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Matthew D. Jacofsky, Psy.D., Melanie T. Santos, Psy.D., Sony Khemlani-Patel, Ph.D. & Fugen Neziroglu, Ph.D. of the Bio Behavioral Institute

People with Generalized Anxiety Disorder (GAD) have uncontrollable, excessive anxiety and excessive worry across several situations. This worry and anxiety happens on more days than not, and persists for six months or more. A person with GAD finds it very difficult to control or discontinue the worry, or anxiety, despite their best efforts to do so. Excessive anxiety is also referred to as anxious apprehension in the literature. This term was coined because anxiety is viewed as an emotion, focused on the future, where a person is preparing to deal with some anticipated negative circumstance. Excessive worry is referred to as apprehensive expectation because a person is always expecting some sort of terrible event will happen at any moment and that they are not safe. The feeling would be similar to walking around in a minefield while blindfolded.

To meet the criteria for GAD, several physical symptoms must also be present on most days. These include; restlessness; becoming easily fatigued; problems concentrating or "zoning out;' irritability; muscle tension; and sleep disturbances.

The anxiety and worries of GAD are not as specific as they are in the other anxiety disorders already discussed (e.g., Phobias and Panic Disorder). Instead, they are more "general," hence the name - Generalized Anxiety Disorder. Adults with GAD tend to worry about everyday things such as finances, job responsibilities, and tending to one's home and family. Children are apt to worry about their abilities, future events, past behaviors, making mistakes, and school performance. This chronic worrying and anxiety causes people with GAD feel "keyed up" or "on edge" much of the time.

The focus of the worry can shift throughout the course of GAD. For instance, if someone with GAD was worrying a lot about their finances, but then received a big promotion at work, their worry would simply shift to something else, such as worrying about the new job responsibilities they now have.

While everyone may tend to worry about their finances, job, and family from time-to-time (which can actually be an adaptive way of coping), individuals with GAD experience anxiety and worry that is out of proportion. They tend to overestimate risk, or to misjudge the likelihood of a negative outcome of some future event. Adults with GAD may not see their anxiety as excessive, but they usually agree that it is having a negative impact on their functioning.

Children and adolescents with GAD tend to worry about their performance, even when it is not being evaluated. As such, they may develop perfectionistic tendencies. They can become highly concerned about being on time, or worry that some unlikely event will cause them to be late. They may seek constant reassurances and approval.

Treatment for GAD is found in the Treatment Section.

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Matthew D. Jacofsky, Psy.D., Melanie T. Santos, Psy.D., Sony Khemlani-Patel, Ph.D. & Fugen Neziroglu, Ph.D. of the Bio Behavioral Institute People with Generalized Anxiety Disorder (GAD) have uncontrollable, excessive anxiety and excessive worry across several situations. This worry and anxiety happens on more days than not, and persists for six months or more.

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The impacts of emotional abuse are just as harmful as physical abuse. How can you help?

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I learned that mental disorders are not always easy to control or get over. It can be difficult to recognize the symptoms or causes, no matter the situation you are involved in. Sometimes the best step towards control is to walk away, seek professional help, seek help from family, or go to a doctor. These solutions do not always work but can be effective in helping. The situation you are in will only defeat you if you allow it to. Suicide is never the answer because you are robbing yourself of the opportunity to live the rest of your life. 

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I learned that mental disorders are not always easy to control or get over. It can be difficult to recognize the symptoms or causes, no matter the situation you are involved in. Sometimes the best step towards control is to walk away, seek professional help, seek help from family, or go to a doctor. These solutions do not always work but can be effective in helping. The situation you are in will only defeat you if you allow it to. Suicide is never the answer because you are robbing yourself of the opportunity to live the rest of your life. 

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Emotional abuse involves controlling another person by using emotions to criticize, embarrass, shame, blame, or otherwise manipulate them. While most common in dating and married relationships, mental or emotional abuse can occur in any relationship-including among friends, family members, and co-workers.

In general, a relationship is emotionally abusive when there is a consistent pattern of abusive words and bullying behaviors that wear down a person's self-esteem and undermine their mental health.

