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At it's very core, Generalized Anxiety Disorder (GAD) is characterised by excessive worry about a wide variety of events and situations. According to the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders, "The intensity, duration or frequency of the anxiety is out of proportion to the actual likelihood or impact of the anticipated event." Essentially, an individual with GAD will worry and stress about the same things the average person would worry and stress about like school, work, and relationships; however, said worry is far worse, lasts longer, and occurs more frequently.

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Both average people and individuals with GAD with stress about the same things, but with varying frequency, duration, and intensity.

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The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (often referred to as the DSM-5) contains the diagnostic criteria for any and all mental illnesses or disorders. In it, the following is outlined as the criteria met by individuals with GAD:
1.) You have had high levels of worry about common things like school, friends, work, etc more often than not in the last 6 months.
2.) It is difficult to keep that worry under control.
3.) You exhibit three of the six following symptoms:

a.) Restlessness/on-edge,
b.) Easily tired,
c.) Mind goes blank and/or is easily distracted,
d.) Unexplained irritability,
e.) Muscle tension,
f.)  And issues with falling and staying asleep.

These psychological symptoms also occur more often than not in the last six months.
4.) Your major areas of functioning (i.e. school performance, work, social abilities etc.) are difficult due to the anxiety and associated physical symptoms.
5.) The symptoms can not be better attributed to other substances or medical concerns.
6.) Your symptoms also can not be better attributed to other concurrent psychiatric disorders.

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In addition to the heightened psychological distress experienced by individuals with GAD, many experience a host of physical symptoms like trembling, headaches, sweating, and intense changes in body temperature. Furthermore, they are at a greater risk for experiencing a panic attack. These physical symptoms only compound the mental and emotional stress that is created by GAD.

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The phrase "panic attack" is thrown around quite casually by many people, but the true reality of panic attacks is grim and quite frankly awful. According to Encyclopedia Britannica, the intense fear and sensitivity created by a panic attack are a result of misinterpreting non-threatening stimuli as harmful and scary. In addition to the physical symptoms like hyperventilation, numbness in the limbs, and chest pains, there are hallmark thoughts associated with panic attacks. These include a fear of losing control, feeling like you're going to die, or the notion that the room is caving in on you. The first time they occur, people often visit the emergency room mistaking them for a heart attack, but while they can have a similar intensity level, they are not life threatening and individual attacks can only last for a maximum of 30 minutes.

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The Link Between Anxiety and Depression 

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The Link Between Anxiety and Depression 

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According to an article written by David Axelson and Boris Birmaher, M.D, there is a significant relationship between depression and anxiety, so much so that recent studies have even lead some psychologists to wonder if that they may be intertwined in the same disorder. Axelson and Birmaher specifically theorized that this connection may be due to the fact that "anxious youth and depressed youth share a cognitive style marked by a negative bias in information." In other words, because both conditions cause people to view the world through a negative veil, similar thought processes and behaviors. The good news is that treatment for both depression and anxiety is very similar.

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The good news is that generalized anxiety is extremely treatable, but it is important to note that treatment is not going to look the same for everyone. The Anxiety and Depression Association of America states that the success and duration of treatment will vary from person to person and is influenced by a variety of factors including (but not limited to) substance abuse, coexisting psychological conditions, or the severity of the anxiety condition itself. Most people use and approach that includes psychotherapy, medication, or a combination of the two.

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This method includes talking with a licensed mental health practitioner to address the root cause of anxiety and reduce those debilitating symptoms.

Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) is widely regarded by psychologists to be the most effective form of psychotherapy for generalized anxiety disorder. It uses the cognitive triangle model to help clients shift their thought processes and alter behaviors that are not conducive to recovery. It is incredibly goal oriented and focuses intensely on building off the momentum developed from previous successes. While it is useful in treating a variety of mental health concerns, CBT for generalized anxiety disorder in particular includes teaching skills like thought stopping, evaluation of perceived and likely outcomes, and problem solving abilities. Sessions are generally on a biweekly basis but can be altered to fit individual needs, and are roughly 1 hour long.

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There are a few different types and classes of medications that are completely safe and effective for treating Generalized Anxiety Disorder. Of course, different medications will work better for different people and a psychiatrist will work with patients to ensure the benefits of a certain drug and dosage outway any potential risks or side effects.

