Do You Worry Too Much?
We all face stress, but constant anxiety can jeopardize our health
Michael Mufson, M.D., is an assistant professor of psychiatry at Harvard Medical School. He is also the faculty editor of Coping With Anxiety and Phobias, a Special Health Report from Harvard Medical School.
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There's certainly no shortage of things for any of us to worry about, from health and finances to our loved ones' struggles and random acts of violence. Anxiety can be a healthy response to uncertainty and danger, but some people worry in general — about nothing in particular or anything at all. This nonstop anxiety can translate into physical symptoms that just add more fuel to the fire. Such persistent worrying, known as generalized anxiety disorder, affects nearly 7 million American adults.
While many types of anxiety disorders — such as specific phobias or social anxiety disorder — arise from particular situations, generalized anxiety disorder is characterized by constant, debilitating worry and agitation about many things. Individuals with generalized anxiety disorder can't shake the feeling that something bad will happen and that they won't be prepared. They may worry to excess about missing an appointment, losing their job or having a car accident. Some worry about worrying too much.
The source of the anxiety may change, but the anxiety itself is present most of the time and is significant enough to interfere with the person's ability to function normally. This constant state of worry can lead to somatization — an excessive focus on physical symptoms, both real and imagined.
Do You Have Generalized Anxiety Disorder?
Many of us are worriers. But how can you tell if the frequency and magnitude of your worries might amount to generalized anxiety disorder? This quiz can help you make the distinction. If you answer "Yes" to four or more of these questions, you may have generalized anxiety disorder:
- Do you worry a lot about all sorts of events or activities (as opposed to a specific thing like flying, becoming ill or being embarrassed in public)?
- Have you been worrying nearly every day for at least six months?
- Do you have trouble controlling your worries?
- Do you usually have at least three of the physical symptoms of generalized anxiety disorder? (See full list below.)
- Do your symptoms cause you considerable distress?
- Are you sure your symptoms can't be explained by the following factors: illness, trauma, medication or another substance (including caffeine)?
The physical symptoms of generalized anxiety disorder include:
- Racing heart or dry mouth.
- Upset stomach.
- Sweating or trembling.
- Fatigue, difficulty sleeping or restlessness.
- Trouble concentrating.
- Muscle tension.
- Feeling tense or on edge.
For a clinical diagnosis of generalized anxiety disorder, at least three of these symptoms must occur more days than not for at least six months. Only your doctor can determine whether or not you meet the criteria.
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For those who have generalized anxiety disorder, therapy can help, particularly cognitive behavioral therapy. CBT helps people recognize when they are misinterpreting events, exaggerating difficulties and making unnecessarily pessimistic assumptions. This form of therapy also helps individuals with generalized anxiety disorder learn new ways to respond to provoking situations.
Medication is sometimes part of treatment as well. Frequently prescribed drugs include antidepressants, like selective serotonin reuptake inhibitors (Prozac or Zoloft) or dual serotonin and norepinephrine reuptake inhibitors (Effexor or Cymbalta). These drugs take longer to work than traditional anti-anxiety drugs, but may provide greater symptom relief over time.
How the Worried Well Can Relax
Not everyone who experiences frequent worry has an anxiety disorder. You may be one of the many "worried well." If you don't have an anxiety disorder but think you worry too much, you can employ some strategies to lighten up:
- Relaxation techniques Listen to music or to relaxation recordings to take your mind off whatever is worrying you. A variety of stress-reducing techniques can help, including mindfulness meditation, body scanning and visualization.
- Exercise Studies have found that physical exercise improves mood and modestly decreases anxiety symptoms. The type of exercise is less important than its frequency — aim for at least 30 minutes of moderate activity on all or most days.
- Biofeedback If other techniques don't do the trick, biofeedback may help. It helps you become more aware of your body's responses to stress and teaches you to control them using relaxation and cognitive techniques. A clinician experienced in biofeedback can help you do this by measuring specific body functions, like heartbeat, and feeding them back to you in the form of sound or light.
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