PSYCHOLOGY

INVESTIGATORY
PROJECT
A CASE STUDY BASED ON A
SUBJECT SUFFERING FROM GAD
(Generalised Anxiety disorder)

MADE BY- MASKEEN KAUR XII-B

PROJECT REPORT :-
History of GAD-
The history of understanding and treating GAD spans
thousands of years, shaped by changing perspectives
on mental health, societal attitudes, and advances in
science. Here’s a brief overview:
1. Ancient Times: Anxiety disorders have always been
part of the human experience. Even as far back as
5,000 BC , descriptions of something that sounds like
post-traumatic stress disorder (PTSD) appear in
ancient Indian writings. But the study of anxiety really
got its start about 2,000 years ago in the Greco-
Roman world.
2. Middle Ages: During this period, GAD was often
seen as a moral or spiritual failing rather than a
medical condition. Treatments were based on
religious or moral practices, like confession or
exorcism, rather than scientific reasoning.
3. Renaissance and Enlightenment: The 17th and 18th
centuries saw a return to more medical and natural
explanations for mental illness. In the 17th century,
Robert Burton described anxiety in The Anatomy of
Melancholy. Panic attacks and generalized anxiety
disorder may be recognized in the “panophobias” in
the nosology published by Boissier de Sauvages in the
18th century.

4. 20th Century: It wasn’t until the early 20th century that

physicians and psychologists began to take meaningful
steps toward easing anxiety for the average patient.

In the 1930s, Orval Mowrer’s 2-factor theory built on

Pavlovian conditioning, also known as fear conditioning, and
began the initial drive toward modern exposure therapies.
 Once anxiety became more widely understood, neurologists
and psychologists like Sigmund Freud and John B. Watson
proposed new ways of treating it.

5. Modern Era: GAD is now recognized as a complex

condition influenced by genetics, biology,
psychology, and environment. Treatments include
medications, various forms of psychotherapy, and
lifestyle changes. Research is ongoing to further
understand its underlying mechanisms and improve
therapies.

Key Features of GAD

1. Introduction to GAD
Generalized Anxiety Disorder (GAD) is a common and chronic mental
health condition characterized by excessive, uncontrollable worry about
topics like health, work, social interactions, and everyday life
circumstances. Unlike normal anxiety, which may arise from specific
situations and subsides once the situation resolves, GAD is persistent and
can interfere significantly with daily functioning. Individuals with GAD
often find it difficult to control their worry, and this can lead to physical
symptoms like restlessness, fatigue, difficulty concentrating, muscle
tension, and sleep disturbances.

2. Core Symptoms
according to ICD-11,
Generalised anxiety disorder is characterised by marked
symptoms of anxiety that persist for at least several
months, for more days than not, manifested by either
general apprehension (i.e. ‘free-floating anxiety’) or
excessive worry focused on multiple everyday events,
most often concerning family, health, finances, and school
or work, together with additional symptoms such as
muscular tension or motor restlessness, sympathetic
autonomic over-activity, subjective experience of
 nervousness, difficulty maintaining concentration,
irritability, or sleep disturbance. The symptoms result in
significant distress or significant impairment in personal,
family, social, educational, occupational, or other
important areas of functioning. The symptoms are not a
manifestation of another health condition and are not due
to the effects of a substance or medication on the central
nervous system.

Essential (Required) Features:

 Marked symptoms of anxiety manifested by either:
 General apprehensiveness that is not restricted to any particular
environmental circumstance (i.e., ‘free-floating anxiety’); or
 Excessive worry (apprehensive expectation) about negative events occurring
in several different aspects of everyday life (e.g., work, finances, health,
family).
 Anxiety and general apprehensiveness or worry are accompanied by
additional characteristic symptoms, such as:
 Muscle tension or motor restlessness.
 Sympathetic autonomic overactivity as evidenced by frequent gastrointestinal
symptoms such as nausea and/or abdominal distress, heart palpitations,
sweating, trembling, shaking, and/or dry mouth.
 Subjective experience of nervousness, restlessness, or being ‘on edge’.
 Difficulty concentrating.
 Irritability.
 Sleep disturbances (difficulty falling or staying asleep, or restless, unsatisfying
sleep).
 The symptoms are not transient and persist for at least several months, for
more days than not.
 The symptoms are not better accounted for by another mental disorder (e.g.,
a Depressive Disorder).
 The symptoms are not a manifestation of another medical condition (e.g.,
hyperthyroidism) and are not due to the effects of a substance or medication
on the central nervous system (e.g., caffeine, cocaine), including withdrawal
effects (e.g., alcohol, benzodiazepines).
 The symptoms result in significant distress about experiencing persistent
anxiety symptoms or significant impairment in personal, family, social,
educational, occupational, or other important areas of functioning. If
functioning is maintained, it is only through significant additional effort.

