Generalised Anxiety Disorder (GAD)
It is perfectly normal for teenagers to be anxious about situations such as exams, starting a new school/job, and so on. Most people will feel anxiety at some point in their lives, but people with GAD feel anxiety or excessive worry most of the time – to the point that their everyday life is affected. The way GAD is different to “normal” anxiety is that it is:
- excessive
- persistent
- intrusive
- debilitating
GAD differs from a phobia in that it is not connected to a specific thing or situation, but is generalised across all things and situations. It also differs in that the associated anxiety is less intense, but it occurs over a longer period of time. People are considered to have GAD when they have been anxious or worried for more than 6 months on more days than not. Some of the symptoms of anxiety include:
- Hot and cold flushes
- Fatigue
- Constant worries that accumulate
- Feeling like the anxiety is uncontrollable
- Pervasive feelings of apprehension or dread
- Rapidly beating heart
- Feeling tense – an inability to relax
- Difficulty sleeping
- Stomach problems
- Feeling “on edge”, restlessness, fidgeting
- Tight chest – difficulty breathing and swallowing
- Obsessive thinking and compulsive behaviour
In teenagers, the anxiety is focused around social acceptance, future events, past behaviours, family matters, their abilities and performance at school and other activities. It is especially important for adults to recognise the symptoms in the teenager, as they will often not be able to recognise themselves that their worrying is disproportionate to the actual situation. Some things to look out for are:
- Perfectionism, a fear of making mistakes, unrealistic expectations of self, excessive self-criticism
- Insecurity and a great need for reassurance and approval
- Feeling that a disaster is sure to occur, and their worrying will avert the disaster
- Debilitating fear about possible future events
Prevalence
Nutter and Pataki found that in America around 2.9 – 4.6% of teenagers will suffer from GAD. But as already discussed it can be hard to determine the exact figures of teenagers with GAD. Also many anxiety conditions are co-morbid with other conditions. They also found that in childhood there is a fairly equal level of GAD in males and females, but as they reach adolescence, there is a ratio of six females to every male with GAD.
Causes of GAD
It is not known exactly what causes GAD, but various contributory factors have been identified. It is thought that familial, biological and environmental factors are important. An early trait of showing an aversion to new situations has later been found to be associated with anxiety conditions. Also, research shows that there is an association between parents with anxiety disorders and children with disorders. Anxiety tends to occur in families. Anxious parents may have a genetic predisposition to anxiety, which they pass on to their children, but they may also have modelled anxious behaviour to their children and perhaps encouraged it in some way. Parents are role models and a child will observe how a parent responds to situations. As a child they may watch a parent ironing and then pretend to iron their clothes themselves. So if a child sees a parent getting anxious about a certain situation, they may also model that behaviour.
Environmental factors can also place a child at risk from GAD, such as disrupted attachment, stressful life events, traumatic experiences and emotional problems. In younger children, it can be harder to understand anxiety, as they may be limited in their development in their ability to benefit from counselling or some interventions.
Treatment for GAD
GAD can be helped by a combined treatment, most often using family intervention, medication and behavioural treatments. Children will not often seek help themselves, but may require support and help from their families to seek help. It is important to seek help to ensure the child does not continue to suffer from anxiety or get worse. Anxiety disorders can cause strain on school performance, family relationships and social functioning. This can obviously then lead to more serious problems, both mentally and physically, for the child, so it is important to get help.
Typically, the treatment will begin with an assessment. This will be a comprehensive evaluation of the child looking at their symptoms, concerns, duration and level of intensity. There will also be a thorough review of the child’s background and development, past medial history, past psychiatric history, family background and also a mental status exam. Parents, carers and family will also be involved in the assessment process, enabling more detailed information and history to be found out about the treatment of the condition.
A psychologist or psychiatrist will then discuss an individual treatment plan for the child. This will usually include medication, family therapy, cognitive behavioural therapy and parent support and education. The parent or guardian is still essential within the treatment process.
