Generalized Anxiety Disorder

objects in mirror are closer than they appear

Note: This was originally published in Oct 2015.

When I was first diagnosed with Generalized Anxiety Disorder (by a neurologist in the middle of a migraine appointment), I thought, “Great! Search terms! Let’s get cozy, Google.”

But I was wrong to assume simple screen time was going to help me find my path with my anxiety disorder. I found little online that informed me in any real way. For one thing, the word “worry” was used again and again. At the time, worry wasn’t what I did or how I identified. Thinking and overthinking, yes. Worry, no.

I know this feeling.

I know this feeling.

A few months after my July diagnosis, in Sept 2015, the tennis player Mardy Fish wrote a great essay that captures the experience of anxiety in vivid detail. At one point he sums it up: “I was, objectively, doing great. And looking back, I wish I had been able to tell myself that. But doing great wasn’t something that my frame of mind back then had time to process. All I could focus on was doing better. It was a double-edged sword.”

By the time I read Fish’s piece, he was confirming something I already knew. I’d talked to many people to piece together what GAD meant, found a book that helped a lot, and started to figure out my own particular form of anxiety for myself.

The goal of this short FAQ is to help people like me when they’re just beginning their journey. You may be realizing you have anxiety. Maybe you’ve been told that that you’re exhibiting some of the symptoms of Generalized Anxiety Disorder. If you are Googling the hell out of your keyboard right now and not finding answers to your questions, welcome, fellow mind traveller.

Q. What is Generalized Anxiety Disorder, exactly?

A. You’ve probably been researching this topic, so I’m not going to give you the same bland answer you’ve already seen about how it’s a psychological disorder characterized by excess “worry” particularly about work, finances, and relationships. I will say that some of the people I know with GAD didn’t know they had it for a long time. They didn’t characterize themselves as “worriers.” Books and doctors tell you that GAD means you worry about worry, but if you don’t even consider it worry, that doesn’t help. And if you are so habituated to pushing away the worry as a coping mechanism, then again, talking in those terms just leads to more trouble.

For me, GAD meant that I was overthinking nearly everything in my life, scrupulously trying to figure it all out. If a problem came up, I’d write it down and begin my crazed attack in every direction. It also meant I had a ton of crippling shoulder and neck pain. I’d be nauseated frequently, especially on buses. I’d get dizzy occasionally, almost to the point of fainting.It was the physical symptoms that led my neurologist to know I had GAD.

Q. Can a person have GAD and not know it?

A. Absolutely. It’s common for people who have GAD to see many doctors before they get properly diagnosed. Gastroenterologist, chiropractor, neurologist, acupuncturist, and gynecologist offices are some of the common stops along the path to diagnosis.

Q. Is it hereditary?

A. I don’t know if this is everyone’s question, but it was one of mine. I wanted to understand where GAD was coming from. Yes, there is a genetic component. As is often the case, that’s only one part of the equation. You may have genetic roots and predisposition to anxiety disorders, but they are also triggered by environmental factors. The death of a loved one, divorce, the sudden loss of a job or your house, or a big change in circumstance can bring on episodic fare-up of GAD.

Q: If it flares up, does that mean it’s dormant at other times?

A: My understanding (I’m a patient, not a doctor!), is that you’re predisposed to GAD, but with proper treatment, you can bring your symptoms into check. But since you are predisposed to this condition, when things happen to you, you will be more likely to have bigger anxiety responses than other people. I almost think of it as a GAD sine wave, and the equation is your life, and what’s happening in it.

Q. How messed up are you, exactly? Please be specific.

A. Very recent example:

ugh

We have had a few ants in the bathroom lately. They appeared to be coming through the window. “We should probably replace the window,” was my immediate thought, and suggestion to my husband, even though we can’t afford it.

I don’t see 5–10 ants. I see the inevitable 100–200 ants that I imagine will invade and eventually carry off our house. It’s very hard for me to deal with the here and now when I am catastrophizing. (That’s a cognitive distortion. Learning to recognize cognitive distortions is one important element of cognitive behavioral therapy, the best method for treating GAD.)

