Generalized anxiety disorder in medical practice

Generalized anxiety disorder (GAD), characterized by excessive anxiety and worry, is one the most common anxiety disorders. Since it is phenomenologically close to normal anxiety, the majority of GAD patients are seen by primary care physicians. Patients often complain of being overstressed rather than anxious and present vague somatic complaints. However, GAD is a heterogeneous disorder; patients differ in onset, type and intensity of worries, degree of hyperarousal, and physical manifestations. Personality traits influence their behavioral responses. Physical complaints tend to cluster around muscular, cardiovascular or gastrointestinal symptoms. On physiologic recordings, increased muscle tension is always present. Autonomic responses tend to show diminished flexibility in response to mild stressors, possibly due to dysfunctional central information processing involving failure to discriminate anxious and neutral stimuli. However, predisposed patients show strong autonomic responses to stressors and, in the presence of medical comorbidity, anxiety may crystallize around the physical state. Therefore, psychologic and pharmacologic treatments for each case need to be considered individually.