Generalized anxiety disorder : aetiological pathways and self-perpetuating characteristics.

Generalized anxiety disorder (GAD), a debilitating disorder that is highly prevalent yet notoriously under-recognised and insufficiently treated, and/or treatment resistent, warrants closer examination. The aims of this study were to explore possible aetiological pathways leading to the development of GAD and characteristics of GAD which may act in a self-perpetuating manner that aids continuation of the disorder. Participants were 274 adult volunteers from the general community (101 males, 173 females) aged between 18 and 84 years (M = 44.S1; SD = 13.86). Participants were allocated into one of five groups after taking part in a semi-structured diagnostic interview using the Anxiety Disorders Interview Schedule for the DSM-IV for lifetime (ADIS-IV-L; Brown, Di Nardo, & Barlow, 1994). The five participant groups represent: (1) GAD comorbid with another anxiety disorder(s) and/or depression (67); (2) pure GAD (74); (3) subclinical pure GAD (S3); (4) previous history of GAD but no symptoms for at least 12 months (30); and, (S) nonanxious controls (SO). Participants answered a number of self-report questionnaires pertaining to their perceived/recollected experiences in various aspects of their interactions with their main caregivers in childhood. Further self-report questionnaires answered related to current attachment behaviours, emotion regulation difficulties, cognitive processing styles (relating to beliefs about worrying, intolerance of uncertainty, perfectionism, and indecisiveness), and self-ambivalence. There was significant support for the hypotheses relating to the notion that the more negative an individual's (perceived) experience in regard to their interactions with their main caregivers when growing up, the higher the level of psychological maladjustment the person is likely to experience as an adult. More specifically, the higher the experienced level of parental overburdening such as role-reversal of child-caregiver emotional support, frequent parental criticism and guilt induction, parent(s) having emotional health problems, and the more lacking in unconditional emotional support, acceptance, and nurturance from care-givers, accompanied by negative parenting styles, the more likely the person will experience the symptoms of GAD during their adulthood. There was also significant support for the hypothesis that the higher the number, frequency, and level of the above negative influences an individual has been exposed to during childhood, the more likely they are to develop, in the following descending order, GAD comorbid with another anxiety disorder(s) and/or depression, pure GAD, subclinical GAD, or to have a history of GAD (if not current). The hypotheses that those with GAD would be significantly more likely to show anxious/ambivalent attachment behaviours and have more difficulties with emotion regulation were supported. In addition, there was support for the hypotheses in regard to cognitive processing styles that were hypothesized to be characteristic of GAD and that appear to serve to maintain the disorder, such as particular beliefs about the usefulness of worrying, intolerance of uncertainty, perfectionism, indecisiveness, and self-ambivalence. The findings of the current study make a significant contribution to our knowledge about GAD in the following five areas: the aetiological influence of child-caregiver interactions (including role-reversal in emotional support), attachment behaviours, emotion regulation deficits, cognitive processing styles, and self-ambivalence. Despite a number of limitations in the current study, the findings of the study may be helpful in advancing our understanding of the aetiology of GAD and common characteristics of GAD that need to be taken into consideration when designing treatment programs and interventions for individuals with GAD symptoms. The findings show that the pathways that may lead to the development of GAD are multidimensional, as are the characteristics which aid in the maintenance of GAD. Further to this, there is a large variance in the number and severity of symptoms that each individual with GAD experiences. It is therefore important to treatment that the uniqueness of each individual be respectfully and carefully addressed. Much more research is needed in the area of GAD in order to improve on existing treatment interventions