The Difference Between “Anxiety” and Generalised Anxiety Disorder (GAD)
- Anxiety is a ubiquitous or common emotion that everyone will feel from time to time. This is a normal human response to stress and when the stressful issue or event is over, the anxiety will go away. Anxiety can be felt i) cognitively, ie worries or fearful thoughts, ii) emotionally, ie nervousness, kan cheong, iii) physically eg heart racing, tremors, butterflies in the tummy.
In normal anxiety, the anxiety is transient, and the individual feels in control. While he or she may be transiently affected, the anxiety is never debilitating and will not cause him or her significant dysfunctions at work or in his or her social life.
Generalised Anxiety Disorder is not just simple anxiety but is a bona fide psychiatric /medical condition. Symptoms of GAD are:
- excessive worry and symptoms of physiological arousal including restlessness, insomnia, and muscle tension.
- The patient must have excessive and difficult to control anxiety about several different events or activities
- In addition to worry, patients must have at least three of the six physiological arousal symptoms:
- Restlessness or feeling “keyed up” or on edge
- Being easily fatigued
- Difficulty concentrating or mind going blank
- Irritability
- Muscle tension
- Sleep disturbance
- In anxiety disorders, removing the stressor or trigger doesn’t always reduce the anxiety.
- What is a normal level of anxiety to have? Can anxiety be good for us?
- Anxiety is a normal response to stress, and isn’t always a bad thing.
- Anxiety and stress follow an inverted U model with our functioning or task performance.
- Some anxiety or stress is useful in pushing us into better performance but when there is too much of anxiety, we break down. This is known as the Yerkes-Dodson law.
- However, when anxiety becomes uncontrollable or excessive to the point where it affects our quality of life, an anxiety disorder may have been triggered.
The Difference Between “Anxiety” and Generalised Anxiety Disorder (GAD)
- What can cause anxiety? What are the causes of GAD?
- Humans have evolved to react to danger with the fight or flight response and anxiety is part and parcel of the flight response.
- Our mind is constantly looking out for danger as ancient men were hunters and was required to do so to survive. When there is a dangerous situation, men become stressed up and this invokes hormones in our body to be released preparing us to fight or to flight (escape).
- It is of note that the danger can be real or imagined.
- In the modern world while we are not in danger of being attacked or eaten up by a beast, we have associated stress with intense situations in our lives of which we cannot cope with.
- Common stressors in life which induces anxiety are:
- Stress at work
- Stress from school
- Stress in a personal relationship such as marriage
- Financial stress
- Stress from global occurrences or political issues
- Stress from unpredictable or uncertain world events, like a pandemic
- Stress from an emotional trauma such as the death of a loved one
- Stress from a serious medical illness
- Like most psychiatric conditions, the causes of GAD are unknown. Today what is largely accepted is that anxiety disorders represent a disruption of monoamine neurotransmitters, namely serotonin, in our brain. It is likely a condition triggered by many factors. Like the Swiss cheese model, when all the holes or factors aligned, severe anxiety which spirals out of control, ie GAD occurs. Risk factors of GAD consist of biological, psychological and social ones and include
- Genetics or Family history of anxiety
- Recent or prolonged exposure to stressful situations, including personal or family illnesses and work stress
- Excessive use of caffeine or tobacco, which can make existing anxiety worse
- Childhood abuse or bullying
- Certain health conditions such as thyroid problems or heart arrhythmias
- How might both present in my life differently?
- Normal anxiety and anxiety disorders lie on a spectrum and are not categorical.
- Anxiety, symptoms are listed in first question. eg:
- If you wake up one morning and you know you have a math test later that day, it’s normal to be nervous or anxious about the test.
- Your heart might pound, and your stomach might churn, and you might be thinking a lot about the test and your possible result. Once the test is over, you’re likely more relaxed, and physically back to normal.
- Then anxiety is transient and although a nuisance, it does not affect your usual functioning significantly.
- GAD
- You have been worried excessively about a myriad of issues for the last six months. For example you may worry about losing your job, getting infected with COVID-19 or your children failing their exams.
- You feel nervous and tensed in the day and you find it harder and harder to control the anxiety and worries.
- You find it hard to fall asleep at night and have been easily tired.
- You have been getting more irritable and would lose your temper at your children.
- Your anxiety has also made it hard for you to make work decisions and you cannot concentrate on your work.
- (Symptoms of GAD are listed above)
Getting Your Anxiety Better: Tips and Treatment
- What are some ways to lower levels of anxiety?
- Having time away from the stressful environment or event is the best way. Unfortunately, stress is everywhere in our small yet competitive island.
- Adequate rest and sleep on a day-to-day basis, and in doing so allow our body and mind to take a break from the stress of the day is of utmost importance.
- It is also important to have hobbies and exercise to take our mind off stress and the anxiety.
- Limit the use of caffeine and cigarettes.
- Cognitively, it is important to moderate our excessive high expectations and need of control. We often quote the serenity prayer: “to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference”
- What are the treatments for GAD?
- Medication treatment include using serotonin reuptake inhibitors (like fluoxetine, sertraline, venlafaxine, etc) These help to enhance the serotonin in our synapse which helps the brain to recover from an anxiety disorder. We can use anxiolytic medications like lorazepam or alprazolam in the short term judiciously to provide for immediate relief for severe anxiety.
- Psychological interventions like Cognitive Behavioural Therapy and Mindfulness Therapy are very effective in the treatment of GAD.
- Social interventions can include providing some rest from work in the form of medical leave or asking for a lower workload for the afflicted individual. Beefing and garnering support from patient’s family and loved ones can help improve things.
Anxiety and Anxiety Disorder in Singapore
The Singapore Mental Health Survey 2016 showed an increase in the prevalence of GAD, from 0.9% in 2010 to 1.6% in 2016:
- What could be some reasons for this increase?
- In Asian cultures, anxiety is often manifested as poor sleep and physical ailments such as headaches and stomachs, and much less as feelings of anxiety. The increase may signify a shift towards a more Western recognition and presentation of our emotions.
- Anxiety Disorders can often be misconstrued. Many relate abnormal anxiety only to being confronted with huge problems in life, and may feel that they cannot be having an Anxiety Disorder since life is good. However, GAD is essentially overblown worries or anxiety feelings, and it is exactly because you have nothing to worry about and yet you are worried which defines it as a disorder. As such, an improvement in mental health literacy and a better understanding of Anxiety Disorder from public mental health education may have helped more identify that they have an anxiety problem.
- There may be less stigmatization about mental health issues and responders to the survey may have been more likely to answer truthfully.
- The survery in 2016 showed that the increase in the prevalence of GAD in Singapore was observed only in the youngest age group of 18–34 years and not among those of the older age. There are some suspicion that the proliferation of social media and unhealthy social media use habits can be related to the increase in prevalence of GAD, given that many studies have pointed to correlation between social media use and adverse mental health outcomes.
- Have Singaporeans become more anxious in the last 10-12 years? What’s the expert take on this?
- Yes, there has been a trend. We do not have actual data but there are some observable trends in people seeking help in my practice. Anxiety towards exams and schoolwork appears to have been increasing as reflected on people enquiring for help for themselves or their children. The number of people seeking help as they are anxious and cannot cope at and around periods where there are major exams have observably increased.
- More people have stepped forward to seek help with regards to their anxiety which often are exacerbated by job stress have also increased. This is encouraging as many are picked up by work place programmes and encouraged by their workplace to seek help. Traditionally, men tends to only seek help when their anxiety are severe but have been doing so in the earlier stages of anxiety disorders in recent years.