according to DSM-5
Diagnostic Criteria A.
A, Excessive anxiety and worry (apprehensive expectation), occurring
more days than not for at least 6 months, about a number of events or
activities (such as work or school performance).
B. The individual finds it difficult to control the worry.
 C. The anxiety and worry are associated with three (or more) of the
following six symptoms (with at least some symptoms having been
present for more days than not for the past 6 months): Note: Only one
item is required in children. 1. Restlessness or feeling keyed up or on
edge. 2. Being easily fatigued. 3. Difficulty concentrating or mind going
blank. 4. Irritability. 5. Muscle tension. 6. Sleep disturbance (difficulty
falling or staying asleep, or restless, unsatisfying sleep).
D. The anxiety, worry, or physical symptoms cause clinically significant
distress or impairment in social, occupational, or other important areas of
functioning.
E. The disturbance is not attributable to the physiological effects of a
substance (e.g., a drug of abuse, a medication) or another medical
condition (e.g., hyperthyroidism).
F. The disturbance is not better explained by another mental disorder
(e.g., anxiety or worry about having panic attacks in panic disorder,
negative evaluation in social anxiety disorder, contamination or other
obsessions in obsessivecompulsive disorder, separation from attachment
figures in separation anxiety disorder, reminders of traumatic events in
posttraumatic stress disorder, gaining weight in anorexia nervosa, physical
complaints in somatic symptom disorder, perceived appearance flaws in
body dysmorphic disorder, having a serious illness in illness anxiety
disorder, or the content of delusional beliefs in schizophrenia or delusional
disorder).

Causes:
The causes of generalized anxiety disorder are complex, and many factors
likely contribute and interact in the development and maintenance of the
condition The causes of generalized anxiety disorder are complex, and
many factors likely contribute and interact in the development and
maintenance of the condition. Such as-
1. Genetic Factors
Studies have shown that first degree relatives of someone with GAD are
more likely to develop mood and anxiety disorders in general, with a
specific increased risk for developing GAD.

Researchers suggest that about 30% of the risk of developing GAD can be
attributed to genetic inheritance
We know, for example, that a person can have a genetic vulnerability to
developing GAD if certain genetic markers have been passed onto them.
Vulnerability, in combination with certain environmental factors, can
trigger the development of symptoms
 .
2. Biological Factors
It is this heightened activity within the amygdala that researchers
 believe might influence the inaccurate interpretations of social
behavior for patients with GAD.
The volume of gray matter is another factor that has been
researched in relation to GAD and other anxiety and mood
disorders. An increased volume of gray matter at certain locations in
the brain has been repeatedly found in people with GAD compared
to controls.
The brain has special chemicals, called neurotransmitters,
that send messages back and forth to control the way a
person feels. Serotonin and dopamine are two important
neurotransmitters that, when disrupted, can cause
feelings of anxiety and depression. Researchers have also
found that several parts of the brain are involved in fear
and anxiety.
3. Psychological Factors
 Mental health researchers have found that trauma in childhood can
increase a person's risk of developing GAD.4 Difficult experiences
such as physical and mental abuse, neglect, the death of a loved
one, abandonment, divorce, or isolation can all be contributing
factors.
 Some behavioral scientists believe that anxiety is a learned
behavior, suggesting that if a person has a parent or caregiver who
demonstrates anxious behavior, they may tend to mirror that same
anxious behavior
4. Environmental and Social Factors
Evidence also suggests that social media exposure contributes to
increased feelings of anxiety. Researchers are finding that the use of
social media, particularly in excess, can greatly impact mental
health, sometimes resulting in anxiety and depression.

