Generalized Anxiety Disorder (GAD)

Diagnostic Criteria: Excessive Preoccupation

Generalized Anxiety Disorder (GAD) is characterized primarily by excessive anxiety and worry, technically known as apprehensive anticipation.

To be considered a disorder and not a situational response, these worries must persist for a minimum of six months and occur on most days.

They are not limited to a single event, but cover various areas of life (health, family, economy, work).

The individual perceives these worries as uncontrollable; that is, he/she tries to stop the flow of negative thoughts and cannot.

In addition to cognition, the condition is accompanied by specific physical and mental symptoms.

At least three of the following six symptoms are required: restlessness or impatience, easy fatigue (exhaustion), difficulty concentrating (blank mind), irritability, muscle tension, and sleep disturbances (difficulty falling asleep or unrefreshing sleep).

Metacognitive Beliefs about Preoccupation

A distinctive factor in GAD is what the patient thinks about his or her own worry. There are positive and negative beliefs about worry.

Positive beliefs hold that worrying is helpful: "If I worry, I am prepared", "Worrying prevents bad things from happening" or "If I don't worry, I am irresponsible". These ideas reinforce rumination behavior.

However, negative beliefs also coexist, where the patient starts to worry about the fact of being worried ("I am going to go crazy from thinking so much", "This is going to damage my health").

This "meta-worry" elevates anxiety to pathological levels, trapping the person in a cycle where he/she believes that worry is necessary for survival, but at the same time feels that it is destroying him/her.

Intolerance to Uncertainty

The cognitive driver of GAD is intolerance to uncertainty. People with this disorder have a biological and psychological inability to endure doubt about future events, no matter how small. They need absolute guarantees of security.

If a friend says "I'll tell you something later", the GAD patient cannot wait calmly; their mind generates multiple catastrophic scenarios to try to "solve" that unknown immediately.

This need for certainty prevents them from living in the present, as their mind is constantly inhabiting a threatening hypothetical future.

In addition, they tend to have a poor orientation to solving real problems, as they spend all their energy on imaginary problems ("What if?") instead of acting on concrete facts.

Summary

GAD is characterized by excessive and uncontrollable worry that persists for at least six months. It encompasses multiple areas of life and is accompanied by physical symptoms such as fatigue, tension, and insomnia.

A key factor is metacognitive beliefs about worry itself. The patient believes that worrying is useful for preparedness, but simultaneously fears that overthinking will damage his or her mental health.

The driver of the disorder is intolerance of uncertainty. The need for absolute guarantees forces the person to live in hypothetical future scenarios ("What if?"), preventing the resolution of real present problems.