Normal or Not? When Worry Takes Over

 
Editor's Note: With the release of the latest edition of the mental health manual, the Diagnostic and Statistical Manual of Mental Disorders (the DSM), LiveScience takes a close look at some of the disorders it defines. This series asks the fundamental question: What is normal, and what is not?
For nearly everyone, worry is a fact of life. But sometimes, worry can take on a life of its own. This, according to the new mental health manual, is when generalized anxiety disorder (GAD) sets in.
"What happens with GAD is that people flit from one specific worry to another," said Robin Rosenberg, co-author of the psychology textbook "Abnormal Psychology" (Worth Publishers, 2009). "So, they may worry about finances and then go on to worry about the health of someone else in their family, then on to another person."
These worries aren't necessarily grounded in reality; for instance, the family members may not have health problems at all, Rosenberg said.
Meanwhile, someone facing bankruptcy has legitimate reason to worry about finances. But if this person is also plagued by other worries, ones not grounded in realistic concerns, then a GAD diagnosis might be appropriate, Rosenberg said. [Top 10 Controversial Psychiatric Disorders]
Not only can people with GAD feel keyed up and irritable, they can experience other symptoms, such as muscle tension and trouble sleeping. And, key to the diagnosis of a mental disorder, the worry impairs their functioning or causes significant distress.
"They are so unable to turn off the worries they can't function well at work. It's in their heads all the time, when they are with other people, or at home with the kids," Rosenberg said.
Unlike panic disorder, in which someone experiences terrifying panic attacks, the anxiety that accompanies GAD is chronic and low-key. Sometimes, those with GAD cannot articulate what they are worrying about. 
Women, particularly those over the age of 40, are more likely to experience GAD than men. And the focus of the worries varies by circumstance. In less developed countries, people with GAD tend to worry more about natural calamities, while in developed nations, people tend to worry more about human calamities, Rosenberg said.
However, the phenomenon of worry that becomes pathological appears to be universal, she said.
Prior to the publication of the DSM-5, the fifth edition of the mental health manual that was officially released on May 22, some critics expressed concern that changes in the manual — including reputed alterations to the definition of GAD — would lead to many new and unnecessary diagnoses of mental illness and drug prescriptions. However, in the case of GAD, this fear will not be realized; the criteria remain virtually identical between the previous DSM-IV and DSM-5.