Treatment:
The treatment of GAD typically involves a combination of psychotherapy,
medication, and lifestyle modifications. The most effective treatments are:
1. Psychotherapy: Cognitive Behavioral Therapy (CBT) is considered the gold
standard for treating GAD. CBT helps individuals identify and challenge
maladaptive thought patterns and develop healthier coping strategies. Other
forms of therapy, such as mindfulness-based therapy, can also be beneficial.
2. Medication: Medications commonly used to treat GAD include selective
serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake
inhibitors (SNRIs), and benzodiazepines. SSRIs and SNRIs are often the first-line
treatment due to their effectiveness and relatively favorable side effect profiles.
Benzodiazepines may be used for short-term relief of severe anxiety but are
generally not recommended for long-term use due to the risk of dependence.
3. Lifestyle Changes: Incorporating stress management techniques, such as
regular exercise, relaxation techniques (e.g., deep breathing, progressive muscle
relaxation), and maintaining a healthy diet, can help manage symptoms of GAD.
Adequate sleep and reducing caffeine and alcohol intake are also important.
4. Support Groups: Participating in support groups can provide individuals with
GAD a sense of community and the opportunity to share experiences and coping
strategies with others who understand what they are going through.
5. Mindfulness and Meditation: Mindfulness-based stress reduction (MBSR) and
meditation practices can help individuals manage anxiety by promoting
relaxation and a focus on the present moment

EPIDEMIOLOGY OF DEPRESSION-
GAD is one of the most common anxiety disorders, with a
lifetime prevalence rate of approximately 5-6% in the general
population. It is more common in women than men, with a
female-to-male ratio of about 2:1. GAD can begin at any age,
but it most commonly starts in childhood or adolescence, with a
median age of onset in the early 30s. The disorder tends to be
chronic, with many individuals experiencing symptoms for
years or even decades

CASE STUDY:- GAD

Subject Information

Name- anonymous
Age- 46
Education- Mba
Gender- Male
Occupation- Businessman
Religion- sikh
Source Of Information- self reported

BACKGROUND INFORMATION-
The subject, a 46-year-old businessperson, has been
experiencing symptoms of Generalized Anxiety Disorder (GAD)
since 2017. His anxiety was first identified when he sought help
with insomnia, which a psychologist attributed to anxiety. The
anxiety was significantly triggered by his decision to start
investing in the stock market in 2017.

Chief Complaints

The subject presented the following primary complaints:

 Insomnia: Persistent difficulty in initiating or maintaining

sleep, first noticed in 2017. The lack of sleep contributes
to daytime fatigue, irritability, and difficulty concentrating.
 Persistent Anxiety: Constant feelings of worry and
unease, particularly in response to financial stress and
work-related challenges. The subject rates this anxiety as
7 out of 10, indicating moderate to severe distress.
 Overthinking: A tendency to ruminate over problems
until the source of stress is resolved, which exacerbates
feelings of restlessness and contributes to an inability to
relax.
 Rigidity: An aversion to change, with a strong preference
for routine and predictability. This trait amplifies anxiety in
unfamiliar or unpredictable situations.

Precipitating Factor

The subject identified a major life event in 2017 as the onset of

his symptoms:

 His decision to begin investing in the stock market

introduced significant financial and emotional stress. The
unpredictable nature of investments created a constant
sense of worry and uncertainty, triggering insomnia and
escalating anxiety levels.
 The lack of prior coping mechanisms to handle high-stakes
situations compounded the stress, making it a persistent
issue.
Mode of Onset

The symptoms of GAD developed progressively over time:

 Initial Phase: The subject first noticed severe insomnia,

which was attributed to the stress of managing new
investments.
 Progression: Over time, anxiety became more pervasive,
affecting multiple aspects of his life, including work and
relationships.
 Current Phase: The subject's anxiety is now chronic, with
episodes of heightened stress during specific triggers,
such as financial fluctuations or changes in routine.

History of Physical Illness

 The subject has not reported any chronic physical

illnesses. However, he acknowledges experiencing
physical manifestations of anxiety, such as:
o Muscle Tension: Noted during periods of heightened
stress.
o Somatic Symptoms: Occasional gastrointestinal
discomfort, which may be stress-induced.
 The absence of significant physical illness suggests the
primary focus should remain on psychological and
behavioral factors in his treatment.

