GAD/SAD

• Generalized Anxiety Disorder (GAD)


  A mental health disorder characterized by excessive and uncontrollable worry about a variety of issues
• Social Anxiety Disorder (SAD)


  A mental health disorder characterized by intense fear or anxiety in social situations where the individual may be scrutinized or evaluated by others
• GAD and SAD are discussed in the context of the Hierarchical Taxonomy of Psychopathology (HiTOP)
• GAD


  • Excessive anxiety and worry, occurring more days than not for at least 6 months, about multiple events or activities
  • Difficult to control the worry
  • Causes significant distress or impairment
  • Symptoms include restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbance
• GAD is controversial as it is almost always comorbid with other disorders, and its status as a distinct disorder is debated
• GAD has a lifetime prevalence of 5-6% and a 12-month prevalence of 3.1%, with a 2:1 female to male ratio
• GAD is the most commonly diagnosed Axis I disorder in primary care, and up to 90% of diagnosed cases meet criteria for another disorder, often a mood disorder
• GAD is associated with increased healthcare utilization, more frequent doctor visits, higher healthcare costs, greater chance of concurrent physical illness, and significant social, academic, and vocational impairment
• Course of GAD


  • Symptoms often evident in adolescence or earlier, with a median age of onset in the 30s
  • Gradual onset and chronic course
  • 12-year follow-up study found a recovery rate of 58%, with a high recurrence rate among those who recover
• GAD has a strong genetic component and runs in families
• Differences between GAD and Major Depressive Disorder (MDD)

  • Reliability of diagnosis
  • Predictive validity
  • Mechanisms of the disorders (attentional biases, memory biases, intolerance of uncertainty, low positive affect)
  • Precipitating stressors (humiliation in MDD, danger events in GAD)
  • Temporal course (extreme goal focus in GAD vs. motivational disengagement in MDD, uncertainty in GAD vs. certainty about negativity in MDD, beliefs of helplessness in GAD vs. hopelessness in MDD)
• Worry


  A cognitive, verbal mental operation that buffers GAD from high emotional arousal, inhibiting emotional processing
• Individuals with GAD often try to control or suppress their worry, leading to a vicious cycle where the inability to control the worry increases the sense of lack of control and the intrusiveness of the thoughts
• Social Anxiety Disorder (SAD)


  • Marked fear or anxiety about one or more social situations where the individual may be exposed to possible scrutiny by others
  • Fear that they will act in a way or show anxiety symptoms that will be negatively evaluated, leading to humiliation, embarrassment, or rejection
  • Social situations almost always provoke fear or anxiety, and are often avoided or endured with great distress
  • Fear or anxiety is out of proportion to the actual threat posed by the social situation
• SAD is the second most common anxiety disorder and the third most common psychiatric disorder
• SAD is associated with impairment in romantic and other social relationships, career, and education
• SAD is slightly more common in men, and there is also a generalized form where multiple social situations are feared or avoided
• SAD has a high comorbidity rate, and individuals with SAD tend to have high standards, be very self-critical, and scrutinize themselves
• Prevalence rates of SAD are much lower in East Asian countries compared to North America, and racial/ethnic differences in prevalence have been observed
• The mean age of onset for social phobia is 16, later than for other specific phobias

  • animal phobia 7
  • blood/injury 9
  • dental phobia 11
• Cognitive theories of social phobia

  • Social situations activate core beliefs about social competencies, leading individuals to believe they will be viewed negatively by others
  • Self-focus functions as a "safety" or avoidance behavior, reinforcing negative expectations and maintaining the disorder
• Social vignette


  • You approach a girl with a seat next to her and ask if it's taken. She pauses for a long time before answering.