Antidepressants:
The first type of medications used to treat chronic anxiety are actually antidepressants. As previously discussed, anxiety and depression are psychologically linked very closely, and actually, can be caused by the same neurochemical imbalances in the brain. The three classes of antidepressants most commonly prescribed for treating generalized anxiety disorder are selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and specific tricyclic antidepressants. These all work by altering the way different neurotransmitters are reabsorbed into the brain and increasing the concentration of those helpful neurotransmitters. Regardless of the reason antidepressants are prescribed, they must be taken on a daily basis regardless of current mental state because they must build up in the body for at least 4-6 weeks and remain in the body for the duration of treatment for them to be effective. It's also important to know that the first medication and dosage tried may not work, and that's okay! It takes a lot of patience, trial-and-error, and perseverance to find the right one for each individual.

Benzodiazepines:
The other most common type of drugs used to treat anxiety is benzodiazepines. While these are most often prescribed and used for short term immediate relief of anxiety and panic, there are some that are appropriate for long term regiments. That being said, benzodiazepines are usually the last line of defence after other forms of medication have been tried and proven ineffective and/or intolerable. This is due to the risk of dependency and possible withdrawal symptoms as a result. However, as noted by Starcevic in their paper, 'Benzodiazepines for anxiety disorders: maximizing the benefits and minimising the risk," this dependence is not quite the same as an addiction in that the pharmacological dependence (i.e. chemical dependence by systems in the body) is far more pronounced than the psychological dependence (i.e. thought processes that promote dependence based behaviors) like we see in other drug or substance abuse cases.

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While certainly not an "end all be all" solution, there are certainly some lifestyle habits and changes that can aid in the recovery process. Exercising, getting enough sleep, and eating healthy balanced meals all help to take some of the physical stress off the body, and avoiding alcohol, drugs, smoking, and caffeine, which all contain substances that worsen anxiety, help promote a healthy balance of chemicals within the nervous system.

It is vital to recognize that most individuals with generalized anxiety disorder cannot simply achieve recovery with lifestyle changes alone, and it is important that they be provide with the support and opportunities needed to seek treatment in the form of psychotherapy and/or medication under the guidance and supervision of a psychiatrist or other qualified medical practitioner in addition to making positive lifestyle changes.

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Despite efforts made by advocates for and individuals battling with mental illness, there is certainly still a prevalence of stigma that surrounds the mental health conversation. While it is not associated solely with generalized anxiety disorder, it still has a massive impact on those who are living with it  In fact,  an article published in the Psychological Science in the Public Interest journal stated, "The prejudice and discrimination that comprise the stigma of mental illness is one important reason for the disconnect between effective treatments and care seeking," (Corrigan, Druss, and Perlick). Unfortunately, the way society and the general population treats mental illness can severely limit the number of people who actively seek help for managing their mental health when they need it most. Since "satisfactory personal experiences with mental health services as well as accurate mental health knowledge contribute to positive mental health attitudes among teens," (Chandra and Minkovitz), it is especially important that high school students receive proper education regarding mental health and available mental health resources.

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Mental health can be divided into 4 sections, as pictured below, however it is important to recognize that one section can certainly have influence over another. For instance, a person who is exposed to large amounts of public stigma may then internalize those comments and the most prevalent type of stigma may transition to self stigma.

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Corrigan, Patrick W., et al. “The Impact of Mental Illness Stigma on
Seeking and Participating in Mental Health Care.” Psychological Science in the Public Interest, vol. 15, no. 2, Mar. 2014, pp. 37–70., doi:10.1177/1529100614531398.

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Many researchers agree that stigma is created from a perfect storm of lack of knowledge, cultural perceptions, and the social network surrounding the individual. Misinformation can help in the circulation of myths, cultural perceptions shape the notion of "acceptable" behaviors and can create shame for "abnormal" behaviors, and the collective beliefs of the social circles a person exists in all play a huge role in the likelihood that an individual seeks treatment. Because these are the major contributing factors to mental illness stigma, they are also the main focus points of campaigns created to end the stigma. Accurate information is spread to minimise the prevalence of hurtful and inaccurate stereotypes, organizations have enacted cross-cultural efforts to begin challenging entrenched discrimination, and creating supportive networks is a key part of most treatment programs.

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1.) It's the reason I do things the way I do and the way that I am.