The underlying goal of emotional abuse is to control the other person by discrediting, isolating, and silencing them. It is one of the hardest forms of abuse to recognize as it can be subtle and insidious. But it can also be overt and manipulative.

Either way, emotional abuse can chip away at your self-esteem, and you can begin to doubt your perceptions and reality. In the end, you may feel trapped. Emotionally abused people are often too wounded to endure the relationship any longer, but also too afraid to leave. So, the cycle repeats itself until something is done.

Press Play for Advice on Setting Boundaries

Signs of Emotional Abuse

There are several red flags of emotional abuse. Keep in mind that even if your partner, parent, co-worker, or friend only does a handful of these things versus doing them all, your relationship with them is still emotionally abusive.

When considering your relationship, also remember that emotional abuse is often subtle. As a result, it can be extremely hard to detect the signs. If you are having trouble discerning whether your relationship is abusive, think about how your interactions make you feel.

Also, don't fall into the trap of telling yourself that "it's not that bad" and minimize the other person's behavior. Everyone deserves to be treated with kindness and respect, including you. Realizing this can help you stop the emotional abuse cycle.

Unrealistic Expectations

One sign of emotional abuse is if the other person places unrealistic expectations on you. Examples of this include:

Making unreasonable demands

Expecting you to put everything aside and meet their needs

Demanding you spend all your time together

Being dissatisfied, no matter how hard you try or how much you give

Criticizing you for not completing tasks according to their standards

Expecting you to share their opinions (i.e., you are not permitted to have a different opinion)

Demanding that you name exact dates and times when discussing things that upset you (and when you cannot do this, they may dismiss the event as if it never happened)

​Invalidates You

Another sign that someone may be emotionally abusive is if they invalidate you. Some examples of invalidation include:

Undermining, dismissing, or distorting your perceptions or your reality

Refusing to accept your feelings by trying to define how you should feel

Requiring you to explain how you feel over and over

Accusing you of being "too sensitive," "too emotional," or "crazy"

Refusing to acknowledge or accept your opinions or ideas as valid

Dismissing your requests, wants, and needs as ridiculous or unmerited

Suggesting that your perceptions are wrong or that you cannot be trusted by saying things like "you're blowing this out of proportion" or "you exaggerate"

Accusing you of being selfish, needy, or materialistic if you express your wants or needs (the expectation is that you should not have any wants or needs)

​Creates Chaos

Emotionally abusive people also tend to create chaos. Some examples of this red flag include:

Starting arguments for the sake of arguing

Making confusing and contradictory statements (sometimes called "crazy-making")

Having drastic mood changes or sudden emotional outbursts

Nitpicking at your clothes, hair, work, and more

Behaving so erratically and unpredictably that you feel like you are "walking on eggshells"

​Uses Emotional Blackmail

If someone tries to use your emotions against you, this is a sign of emotional abuse. Examples of emotional blackmail include:

Manipulating and controlling you by making you feel guilty; giving you a guilt trip

Humiliating you in public or in private

Using your fears, values, compassion, or other hot buttons to control you or the situation

Exaggerating your flaws or pointing them out in order to deflect attention or to avoid taking responsibility for their own poor choices or mistakes

Denying that an event took place or lying about it

Punishing you by withholding affection or giving you the silent treatment

Acts Superior

People who are emotionally abusive often act superior and entitled. Things to look for when considering whether the person in your life exhibits this sign of emotional abuse include:

Treating you like you are inferior

Blaming you for their mistakes and shortcomings

Doubting everything you say and attempting to prove you wrong

Making jokes at your expense

Telling you that your opinions, ideas, values, and thoughts are stupid, illogical, or "do not make sense"

Talking down to you or being condescending

Using sarcasm when interacting with you

Acting like they are always right, know what is best, and are smarter than you

Controls and Isolates You

​Emotionally abusive people will attempt to isolate and control you. Some examples of this form of emotional abuse include:

Controlling who you see or spend time with, including friends and family

Monitoring you digitally, including text messages, social media, and email

Accusing you of cheating and being jealous of outside relationships

Taking or hiding your car keys

Demanding to know where you are at all times or using GPS to track your every move

