We’ve seen such symptoms before; they’re signs of an overactive
sympathetic nervous system. All of us experience symptoms like these occa-
sionally when we’re under stress. People with generalized anxiety disorder
experience them constantly, because they are constantly generating stress
for themselves.
The self-generation is what defines the disorder psychologically.
People with generalized anxiety disorder continuously imagine potential
dangers, often as a means of protecting themselves. Their internal world
features continuous replays of remotely possible disasters, shown in gruesome
closeup, with every hideous detail—both real and imaginary—blown
completely out of proportion. Their poor brains can’t tell the difference
between reality and fantasy, so every replay switches on the fight or flight
response. This continual arousal in the face of imaginary threat wears
them down in ways reality can never hope to match. In PTSD, people are
haunted by a single terrifying and all too real memory. With generalized
anxiety disorder, people are pecked to death by their own fantasies.
Anxious people believe that if they know about problems in
advance, they can at least be prepared. They always expect the worst, just
to be on the safe side. What they do to be safe is usually more perilous
than actual danger.
There are two basic strategies people use to protect themselves: passive
avoidance of supposedly dangerous situations, and active attempts to control
possible dangers by worrying about them. Both strategies create more anx-
iety than they dissipate.
Medications can’t cure generalized anxiety disorder, but they can
sometimes provide a short-term solution. Though serotonin reuptake
inhibitors are sometimes prescribed for generalized anxiety, they don’t
work nearly so well as they do for panic disorder. Effexor, an SNRI, seems
to work a little better. Anticonvulsants like Neurontin are prescribed also,
with mixed results. They sometimes relieve anxiety, but often at the
expense of feeling bleary and disconnected.
Benzodiazepines, as you might imagine, do work, but since the anx-
iety is constant, they have to be taken constantly. The danger of addiction is
considerable. Often, doctors will prescribe Valium, Xanax, or Klonopin, or
a similar drug in limited doses to be used when the anxiety is particularly
acute. Benzodiazepine sleeping medications like Ambien and Halcion are
used in a limited fashion too.
126 ❧Explosions into Fear