Treatment Undergoing

The subject is actively pursuing a combination of therapeutic

and lifestyle interventions:

 Medication: Prescribed anxiolytics and hypnotics have

been used for the past seven years to manage anxiety
and insomnia. The specific medications and dosages have
not been disclosed but are reported as effective in
mitigating acute symptoms.
 Yoga and Meditation: Regular practice of yoga and
mindfulness-based meditation helps in relaxation and
stress management.
  Lifestyle Modifications: Incorporating routines aimed at
promoting mental calmness, such as structured schedules
and avoiding stress-inducing activities during peak anxiety
periods.
 Therapeutic Interventions: Although no formal
psychotherapy is currently in place, options like Cognitive
Behavioral Therapy (CBT) have been suggested to address
maladaptive thought patterns and overthinking behaviors.

Personal History

Prenatal

 The subject’s prenatal history is unremarkable. The

mother did not report any complications during
pregnancy, and there were no known exposures to harmful
substances or stressors that might have affected prenatal
development.

Natal

 The subject was born via a normal delivery without

complications. Birth weight and developmental milestones
were within normal ranges.

Neo-Adolescence

 During the neo-adolescent phase (approximately ages 10–

13), the subject began showing early signs of
perfectionism and heightened sensitivity to external
expectations.
 He developed a need for approval from authority figures,
particularly his father, which increased his anxiety in
academic and social contexts.
 Peer relationships during this stage were functional but
often marked by self-consciousness and a fear of criticism.
Childhood

 The subject’s childhood was characterized by a

hyperactive and fearful demeanor, shaped significantly by
a strict and authoritarian father.
 Experiences of punishment and high parental expectations
instilled a persistent sense of inferiority, which influenced
his developing self-esteem.
 He displayed a strong work ethic and performed well
academically but struggled with feelings of inadequacy
and over-dependence on routines for stability.

Adulthood

 The subject transitioned into adulthood with a successful

career as a businessman. However, the decision to invest
in the stock market in 2017 introduced significant financial
and emotional stress, triggering anxiety and insomnia.
 Adult life has been marked by a rigid and perfectionistic
lifestyle, which exacerbates his inability to adapt to
unexpected changes or challenges.
 Current coping mechanisms include medication, yoga, and
meditation, though the lack of structured psychotherapy
leaves underlying issues unaddressed.

Personality: Premorbid vs. Current

Premorbid Personality

 Perfectionism: The subject displayed a strong desire for

perfection in all aspects of life, stemming from familial
expectations and a need to prove self-worth.
 Sensitivity and Inferiority Complex: From a young age,
the subject exhibited heightened sensitivity to criticism
and an enduring sense of inferiority, primarily influenced
by a strict and critical father.
 Resilience and Helpfulness: Despite personal struggles,
the subject was proactive, helpful, and maintained positive
social connections.
  Adaptability: Though inclined toward routines, he
showed some ability to adapt and excel academically and
socially when required.

Current Personality

 Rigidity: The subject’s perfectionistic tendencies have

evolved into rigid behavior, with an aversion to change
and a preference for structured routines.
 Heightened Anxiety: The inferiority complex persists,
now compounded by chronic anxiety and difficulty
managing stress in professional and personal settings.
 Limited Social Engagement: While still helpful, the
subject now avoids situations where failure or criticism is
possible, limiting his social connections and opportunities
for growth.
 Reliance on External Support: Dependence on yoga,
meditation, and medication has become central to
managing daily stress, though deeper issues remain
unresolved.

Comparison

 Flexibility vs. Rigidity: While the premorbid personality

showed some adaptability, the current personality is
marked by rigidity and resistance to change.
 Coping Strategies: Previously, the subject demonstrated
resilience despite challenges. Currently, reliance on
external support highlights an inability to address stress
independently.
 Social Dynamics: The subject’s earlier helpfulness and
engagement have diminished due to heightened self-
consciousness and anxiety.
 Stress Response: Premorbid traits included managing
challenges moderately well, whereas the current
personality exhibits a marked deterioration in stress
tolerance.