• Generalised Anxiety Disorder (GAD) is characterised by persistent and excessive anxiety and worry about a number of things, which the person finds difficult to control.
• The anxiety is described as free-floating, meaning it is not attached to any specific situation.

• The source material does note that people with GAD usually have a history of experiencing small but uncontrollable negative events, leading them to have automatic thoughts about the uncontrollability of events.

• GAD also results in a loss of sense of mastery and an inability to finish tasks calmly.

6) State the prevalence rate of Generalised Anxiety Disorder.

The prevalence rate of GAD is estimated to be about 3% to 5% of the general population. It usually begins in the teens and is more common in women. It often has other anxiety disorders and mood disorders as co-morbid conditions.

7) Discuss the aetiological factors of Generalised Anxiety Disorder.

The aetiology of GAD can be classified into:

• Genetic factors: Research indicates a moderate role of genetic factors.
• Psychological factors which include:
  • Psychoanalytical approach: This approach traces the anxiety to the unconscious conflict between the ego and id impulses, often of a sexual or aggressive nature.
  • Cognitive-behavioural approach: This approach emphasizes the role of worry and the sense of mastery in GAD. A history of uncontrollable negative events contributes to a perception of a lack of control. It notes that a person's early environment may have been one where they were never allowed to feel safe and relax.

8) Discuss the treatment options of Generalised Anxiety Disorder.

Treatment options for GAD include:

• Medications:
  • Benzodiazepines have been used, but they can be habit-forming.
  • Buspirone is also prescribed, but it takes a few weeks to take effect.
  • Antidepressants have also been used.
• Psychological treatments that involve a combination of cognitive and behavioural techniques. However, GAD is considered a relatively difficult anxiety problem to treat, as efforts to stop negative thoughts usually lead to more negative thoughts. Muscular relaxation may also be helpful.

9) Discuss the symptoms and clinical features of Obsessive Compulsive Disorder with case examples.

• Obsessive Compulsive Disorder (OCD) involves both obsessions and compulsions. Obsessions are defined as intrusive thoughts, images or impulses of a negative event. Compulsions are ritualistic acts that are performed to undo or prevent these obsessive thoughts.
• The source material states that the key to distinguishing normal thoughts from the symptoms of OCD is that the person with OCD cannot control or ward off their thoughts even when they try to.
• The source material does not include specific case examples of OCD.

10) Discuss the aetiological factors of Obsessive Compulsive Disorder.

Both biological and psychological factors contribute to the aetiology of OCD:

• Biological factors: These may include genetic factors and neurobiological factors, specifically imbalances in neurotransmitters such as serotonin.
• Psychological factors:
  • Psychoanalytic theories: These suggest that the obsessions are a result of the ego's unsuccessful attempts to manage the id's sexual and aggressive impulses. Compulsions arise as a way to control these unacceptable impulses.
  • Cognitive theories: These approaches propose that negative automatic thoughts underlie obsessions. People with OCD are often excessively responsible and perfectionistic, with a tendency to believe that thinking about something is the same as acting on it. This is known as thought-action fusion, which may lead to catastrophic thinking.

11) Discuss the treatment options of Obsessive Compulsive Disorder.

Treatment options for OCD include:

• Medications: The source does not discuss particular medications for OCD other than saying medicines have only moderate success.
• Psychological treatment: Cognitive behavioural approaches seem to be the best option for treatment, although the source notes that psychoanalytically oriented treatment has little impact.
• Exposure and response prevention (E&RP) is a type of cognitive-behavioural therapy for OCD.

Important Points

• In a person with GAD, there are often histories of series of small negative events
• Buspirone is not a very quick acting drug
• There can be cases with obsessions only with no symptom of compulsion 
• In terms of learning theory compulsions are maintained by reinforcement, since they reduce anxiety
• E&RP stands for Exposure and Response Prevention.