PTSD and Generalized Anxiety Disorder (GAD)

PTSD and generalized anxiety disorder often occur together

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PTSD and generalized anxiety disorder (GAD) often occur together. This is not entirely surprising given that people with post-traumatic stress disorder (PTSD) are at heightened risk to develop a number of different anxiety disorders, including panic disorder, social anxiety disorder and obsessive-compulsive disorder. Before talking about the relationship between PTSD and GAD, it is important to first describe the symptoms of GAD.

What is Generalized Anxiety Disorder?

GAD is an anxiety disorder. According to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, GAD is made up of the following symptoms:

  • The presence of excessive anxiety and worry about a variety of topics, events, or activities. Worry occurs more often than not for at least six months, and is clearly excessive.

Excessive worry means worrying even when there is nothing wrong, or in a manner that is disproportionate to actual risk. This typically involves spending a high percentage of waking hours worrying about something. The worry may be accompanied by reassurance-seeking from others.

In adults, the worry can be about job responsibilities or performance, one’s own health or the health of family members, financial matters, and other everyday, typical life circumstances.

  • The worry is experienced as very challenging to control.

Worry in both adults and children may shift from one topic to another.

  • The anxiety and worry is associated with at least three of the following physical or cognitive symptoms (In children, only one symptom is necessary for a diagnosis of GAD.):
  1. Edginess or restlessness.
  2. Tiring easily; more fatigued than usual.
  3. Impaired concentration or feeling as though the mind goes blank.
  1. Irritability (which may or may not be observable to others).
  2. Increased muscle aches or soreness.
  3. Difficulty sleeping (due to trouble falling asleep or staying asleep, restlessness at night, or unsatisfying sleep).
  4. Many individuals with GAD also experience symptoms such as sweating, nausea or diarrhea.

  5. The anxiety, worry, or associated symptoms make it hard to carry out day-to-day activities and responsibilities. They may cause problems in relationships, at work, or in other important areas.
  6. These symptoms are unrelated to any other medical conditions and cannot be explained by the effect of substances including a prescription medication, alcohol or recreational drugs.
  7. These symptoms are not better explained by a different mental disorder.

The Relationship Between PTSD and GAD

Studies have found that approximately 17 percent of people who have had PTSD at some point in their life have had GAD as well. This rate is much higher than what is found in the general population for GAD (4 to 6 percent).

In fact, people with a history of PTSD are almost six times as likely to have a current or past diagnosis of GAD compared to people without PTSD.

Why Might PTSD and GAD Occur Together?

Although more research needs to be done to better understand the association between PTSD and GAD, there are some theories as to why these two conditions often co-occur. First, compared to people without PTSD, those with a diagnosis of PTSD may be more likely to engage in worry -- the central, defining feature of GAD. Worry has been found to reduce bodily arousal, and people with PTSD suffering from intense hyperarousal symptoms may be particularly likely to rely on coping strategies that can reduce that arousal.

In addition, people who worry often report that their worry distracts them from more upsetting things. Given this, people with PTSD may use worry as a way of getting some distance (even if it is temporary) from upsetting thoughts and feelings.

Another possible explanation for the association between PTSD and GAD is that these two disorders have similar origins. Just as the experience of a traumatic event increases risk for PTSD, it also increases risk for GAD. People with GAD are much more likely to have had experienced a past traumatic event than people without GAD.

Finally, it is also important to consider that there might be a shared biological cause for both disorders. In other words, some people might have some kind of genetic vulnerability for developing both PTSD and GAD following the experience of a traumatic event.

References:

American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed. Washington, DC: Author.

Borkovec, T.D., & Hu, S. (1990). The effect of worry on cardiovascular response to phobic imagery. Behaviour Research and Therapy, 28, 69-73.

Borkovec, T.D., & Roemer, L. (1995). Perceived functions of worry among generalized anxiety disorder subjects: Distraction from more emotionally distressing topics? Journal of Behavior Therapy and Experimental Psychiatry, 26, 25-30.

Kessler, R.C., Berglund, P.A., Demler, O., Jin, R., Merikangas, K.R., & Walters, E.E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 62, 593-602.

Kessler, R.C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C.B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048-1060.

Roemer, L., Molina, S., Litz, B.T., & Borkovec, T.D. (1996/1997). Preliminary investigation of the role of previous exposure to potentially traumatizing events in generalized anxiety disorder. Depression and Anxiety, 4, 134-138.

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