Treating you like a possession or property

Criticizing or making fun of your friends, family, and co-workers

Using jealousy and envy as a sign of love and to keep you from being with others

Coercing you into spending all your time together

Controlling the finances

Types of Emotional Abuse

Emotional abuse can take several different forms, including:

Accusations of cheating or other signs of jealousy and possessiveness

Constant checking on or attempting to control the other person's behavior

Constantly arguing or opposing

Criticizing

Gaslighting

Isolating the individual from their family and friends

Name-calling and verbal abuse

Refusing to participate in the relationship

Shaming or blaming

Silent treatment

Trivializing the other person's concerns

Withholding affection and attention

Your relationship may appear to be normal and loving at the start, with these types of emotional abuse being employed later (as the relationship progresses) in an attempt to begin to manipulate and control you. They may begin so slowly that you may not even notice them at first.

Emotional Abuse vs. Normal Conflict

Impact of Emotional Abuse

Research indicates that the consequences of emotional abuse are just as severe as those of physical abuse. Except, instead of physical marks and bruises, your wounds are invisible to others-hidden in the self-doubt, worthlessness, and self-loathing you may feel.

When emotional abuse is severe and ongoing, you can lose your entire sense of self. Over time, the accusations, verbal abuse, name-calling, criticisms, and gaslighting can erode your sense of self so much that you can no longer see yourself realistically.

Consequently, you may begin to agree with the abuser and become internally critical. Once this happens, you become trapped in the abusive relationship, believing that you will never be good enough for anyone else. Eventually, you may pull back from friendships and isolate yourself, convinced that no one likes you.

What's more, emotional abuse can cause a number of health problems. Mental health effects of abuse include depression, anxiety, and sometimes the development of an eating disorder. Being abused emotionally can also impact you physically, causing you to develop stomach ulcers, heart palpitations, and insomnia.

Tips for Dealing With Emotional Abuse

The first step in dealing with an emotionally abusive relationship is to recognize the abuse. If you are able to identify any aspect of emotional abuse in your relationship, it is important to acknowledge that first and foremost.

By being honest about what you are experiencing, you can begin to take control of your life again. Here are seven more strategies for reclaiming your life that you can put into practice today.

Make Yourself a Priority

When it comes to your mental and physical health, make yourself a priority. Stop worrying about pleasing the person abusing you. Take care of your needs. Do something that will help you think positively and affirm who you are.

Also, be sure to get an appropriate amount of rest and eat healthy meals. These simple self-care steps can go a long way in helping you deal with the day-to-day stresses of emotional abuse.

Establish Boundaries

Firmly tell the abusive person that they may no longer yell at you, call you names, insult you, be rude to you, and so on. Then, tell them what will happen if they choose to engage in this behavior.

For instance, tell them that if they call you names or insult you, the conversation will be over and you will leave the room. The key is to follow through on your boundaries. This reinforces to the other person that their emotional abuse will not be tolerated.

Stop Blaming Yourself

If you have been in an emotionally abusive relationship for any amount of time, you may believe that there is something severely wrong with you. But you are not the problem. To abuse is to make a choice. Stop blaming yourself for something you have no control over.

Realize You Can't Fix Them

Despite your best efforts, you will never be able to change an emotionally abusive person by doing something different or by being different. An abusive person makes a choice to behave abusively.

Avoid Engaging

Do not engage with an abusive person. In other words, if an abuser tries to start an argument with you, begins insulting you, demands things from you, or rages with jealousy, do not try to make explanations, soothe their feelings, or make apologies for things you did not do.

Simply walk away from the situation if you can. Engaging with an abuser only sets you up for more abuse and heartache. No matter how hard you try, you will not be able to make things right in their eyes.

Build a Support Network

Although it can be tough to tell someone that you are going through emotional abuse, speaking up can help. Talk to a trusted friend, family member, or even a counselor about what you are experiencing. Take time away from the abusive person as much as possible and spend time with people who love and support you.

This network of healthy friends and confidantes will help you feel less lonely and isolated. They also can speak truth into your life and help you put things into perspective.

Work on an Exit Plan

If your partner, friend, or family member has no intention of changing or working on their poor choices, you will not be able to remain in the abusive relationship forever. It will eventually take a toll on you both mentally and physically.

