GENERALIZED ANXIETY DISORDER
Constantly feeling anxious, often about small things, having chronic worries,
spending a lot of time worrying about things that are considered uncontrollable,
difficulty concentrating, fatigue, impatience, irritability, and extreme muscle tension.
Concerns that are often felt are their health and daily problems (being late for a meeting
or a lot of work to get done). GAD generally begins in mid-teens.
• Kriteria DSM-IV-TR :
1. Excessive anxiety and worry
2. These concerns are difficult to control
3. The patient experiences three or more of the following: impatience, extreme
fatigue, difficulty concentrating, irritability, muscle tension, sleep
disturbances
• Etiologi Generalized Anxiety Disorder
a. Psychoanalytic Views
An unconscious conflict between the ego and impulses – impulses id (usually
sexual or aggression in nature). Anxiety is not diverted to a specific object or
situation so that it always feels anxious
b. Cognitive Behavioral Views
Caused by a distorted thought process. Example: crossing the road is
considered a threatening thing and their cognition is focused on anticipating
various disasters in the future. Borkovec and his colleagues focused on the
main symptom of GAD being worry. The main key to dealing with GAD is
to realize that worry doesn't create much emotional tension. Example: people
with GAD are more likely to experience post-traumatic events that include
death, injury, or illness. Even though this is not something they are worried
about, but various images of the painful post-trauma
c. Biological Perspectives
GAD can have a genetic component. GAD is often found in people who have
a family relationship with the person with this disorder. However, the level
of this genetic component seems to be low
• GAD Therapy
a. Psychoanalytic Approach
The treatment is almost the same as a phobia. Focus on interpersonal conflicts
in past and present lives . Today, cognitive behavioral therapists are
encouraged to solve social problems.
b. Behavioral Approach
Clients who experience GAD are considered afraid to criticize and be
criticized by others. Systematic desensitization becomes a possible therapy.
General treatments such as intensive relaxation are expected to learn to relax
when experiencing tension.
c. Cognitive Approach
Helping clients master any skills that can foster a sense of competence.
Including assertiveness can be taught through verbal instruction, modeling,
or the formation of an operant or a careful combination of the three.
d. Biological Approach
Anxiolytic is probably the most widely used handle for GAD. Valium and
xanax setra buspirone (buSpar) are also often used. Unfortunately, the drug
has side effects ranging from drowsiness, memory loss, and depression to
physical dependence and damage to body organs. In addition, if you do not
use the drug, the benefits you feel will be lost.
Case Examples
#Generalized Anxiety Disorder
Margie, 10, was referred to for crying too often at school, which has worsened
little by little in recent months. This sadness is unpredictable. He often cries when he is
talked to by his teacher or when playing with his friends during recess. In the referral
letter, her family doctor described Margie as a worried person.
In a preliminary interview, Margie said that she was worried about various daily
routine activities and responsibilities. He was worried about doing poorly at school,
worried that his friends wouldn't like him, and that his parents would be disappointed
in the way he did his housework. Margie is also worried about her health and often
suffers from stomach pain. He also has fears about his family's safety. Mergie has a
great concern for the future: worried about failing exams, not being able to find a job,
not being able to find a partner and marrying the wrong person. He constantly feels
restless and cannot relax. Margie is the eldest of 4 children and the only daughter in the
family.
#Phobias
Andri is a student at one of the elementary schools in Semarang, he has the
problem of not being able to establish good social relationships with his peers because
he plays too many online games. As time went by and Andri's inability to solve the
problems he faced, Andri's problems became widespread. Not only with their peers but
also with teachers. What is of concern is when Andri talks to other people. Unfocused
on the other person, only smiling while moving his head with a broken count like a stiff
wooden doll and a blank gaze straight ahead. The focus count for staring at the
interlocutor is less than 6 seconds and focusing on the topic of conversation is less than
9 seconds. This pattern repeats continuously when Andri is faced with a situation that
requires him to communicate with two or more people. The pattern that repeats
constantly every time he talks to Andri, makes his classmates stay away from Andri.
There was even a teacher who yelled at Andri by using the words "gendheng and
autistic."
A new problem arises. Andri was not present at school for almost 1 week.
According to his mother's confession, every time he was told to go to school, Andri's
body suddenly became hot and his feet were cold accompanied by diarrhea. Four
permits were not allowed to enter due to illness from Andri's parents, which were on the
teacher's desk. Three times checked by his parents, no dangerous diseases were known.
According to the doctor's analysis, Andri's illness was due to Andri's severe stress and
fear of something. To his mother, Andri said that he was afraid of facing a teacher who
said he was fat and autistic. So that makes him afraid to go to school.
#Panic Disorder
Toni, a 35-year-old young executive, suddenly felt her heart pounding very fast.
At that time he was on the way to his office in the Sudirman area. He also felt shortness
of breath and felt like he was suffocating. Toni became so frightened of this situation
that she sidelined her car. At that time, he was afraid of dying, so he went to the
emergency department (ER) as soon as his heart began to feel less palpitations, 10
minutes later. At the ER, Toni was examined by the heart and other supporting
laboratories. The results are all within normal limits. Toni was then confused about what
she had just experienced. The doctor advised Toni not to worry because nothing was
found wrong. "Maybe you're just tired," the doctor said calmly.