A friend put it well: “I realized that I did everything in a rush. Even simple things like brushing my teeth or making coffee. And 80 percent of what I do on a typical day does not require hurrying and rushing. That creates a lot of stress and worry throughout the day.” I know exactly what he means. I sometimes have the feeling that if I don’t get whatever small household task done at any given moment, the world might end. GADs are not known for their patience.

The worst era of my anxiety disorder was the time before I knew I had it. I knew something was wrong, but not what. I desperately wanted to figure it out. I’d go down every known avenue trying to get an answer. My diagnosis was one of the best things that’s ever happened to me. I am very thankful for it.

Q. If I have GAD, how do I make it go away? Does it last forever?

A. Here’s my thinking on it. The ideal situation is that I’m able to ride the wave. Maybe even get to the point where I can hang in the lull for a long time with little anxiety. When stressful things happen, I expect that my particular gremlin will poke his head out of the wave’s crest. Knowing what to do with him and that I’ve survived his visits before helps a lot.

how I ride the sine wave

how I ride the sine wave

Meditation. Medication. A moderate amount of reading and learning (in other words, don’t overdo it). Communication.

Q. Can anyone develop it? What’s the line between having it and just being a regular stressed out American?

A. Right now, I am seeing the world through anxiety-tinted lenses, so I tend to see anxiety in a lot of people around me. Ultimately, though, the difference between regular anxiety, stress, and GAD comes down to degree. Most people aren’t fainting or getting up in the middle of the night. Most don’t need neck rubs every day. And most aren’t negatively predicting the outcomes of regular social interactions in a way that adds extra stress to daily life.

One of my friends, who learned through my experience that he has GAD too, said, “I tend to project into the future as I experience almost everything. And I’m often planning how to deal with some negative turn of events that might happen in the future, but most likely never will. So I’m worrying in the present about something that will never happen in the future.” If that sounds familiar, you might want to read more about Generalized Anxiety Disorder.

Q. Is this what has been wrong with me?

A. I can’t tell you that, but I can tell you that if anything that I’ve said has rung true, a great place to start is the book The Worry Cure. Don’t think about the title too much and don’t think about the word “worry.” Just investigate your physical symptoms through the lens of your thoughts, and see if what this book has to say relates to you. If not, then you don’t have GAD.

Q. Will I ever feel better?

A. I believe that you will feel better if you have GAD. This is a hard won statement coming from me. I am a skeptic and not one to placate you, reader. But I think that simply the fact of you reading this means that you are going to feel better.

Q. How do you know?

A. Times are changing. People are talking openly about depression, anxiety, and other forms of mental suffering in a way that they never did when I was in my 20s. I’m so glad to see it on behalf of my 5-year-old daughter. The more people speak openly about the spectrum of mental conditions, the more they can be helped earlier on.

I wouldn’t have dreamed of writing something this personal just one year ago. I now feel as though my anxiety needs to be an integrated part of me in order to be managed in a healthy way. I hope that others will feel that way too.

Q: What should I do if I’m a friend or family member of a Gaddie?

A: I feel for you. It’s not easy to deal with an anxious person, especially at the high pitch levels that people with GAD specialize in.

Yeah, I could see where Bob was coming from.

It’s hard to avoid the role of friend-therapist. You might find yourself talking your friend down and trying to give them a more realistic view of their surroundings. The goal is to help them build those muscles for themselves without exhausting yourself. Bottom line: get the oxygen mask on yourself first.

On the other hand, it can also be confusing because GAD often presents as perfectionism, or invulnerability. How do you help someone who doesn’t seem to need help? Take in the information you have and tune in to your instincts. Is the person talking super fast? Are they in a lot of physical pain? Do they seem complainy? If so, they may need to learn to tune in to how they are responding to the world around them. As a friend, you can help by gently encouraging them to go easy on themselves and stay grounded in the moment. Send them a link to this piece. Do it with love.

Originally published on Oct 15, 2015 on Medium and Huffington Post. Updated April 8, 2017.