Depending on your situation, you may need to take steps to end the relationship. Each situation is different. So, discuss your thoughts and ideas with a trusted friend, family member, or counselor. Emotional abuse can have serious long-term effects, but it can also be a precursor to physical abuse and violence.

Remember too that abuse often escalates when the person being abused makes a decision to leave. So, be sure you have a safety plan in place should the abuse get worse.

What Doesn't Work With Emotional Abuse

Sometimes attempts to deal with or reduce emotional abuse can backfire and actually make the abuse worse. Some tactics that are not effective ways of dealing with abuse include:

Arguing with the abuser. Trying to argue with an abuser can escalate the problem and may result in violence. There is no way to argue with an abuser because they will always find more ways to blame, shame, or criticize. They may also try to turn the tables and play the victim.

Trying to understand or make excuses for the abuser. It might be tempting to try to make sense of the other person's behavior or to come up with excuses to justify their actions. Finding ways to sympathize with or minimize an abuser's actions can make leaving the situation that much more difficult.

Attempting to appease the abuser. Appeasing the other person might seem like a form of de-escalation, but it tends to backfire in the long run and may serve to enable further abuse. Instead of trying to change yourself or your behaviors to suit the abuser's whims, focus on establishing clear boundaries and avoid engaging with them if possible.

Healing From Emotional Abuse

If you've experienced emotional abuse, there are a few things you can do to aid in the healing process.

Acknowledge the abuse. Stop minimizing or even denying the abuse and admit that it did happen so you can begin to heal from it.

Make a commitment to yourself. Commit to stopping the emotional abuse cycle. Also, commit to sticking with the healing process no matter how long it takes because you are worth it and deserve to live a happy life.

Practice self-compassion. Give yourself the same level of compassion, kindness, and flexibility to grow as you would give a friend who has experienced emotional abuse.

Reach out to loved ones. Get in touch with the people who care about and support you so they can help you through this difficult time.

Seek counseling. Psychotherapy can help you put your emotionally abusive relationship into perspective while also providing tools for overcoming the abuse.

Talk with others who've been emotionally abused. Sharing your experiences with others who've been through the same can help you recognize that you aren't alone, also providing access to the strategies they used that helped them heal.

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How to Identify and Cope With Emotional Abuse

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Emotional abuse involves controlling and manipulating with emotionally abusive tactics. Learn more about how emotional abuse is defined and red flags to look for.

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Emotional Abuse: What It Is and Signs to Watch For

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Emotional abuse involves attempts to frighten, control, or isolate you. It can happen in all kinds of relationships. Here's how to recognize it and what to do next.

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Know the Warning Signs | NAMI: National Alliance on Mental Illness

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Learn to identify and talk about symptoms and behavior related to mental health. Find ways to get help, a diagnosis and treatment.

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According to the most recent Diagnostic and Statistical Manual of Mental Disorders (DSM 5), there are nearly 400 different psychological disorders. Some of these disorders fit the definition of "disease," a problem that impairs functioning and that mostly stems from biological causes. Common examples include bipolar disorder and schizophrenia.

Other "disorders" impair functioning but are determined by a more diverse array of causes, some of which are psychological and social/cultural in nature. In this sense, these conditions are not true "diseases." Examples include anxiety disorders, depression, addictive disorders, and eating disorders.

The distinction between "diseases" and "disorders" helps to suggest appropriate treatments. In general, diseases require biological intervention. Research suggests, for example, that medication is very successful in helping individuals to manage symptoms that accompany bipolar disorder and schizophrenia. Although it may encourage them to take their medication regularly, manage stress effectively, and help with emotional struggles, research shows that psychotherapy generally does not help people overcome the symptoms of these diseases very well without biological intervention.

Biological treatments also may help people with disorders in some cases. For example, in one of the largest and most rigorous studies ever conducted on the treatment of clinical depression, researchers in the late 1980s found that antidepressant medication helped manage the symptoms of severe depression (which I would define as involving significant suicidal thinking, that often recurs, or that is chronic) more than other treatment options, at least during the time span in which individuals were taking the medicine.

On the other hand, decades of carefully controlled clinical studies have shown that medication often is not the best treatment for many disorders. Often times, any symptom relief that medication provides ends when individuals stop taking them.

