Anxiety and Its Disorders: The Nature and Treatment of Anxiety and Panic

By David H. Barlow | Go to book overview

CHAPTER 14
Generalized Anxiety Disorder

LIZABETH ROEMER SUSAN M. ORSILLO DAVID H. BARLOW

In the first edition of this book (Barlow, 1988) it was noted that despite the apparent prevalence of chronic, general anxiety (according to estimates from primary care physicians), it had been difficult to successfully identify and classify individuals under the rubric of generalized anxiety disorder (GAD). At the time of that edition, GAD had just recently been classified as a separate, nonresidual category, based in part on the identification of worry (apprehensive expectation) as its central defining feature. This development, along with the diagnostic revisions that followed it, has dramatically increased our understanding of the nature of this disorder, its associated features, and its successful treatment. In large part, this improvement stems from extensive basic research on the phenomenon of worry, elucidating its nature, function, and maintaining factors.

Because worry and accompanying neurobiological features are common features across the anxiety disorders (see Chapter 3), GAD (centrally defined by worry) may in fact be the "basic" anxiety disorder. That is, our understanding of the etiological and maintaining factors of GAD may have implications for the understanding of all anxiety disorders. In fact, given the apparent close association between GAD and major depression (discussed below), the study of this disorder may indeed be relevant to the understanding and treatment of all emotional disorders.

We begin this chapter with a brief review of the history of the diagnosis of GAD, because the refinements in the diagnostic criteria for GAD have played an important role in enhancing our understanding and successful treatment of this disorder. We then review the epidemiology and demographic characteristics of GAD. A large portion of the chapter is devoted to reviewing research and theory regarding important characteristics and maintaining factors of GAD and worry; it is here that conceptualizations likely to be relevant to many (if not all) emotional disorders are introduced. The etiological model of GAD (similarly relevant across the anxiety disorders; see Chapter 8) is reviewed next. After a summary of major assessment tools commonly used with individuals diagnosed with GAD, we conclude with discussions of pharmacological and psychosocial interventions for GAD. We address the existing literature in these areas, as well as issues that are the focus of current theoretical and empirical inquiry.

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