increase in dosage. According to the patient’s chart, she had been prescribed 10

mg of Escitalopram, 1 tab daily at her last appointment. Upon arrival, the patient’s vitals were

normal; temperature was 98.8° F, pulse was 79, respiration rate was 16, blood pressure was

116/70, oxygen saturation was 94%, and the patient weighed 171 lbs.

When collecting health history, the patient discussed that she began taking Escitalopram

a few months after the birth of her third child. The patient continued on by stating that she was
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becoming overwhelmed with the care of not only her infant, but her other two children as well.

When asked if the medication aided with her feelings of stress and being overwhelmed, the

patient claimed that she noticed that she was not quick to become frustrated with her children

when taking the medication. With this being the patient's first refill of Escitalopram, the patient

was asked if she was tolerating her dosage and she said that she was doing just fine on her

current dosage, but would like to increase her dosage to for more support. When questioned if

she was taking any other medication or supplement for anxiety, the patient said no. At the

conclusion of the appointment, the patient was approved for a refill and her dosage was increased

to 20 mg 1 tab daily.

Discussion

As previously discussed, the characteristics of GAD, which are persistent and excessive

feelings of worry, can lead into various nonspecific physical and psychological signs and

symptoms.1 Since the signs and symptoms of GAD can be indicative to countless other mental

health and other health conditions, this disorder can be difficult to diagnosis. According to the

Diagnostic and Statistical Manual of Mental Disorders, 5th ed, (DSM-5), the criteria for an

official GAD diagnosis includes, (I) having excessive anxiety and/or worry for at least 6 six

months, (II) inability to control one’s worries, (III) the anxiety and/or worry is associated with at

least three of the following six symptoms: being on edge, fatigue, trouble concentrating, muscle

tension, irritability, and inability falling and/or staying asleep, (IV) the signs and symptoms of

associated with excessive anxiety and/or worry are causing everyday impairment, (V) the

excessive anxiety and/or worry cannot be attributed to substance abuse or other health

conditions, for example hyperthyroidism, and (VI) the excessive anxiety and/or worry cannot be

better explained by other mental disorder, such as panic disorder or social phobia.7 If a patient
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fits the above criteria, only then is a diagnosis of GAD formally given by a physician.

Additionally, like many other mental disorders, GAD is on a spectrum, so a GAD-7 screening

tool is often given to a patient to assess the severity of their GAD diagnosis. The GAD-7

screening tool evaluates an individual based on their total score for the seven questions.

Cumulatively, the screening tool result can range from one to ten, with a greater score being

indicative of higher severity of GAD.

Upon receiving a diagnosis of GAD, there are two main treatment plans that a physician

can prescribe: cognitive behavioral therapy (CBT) and/or medications.1 However, doctors most

often recommend a combination of CBT and medication, as the two treatment plans in

conjunction can offer the most benefit to a patient. Despite common beliefs, CBT is not just a

“toolbox” for patients, but rather a method to understand the human mind and how it functions

via neuroscience and scientific psychology.8 CBT can aid with GAD management by utilizing

the following techniques: functional analysis, psychoeducation, and the behavioral and emotional

approach. Functional analysis at its essence allows individuals with GAD to understand the

frequency and intensity of their triggers to signs and symptoms of GAD. Psychoeducation allows

for patients to begin thinking about therapeutic tools that can aid management and increase

positive change within their GAD diagnosis. Lastly, the behavioral and emotional approach

teaches patients new behaviors that bring about positive feelings, and release negative ones.

