Abnormal Psychology

252 CHAPTER 7

Generalized Anxiety Disorder

Earl Campbell became a worrier—even during the best of times:

On a day when life seems absolutely wonderful—say, a beautiful fall Saturday or Sun-

day when I’m watching one of my boys play football—I’ll often be overcome by the

fear that it will all come to an end somehow. It’s just too good. Something bad is going

to ruin it for me. This past year was the most diffi cult one I’ve had... Tyler [his son]

was in the fi fth grade, and I worried the entire year. I was in the fi fth grade when my

father died, and I thought my fate was sealed. I was scared I would die and my boys

would have to go through life without a father, the way I did.

(Campbell & Ruane, 1999, p. 204)

Worrying is a normal part of life, but some people worry more than others. How

much is “too much” worrying?

What Is Generalized Anxiety Disorder?

Generalized anxiety disorder (GAD) is characterized by uncontrollable worry and

anxiety about a number of events or activities (which are not solely the focus of an-

other Axis I disorder, such as about having a panic attack) (see Table 7.1; American

Psychiatric Association, 2000). The worry and anxiety among individuals suffer-

ing from GAD primarily focus on family, fi nances, work, and illness (Sanderson &

Barlow, 1990); Earl Campbell worried mostly about family and illness; other people

may worry about minor matters (Craske, Rapee, Jackel, & Barlow, 1989). In con-

trast to most people, people with GAD worry even when things are going well.

Moreover, their worries intrude into their awareness when they are trying to focus on

other thoughts—and they cannot stop worrying (American Psychiatric Association,

2000). Symptoms are present for at least half the days during a 6-month period. Like

A. H., discussed in Case 7.1, people with GAD feel a chronic, low level of anxiety

or worry about many things. Moreover, the fact that they constantly worry in itself

causes them distress.

Generalized anxiety disorder (GAD)
The anxiety disorder characterized by
uncontrollable worry and anxiety about a
number of events or activities that are not
solely the focus of another Axis I disorder.

CASE 7.1 • FROM THE OUTSIDE: Generalized Anxiety Disorder

A. H. was a 39-year-old divorced mother of two (son aged 12, daughter aged 7) who worked as a bank

manager. However, she had become concerned about her ability to concentrate on and remember

information while at work. A. H. had made some “fi nancially disastrous” mistakes, and was now—at

the suggestion of her supervisor—taking some vacation time to “get her head together.” Because

of her concentration and memory problems, it had been taking her longer to complete her work,

so she had been arriving at work 30 minutes early each day, and often took work home. She re-

ported being unable to relax, even outside of work, and at work it was hard to make decisions be-

cause she ruminated endlessly (“Is this the right decision, or should I do that?”), and hence tried

to avoid making decisions altogether. Her concentration and memory problems were worst when

she was worried about some aspect of life, which was most of the time. She reported that 75% of her

waking life each day was spent in a state of anxiety and worry. In addition to worrying about

Key Concepts and Facts About Common Features of Anxiety Disorders

• The key symptoms of anxiety disorders are extreme anxiety,
  intense arousal, and attempts to avoid stimuli that lead to fear
  and anxiety.


• The fight-or-flight response arises when people perceive a
  threat; when the arousal feels out of control—either because
  the individual has an overactive stress response or because he
  or she misinterprets the arousal—the person may experience
  panic. In response to the panic, some people develop a phobia
  of stimuli related to their panic and anxiety symptoms.
  
  
  • Anxiety disorders frequently co-occur with other psychological
    disorders, such as depression or substance-related disorders.
    Mental health clinicians must determine whether the anxi-
    ety symptoms are the primary cause of the problem or are the
    by-product of another type of disorder.
  
  
  • The high comorbidity of depression and anxiety disorders sug-
    gests that the two disorders share some of the same features,
    specifi cally high levels of negative emotions and distress—which
    can lead to concentration and sleep problems and irritability.