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1.) It's the reason I do things the way I do and the way that I am.

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If someone were to follow me throughout my day, I could very easily point out reactions, habits, and thought processes about everyday things that occur as a result of my anxiety or as a result of my recovery journey. In the mornings I set my alarm an hour early because that's how long it takes me to mentally prepare for my day. In classrooms I always sit as close to the door because having a visible out is a bit like a security blanket for me. I keep a very detailed planner because I've learned that being organized about dates and times alleviates some of my stress. I always carry earbuds with me because my anxiety makes my hypersensitive to sensory input. I carry safety cards in my backpack and car in case I have a panic attack in public and someone is trying to communicate or help me. Sometimes it can be a bit consuming because it feels like all I am doing is managing my worries, but the more I work on it and the more I build those skills, the easier it is to fall back on my habits and routines to keep me happy and healthy. By describing my experiences to others, it helps them understand some of my quirks which in turn helps me form stronger relationships with them.

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I'm an independent individual with a fierce stubborn streak, so when I was first coming to terms with my current diagnosis there was definitely a period of denial that I had to work through. Part of that process for me was having many conversations that went over and over all of the information included in this project. While doing so was often difficult, it really helped me reach a place of acceptance with it. It was a habit I kept up when I discovered that being truly honest with the people who care about me and my mental health opened up doors for me to grow that support network that is so important. Not only to I have a strong safety net of people who walk with me on my journey, but I have connected with people who are on journeys of their own. We offer each other support and advice during our lowest points and celebrate the tiny little victories we have each day. Being upfront and honest with people about my anxiety has helped me to form some of the closest relationships I have with people.

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If there's anything I'd like to leave people with by talking about generalized anxiety is that they are not alone, their struggles are legitimate, and that there are options out there that will help them find recovery. For friends of people who are dealing with GAD or any sort of mental health challenge, I hope there is at least one thing I share that makes them feel like they can help or at the very least invokes a sense of empathy and compassion.

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If you or someone you know is in crisis PLEASE reach out for help. The hotlines listed below are completely confidential, open 24/7, and many offer chat lines and text services if calling is too intimidating or scary. Take a picture. Save them in your phone. You never know when you might need them for yourself or someone you love.

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Bailey , Eileen. “How Antidepressants Are Used to Treat Anxiety.” Health Central, Health Central, www.healthcentral.com/anxiety/medication-285693-5.html.

Chandra, Anita, and Cynthia S. Minkovitz. “Factors That Influence Mental Health Stigma Among 8th Grade Adolescents.” Journal of Youth and Adolescence, vol. 36, no. 6, 2006, pp. 763–774., doi:10.1007/s10964-006-9091-0.

Corrigan, Patrick W., et al. “The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care.” Psychological Science in the Public Interest, vol. 15, no. 2, Mar. 2014, pp. 37–70., doi:10.1177/1529100614531398.

Diagnostic and Statistical Manual of Mental Disorders: DSM-5. American Psychiatric Publishing, 2014.

“Generalized Anxiety Disorder.” Beck Institute for Cognitive Behavior Therapy, Beck Institute for Cognitive Behavior Therapy, www.beckinstitute.org/detail/generalized-anxiety-disorder/.

Mayo Clinic Staff. “Generalized Anxiety Disorder.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 25 Sept. 2014, www.mayoclinic.org/diseases-conditions/generalized-anxiety-disorder/basics/treatment/con-20024562.

Starcevic, V. “Benzodiazepines for Anxiety Disorders: Maximising the Benefits and Minimising the Risks.” Advances in Psychiatric Treatment, vol. 18, no. 4, Jan. 2012, pp. 250–258., doi:10.1192/apt.bp.110.008631.

“Treatment.” Anxiety and Depression Association of America, ADAA, ADAA, adaa.org/finding-help/treatment.

“Understanding Generalized Anxiety Disorder -- Diagnosis and Treatment.” WebMD, WebMD, www.webmd.com/anxiety-panic/guide/understanding-anxiety-treatment#1.

“What Is Cognitive Behavior Therapy | Beck Institute.” Beck Institute for Cognitive Behavior Therapy, Beck Institute for Cognitive Behavior Therapy, www.beckinstitute.org/get-informed/what-is-cognitive-therapy/.

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Unless otherwise noted in caption, all images were created and are owned by Sophie Kooiman.