Generalized Anxiety Disorder in Women

Generalized anxiety disorder (GAD) is a form of medically serious anxiety characterized by persistent, extreme worry about a variety of everyday events, situations and circumstances. While most people worry about things in their lives to a certain degree, people with GAD develop ongoing levels of stress and anxiety that damage their ability to function and participate in relationships, social activities, leisure activities, school, or work. Compared to men, women have much greater chances of developing generalized anxiety. In addition, women have gender-specific risks for the disorder during pregnancy and menopause.

GAD Basics

According to guidelines established by the American Psychiatric Association, doctors must follow certain criteria in order to make a generalized anxiety disorder diagnosis. First, the affected individual must experience unusually high levels of generalized worry and anxiety for at least six months. He or she must also have at least three of six specific anxiety symptoms during this time period, including sleeping difficulties, irritability, difficulty concentrating, unusual susceptibility to fatigue, noticeable muscular tension, or feelings of restlessness or mental tension. In addition, the affected individual must have considerable difficulty controlling his or her anxiety-related symptoms; must have symptoms not attributable to other psychiatric problems; and must have symptoms severe enough to disrupt participation in daily life. A number of factors can potentially contribute to the onset of GAD. For example, the condition tends to run in family bloodlines, and therefore may have a strong genetic component. People with the disorder also may have alterations in their normal levels of certain brain chemicals called neurotransmitters; specific neurotransmitters that may play a role here include norepinephrine, dopamine, and serotonin. In some cases, GAD first appears in the aftermath of a specific stressful or traumatic event (or series of events) such as a death in the family or sexual or physical abuse. In other cases, use of chemically addictive substances such as alcohol, nicotine or various drugs contributes to the formation of GAD symptoms. Practically speaking, these factors regularly overlap and reinforce each other. Additional potential contributing factors include the onset of menopause and the presence of health problems such as heart disease, thyroid gland dysfunction and gastroesophageal reflux disease (GERD). Generalized anxiety disorder commonly appears for the first time during childhood or adolescence, but it can also appear in early or later adulthood. Typically, its symptoms take hold gradually and only cause significant problems after an extended amount of time. While people with the disorder have a generally heightened level of anxiety, the severity of specific symptoms typically builds and dissipates instead of remaining constant. Most people with GAD experience an increase in symptom severity when they’re exposed to high levels of real-world stress. Roughly 7 million American adults have some form of the disorder.

Frequency in Women

Compared to men, women develop generalized anxiety disorder at a ratio of more than two to one. This phenomenon may occur, in part, because women undergo menopause and have higher risks than men for thyroid disease. It may also stem from women’s relatively high risks for borderline personality disorder and certain other personality-related conditions that can increase risks for GAD. In addition, it may stem from the greater frequency of sexual abuse in female children. Interestingly, this 2:1 gender ratio between men and women remains the same for essentially all other types of anxiety disorders as well.

GAD and Pregnancy

Women have increased risks for both anxiety and depression during pregnancy. According to a 2007 study published in “Obstetrics and Gynecology,” approximately 54 percent of all pregnant women develop medically serious forms of anxiety, and approximately 37 percent of all pregnant women develop medically serious forms of depression. In 2011, the Massachusetts General Hospital Center for Women’s Health released the results of a study that specifically examined the prevalence of GAD during pregnancy. The authors of the study found that 9.5 percent of pregnant women develop the disorder in at least one of their three trimesters. This compares to the roughly 8 percent of non-pregnant women with a GAD diagnosis. The highest percentage of GAD cases appears during the first trimester of pregnancy, and each successive trimester produces smaller and smaller percentages of the disorder. Women who develop serious manifestations of GAD symptoms before pregnancy have the highest risks for the disorder during pregnancy. Other factors that contribute to the appearance of generalized anxiety during pregnancy include a personal history of child abuse and a relative lack of education or general social support.

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