When patients do not respond to CBT, or may just need additional assistance, a physician will

then prescribe medication for the management of GAD.1

Currently there are several medications on the market that used to treat GAD. 1 These

medications are categorized by first-line, second-line, and third-line therapies, plus

augmentations.7 First-line therapies are classified as selective serotonin reuptake inhibitors

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(SSRIs). These are often given to patients with GAD first, as they have proven to be the most

effective in managing GAD. Second-line therapies include tricyclic antidepressants, which has

been better studied for other mental disorders, such as panic disorder, but show promise in those

with a GAD diagnosis. Both third-line therapies and augmentations are not preferred for initial

treatment of GAD due to either being not as effective as other options, having a higher risk for

addiction, and/or having more adverse side effects. Overall, it is important to note that GAD

patients may have to undergo some trial and error when finding a treatment plan that is most

suited to them.1

Sadly, due to the nature of GAD, there is no “true” prevention methods for GAD as there is no

way to accurately predict the cause behind someone developing this mental disorder.4 Despite

non-existence prevention methods, there are ways for one to reduce signs and symptoms

associated with anxiety. Seeking professional help early, keeping a journal that documents

potential triggers of anxiety, managing time more efficiently, and avoiding unhealthy use of

substances, such as drugs and alcohol, are great ways for one to reduce the physical and

psychological signs and symptoms of anxiety.

Conclusion

Generalized anxiety disorder (GAD) is the most common mental health disorder amongst

individuals, and is often characterized by persistent, excessive, and unrealistic worry of everyday

events or things.1 Due to those with GAD having a difficult time controlling their worries, the

physical and psychological signs and symptoms of GAD are nonspecific, thus making a GAD

diagnosis difficult. Currently, medical professions utilize the criteria with the DSM-5, along with

the GAD-7 screening tool, to make an official diagnosis of GAD.7 Furthermore, there are two

main treatment plan for GAD, and they are CBT and medication.1 Most often, doctors will
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combine these treatment plans for the best results amongst patients. It is important to note that

patients will most likely have to undergo some trial and error when trying to find the best

treatment plan for them. Unfortunately, due to the nature of GAD, there is no “true” prevention

methods for GAD as there is no way to accurately predict the cause behind someone developing

this mental disorder.4 However there are ways in which an individual can reduce the signs and

symptoms associated with anxiety, such as seeking medical help early on, keeping track of

anxiety triggers, and avoiding abuse of substances, for example drugs and alcohol.

References

1. Munir, S., & Takov , V. (n.d.). Generalized anxiety disorder

.https://www.ncbi.nlm.nih.gov/books/NBK441870/

2. Facts & Statistics: Anxiety and Depression Association of America, ADAA. Facts
& Statistics | Anxiety and Depression Association of America, ADAA. (n.d.).
https://adaa.org/understanding-anxiety/facts-statistics#:~:text=Generalized%20Anxiety
%20Disorder%20(GAD),co%2Doccurs%20wih%20major%20depression.

3. Mayo Foundation for Medical Education and Research. (2017, October 13).
Generalized Anxiety Disorder. Mayo Clinic. https://www.mayoclinic.org/diseases
conditions/generalized-anxiety-disorder/symptoms-causes/syc-20360803

4. Generalized anxiety disorder (GAD). Johns Hopkins Medicine. (2023, January

31). https://www.hopkinsmedicine.org/health/conditions-and-diseases/generalized-
anxiety-disorder#:~:text=Key%20points%20about%20GAD%3F,muscle%20tension%2C
%20an%20trouble%20sleeping.

5. Gottschalk, M. G., & Domschke, K. (2017, June). Genetics of generalized anxiety

disorder and related traits. Dialogues in clinical
neuroscience.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573560/
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6. Facts. Facts | Anxiety and Depression Association of America, ADAA. (n.d.).

https://adaa.org/living-with-anxiety/women/facts#:~:text=Recent%20research%20has
%20found%20that,men%20t%20stress%2Drelated%20disorders.

7. Locke, A. B., Kirst, N., & Shultz, C. G. (2015, May 1). Diagnosis and
management of generalized anxiety disorder and panic disorder in adults. American
Family Physician.https://www.aafp.org/pubs/afp/issues/2015/0501/p617.html

8. Borza, L. (2017, June). Cognitive-behavioral therapy for generalized anxiety.

Dialogues in clinical neuroscience.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573564/