Counselling in Chichester &
West Sussex

General Anxiety Disorder

General Anxiety Disorder

A well known reference work on mental health is a rather weighty publication entitled The Diagnostic Statistical Manual for Mental Disorders (DSM).  This book attempts to categorise any form of emotional response which deviates from a strict definition of normality. A key driver behind this structured American lead approach is the healthcare insurance industry.  If any emotional reactions are identified as varying from a given norm a diagnosis or label can now be given to be quickly followed by recommended treatment plans.

That approach of analyse, diagnose and remedy is clearly appropriate when there is an ongoing condition which is causing unnecessary emotional pain and discomfort for the individual. There is however growing unease at the tendency to provide a diagnosis or label to cover every emotional reaction. This is particularly concerning when the emotional reaction identified may not actually be a mental instability but is instead a perfectly reasonable albeit uncomfortable response to a difficult set of circumstances

For example the individual who wakes with a slight cold on a wet January morning to find a car with a flat tyre to be fixed before a long uncomfortable journey into work where she or he is given a least favourite work task, may well feel fed up and depressed. Yet many will see this as a wholly appropriate reaction to what has just been a bad Monday morning.  That feeling of ‘fed up’ or ‘depressed’ does not mean that the client is suffering from clinical depression or any form of defined mental illness. It is an appropriate if downbeat reaction to a bad set of circumstances.

Similarly the individual faced with making an important speech to a large group may quail at the prospect of talking in public and feel extremely anxious.  That unease may invoke many of the classic physical symptoms of stress. Yet this level of anxiety could again be seen as a wholly appropriate reaction given the daunting task ahead.  To stand in front of an audience provokes stress. That is a reality for most people. It does not follow that the individual is suffering from an anxiety disorder that requires treatment be that medication or exposure to talking therapies.

In western society personal expectations are set high.  The ideal personality is seen as robust, confident, consistent and able to always deal with whatever comes from life. If that standard is not met there is an implicit assumption that something is wrong. There is a fault, a condition and an issue to be addressed.

We are currently told that stress levels are at an all time high. Yet there is likely to be some over diagnosis in these statements. An occasional feeling of stress can be an acceptable reaction to certain circumstances. We live in a demanding world where rapid and unexpected change can bring sudden emotionally challenges. That resulting anxiety although disturbing may not necessarily be indicative of some form of mental fragility requiring specialist treatment. For example with reference to the recent unfortunate demise of Thomas Cook, if whilst on holiday our tour company goes bust we are entitled to feel anxious and stressed.

There will however be other occasions when a diagnosis of some form of emotional imbalance is clearly appropriate. If with regard to the two situations described above, the depression and stress continue to persist long after the memory of the bad Monday has faded and that speech is long forgotten, then there may indeed be an issue to be addressed.

DSM (as above) lists various symptoms of a condition known as General Anxiety Disorder (GAD). A persistent feeling of anxiety continuing when all is well or a prolonged sense of ongoing worry when there are no obvious issues of concern, could be indicative of or GAD.  Those DSM listed symptoms include excessive worry over a 6 month period covering different activities such as work and social activities, a continual feeling of restlessness and of being on edge, having difficulty in concentrating, displaying irritability and enduring regular sleep disturbance.

GAD can be likened to the emotional equivalent of a continuing cold that just cannot be shaken off. Just as the perpetual sense of feeling physically unwell can impact on our general enjoyment of life so that perpetual feeling of unease and concern which is present with GAD can affect our social and professional well-being.

If those GAD symptoms resonate for you then it may well be sensible to look for some professional support. Your GP may provide advice and is likely to propose a CBT based NHS intervention.  That may however take some time to become available.  In those cases another option would be to consider contacting another agency or a private counsellor.

Let’s return to this issue of labelling. A correct diagnosis of GAD can be helpful in alerting the individual to the fact that things are not right. That can lead to a search for remedies.   Accredited professional therapists with the right experience may well be able to help the client to understand and work though GAD. The counsellor can also assist the individual to develop new coping strategies to then keep those anxieties at bay.

Sometimes however mental health professionals can be perhaps too quick to pathologise an emotional response which may be just a perfectly normal reaction to difficult life events. That can result in unnecessary prescriptions and therapy sessions.

This concern suggests that the first step in any discussion on emotional health should not be to reach for a reference manual to find an appropriate label. Instead importance should be given to ensuring that an informed discussion can take place between counsellor and client to ascertain what is happening in the client’s life and whether there really is an issue of emotional dysfunction to be addressed.