Toward a definition of generalized anxiety disorder as an anxious temperament type.
Generalized anxiety disorder (GAD) is defined as an uncontrollable disposition to worry about one's welfare and that of one's immediate kin. Associated manifestations include arousal, vigilance, tension, irritability, unrestful sleep and gastrointestinal distress. There is growing evidence for the lifelong nature of this condition among many of its sufferers. This and other evidence reviewed in the present paper provide further support for the thesis that the chronic disposition to worry should probably be classified under constitutional or trait anxiety. GAD is best considered an exaggeration of a normal personality disposition that can be named 'Generalized anxious temperament' (GAT). Despite some overlap with anxious-phobic, inhibited and avoidant-sensitive temperaments, GAT seems to have a distinct profile with altruistic overtones; on the other hand, GAT is less easily distinguished from harm-avoidant and obsessive traits. That worrying would increase upon relaxation is not a paradox at all, and is understandable in an ethological perspective as subserving the defensive function of being vigilant of ever present yet uncertain external dangers--to oneself and one's kin--in day-to-day living. GAT can thus be considered as 'altruistic anxiety', subserving hypothetically the survival of one's extended phenotype in a 'kin selection' paradigm. Only when extreme does worrying manifest in a clinical context, impairing one's interpersonal life and functioning at work, and increasing use of general health care resources. Furthermore, generalized anxiety appears to predispose to and is often associated with depression, and a spectrum of phobic disorders, as well as alcohol and sedative use. These considerations place GAD (and the putative GAT) in the limelight and underscore the need for more research into its fundamental characteristics. Towards this aim, a self-rated GAT measure under development in our center is provided in an appendix to this paper.
Department of Psychiatry, University of California at San Diego, USA.
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Akiskal
D000818:Animals; D001008:Anxiety Disorders / Q000145:classification / Q000175:diagnosis* / Q000523:psychology; D001143:Arousal; D002908:Chronic Disease; D003866:Depressive Disorder / Q000145:classification / Q000175:diagnosis / Q000523:psychology; D006801:Humans; D016584:Panic Disorder / Q000145:classification / Q000175:diagnosis / Q000523:psychology; D010553:Personality Development; D013694:Temperament