Increasingly, I also see researchers skeptical of the underlying pharmaceutical claim that "chemical imbalances" of serotonin explain why some people struggle with emotional disorders. Apparently, some of the best evidence that there is a chemical imbalance of serotonin involved in disorders such as depression is that antidepressant medications sometimes help. However, this is akin to saying that if Tylenol sometimes helps you overcome a headache, then headaches must be caused by a "Tylenol imbalance." This doesn't necessarily take away from the fact that antidepressant medications can be helpful in some circumstances, but it does suggest, at least, that the mechanisms by which antidepressants sometimes work are in question by many in the scientific community.

According to the most recent data released by the National Center for Health Statistics, approximately 11 percent of all Americans aged 12 and older are taking an antidepressant medication for some reason. Approximately 25 percent of American women aged 40 to 59 are taking an antidepressant. More than 60 percent of individuals taking an antidepressant have done so for over 2 years, and approximately 14 percent have been taking them for over 10 years.

Many of these individuals taking antidepressant medication suffer from significant side effects. Others believe that they are being helped by the medicine and thus do not work to resolve the underlying issues that are at the "root" of the problem. In fact, much of the therapeutic effect of medicine likely stems from psychological factors such as the cathartic release of telling their doctor about their problems, the relationship between them and their doctor, or the faith or hope they experience from the treatment. Of course, there are other ways to treat psychological disorders that may provide these factors without needing to take a pharmacological substance.

The best treatment option for many people who struggle with disorders is psychotherapy. Several forms of psychotherapy - cognitive therapy, behavioral therapy, interpersonal therapy, and psychodynamic therapy - have been found to successfully treat many disorders, including disorders with severe symptoms. Furthermore, compared with the effects of medication, psychotherapy often seems to provide better treatment in the long-term. Perhaps one of the reasons why psychotherapy is so helpful in many cases is that it gets at the "root" causes of people's problems. Furthermore, although psychotherapy seems unrelated to biology, research shows that biological changes happen through this treatment just like it does when medication is helpful.

Available research suggests that there is not necessarily one kind of psychotherapy that is better than the rest (the main exception being that exposure-based treatments seem to work better than all other treatments for anxiety disorders). Rather, it seems that there are certain "common factors" involved in good treatment, including a trusting relationship with a treatment provider, client factors such as motivation to follow suggestions, and the faith and hope that the treatment will help.

Based on this, individuals struggling with depression would do well to seek a referral to a good therapist and "try them out" to see how they "click" with them. Usually, someone can tell after the first session whether they like the therapist. If the first therapist one tries doesn't work out, another provider might work better.

There also are other activities that might help people with disorders. Some of these might be encouraged by a therapist, and include working through self-help materials (see David Burns' books "Feeling Good" and "When Panic Attacks" for books shown to work in comparative research), regular aerobic exercise, keeping an emotions journal in which one writes about difficult emotions, keeping a gratitude journal in which one records what one is most thankful for, engaging in pleasurable activities, talking with a trusted friend about one's problems, performing random acts of kindness, getting lost in nature, and managing stress through effective coping techniques. Although these kinds of activities haven't really been established as successful treatments in themselves, they are linked with mood in various ways. In fact, I wouldn't be surprised if many of these lifestyle-based approaches someday are shown to perform at least as well as - if not better than - conventional treatments available today.

In conclusion, people struggling with a mental illness should know that there is hope. Almost all conditions can be managed effectively through the right combination of treatment options. Many disorders can be overcome long-term without the use of medicine. Probably the most difficult step in treatment is acknowledging that you have a problem and taking the first step to seek help. However, with this humility and courage, people can experience relief and improvement.
Andy Tix, Ph.D., also often blogs at his site The Quest for a Good Life. You can sign up to receive e-mail notifications of new posts at this site.

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Treatment of Psychological Diseases and Disorders

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According to the most recent Diagnostic and Statistical Manual of Mental Disorders (DSM 5), there are nearly 400 different psychological disorders. Some of these disorders fit the definition of "disease," a problem that impairs functioning and that mostly stems from biological causes. Common examples include bipolar disorder and schizophrenia.