The Deconstructing Anxiety model* provides an especially useful insight into the mechanism of the various anxiety disorders. It posits that generalized anxiety disorder can be understood as the source of other anxiety disorders, giving rise to them through a process of increasing specificity. In brief, our model understands generalized anxiety disorder as a sort of “free-floating” anxiety that has not attached itself to any specific situation or object. In this way, it serves as a foundation or matrix from which the other anxiety disorders derive as they “latch on” to a specific situation or object. Let us explore what this means in detail.
Understanding generalized anxiety disorder
We begin with the definition of generalized anxiety disorder. The DSM 5** uses the following criteria for diagnosing someone with a generalized anxiety disorder (GAD). It says*** GAD is defined by excessive anxiety about a number of events or activities, associated with three or more of the following:
Restlessness, feeling keyed up or on edge.
Being easily fatigued.
Difficulty concentrating or mind going blank.
Irritability.
Muscle tension.
Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).
Therefore, we may say that GAD is being treated here as non-specific anxiety, i.e. it is “anxiety about a number of events or activities”. This, of course, is why it employs the word “generalized”. But if we understand this non-specific anxiety as a free-floating anxiety that has not “latched on” to a particular object or situation, we discover something interesting: the other anxiety disorders, by contrast, have very much latched on to a particular object or situation. Where GAD lives more
as a constant, diffuse anxiety in the background (think Karen Horney’s concept of “basic anxiety”), the other anxiety disorders come to the foreground in response to specific conditions.
To take some artistic license in the service of clarification: we may imagine that the other anxiety disorders start out as generalized anxiety disorder, and then morph into specific variations on the theme. In the Deconstructing Anxiety model, we understand that our psychological experience is the result of the meaning we project onto our circumstances. With GAD, we can project the meaning of anxiety onto anything and everything, creating a “general” sense of danger. In the other anxiety disorders, we take this a step further, and single out certain aspects of life to project this meaning of danger.
The concept really comes to life when we consider specific phobias. If GAD may be called a first iteration of anxiety, then certain of the other anxiety disorders would be understood as a second iteration, one level more refined in what they consider anxiety-producing. Specific phobias can be seen as a third iteration of this same process. Social phobia, for instance, creates anxiety just as GAD does, but focuses its projection onto a limited set of circumstances out of the generalized circumstances of GAD–someone with social phobia only gets anxious about social situations. Specific phobia takes this same process and gets even more precise. In specific phobia, one is afraid of highly specific objects or circumstances, such as spiders, flying, etc. The process of assigning meaning to that which triggers anxiety has become highly focused.
With this example, we can almost see, as if in time-lapse photography, the generalized anxiety of GAD morph into a second iteration of specificity, and then morph again into an even more targeted level of specificity, honing in like a laser on exactly what we have decided will scare us.
How other anxiety disorders related to GAD
In the Deconstructing Anxiety, we propose that all struggles in life derive from what is called the “core fear/chief defense dynamic.” The core fear is understood
as a primary interpretation of how life can be threatening or dangerous, while the chief defense is defined as the primary strategy we develop to protect ourselves from the core fear (see previous blogs for further insight). Therefore, when looking for the causes of generalized anxiety disorder, we want to look for a core fear born out of a general atmosphere of threat, rather than some more specifcally dangerous situation. Similarly, we would appreciate that the chief defense of someone with GAD would be one that responds to that atomsphere of threat in a great variety of ways.
For example, if one’s parent was an alcoholic whose mood could change in unpredictable and threatening ways, one’s core fear might not have a specific target to latch onto and would therefore stay more generalized. When forming a chief defense, they would also have to decide that a non-specific approach to self-protection was most helpful. In one instance they might hide from the parent, in another they might become highly attentive to the parent, and so forth. In other words, to develop GAD, they would have to use a broad brush approach to the problem. And this is what we see in the DSM criteria for GAD when it describes a feeling of being “keyed up or on edge“–a very generalized description of how the core fear and chief defense might manifest.****
This is in contrast to, for example, someone who suffers a trauma and develops PTSD. Their anxiety is only focused on triggers that remind them of the trauma. In the case of OCD, one’s, chief defense lands on obsessions and compulsions as a way to protect from the core fear. They might, for instance, check that the stove is turned off compulsively in response to a core fear of dying in a fire. With social phobia, as we have seen, the specific focus is on social situations, in agoraphobia, on situations where one is in an open place and cannot escape. In panic disorder, we may understand the initial incidence of panic as seeming to come out of the blue, but it is clear that it is a more intense form of specific, pre-existing anxiety of of some sort. And after the original incidence or two, one’s anxiety becomes highly focused specifically on when the next panic attack might occur.
How to treat generalized anxiety disorder
In the Deconstructing anxiety model, we have the all-important principle that in order to resolve anxiety of any sort, we must “do the opposite” of the chief defense. This necessarily provides an exposure to the core fear, the true source of a problem, and that exposure can then extinguish the fear. Doing so gives the anxious person the direct experience that what they were so afraid of is not truly scary. This works for the anxiety disorders that attach to a specific object or situation by creating exposures to the specific trigger. And it works for GAD when one realizes through a variety of exposures, that none of them are threatening as previously imagined. This discovery then generalizes, in a process that is the exact reverse of the generalizing process which created the anxiety, to help one realize that none of the previous sources of anxiety are truly dangerous. This is so for any manifestation of the GAD, and works for severe generalized anxiety disorder as well as milder forms.
When looking for generalized anxiety disorder causes, or the causes for any of the other anxiety disorders, or in fact of any problem at all, the Deconstructing Anxiety model gives us a clear map to healing: Find the core fear and chief defense under the problem, and do the opposite of the chief defense. This creates an exposure to the core fear, the true source of the problem. And because it is the true source of the problem, the opportunity for a complete extinction of the fear becomes available.
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*Pressman, T. (2019). Deconstructing Anxiety: The Journey from Fear to Fulfillment. Maryland: Rowman and Littlefield.
**American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
https://doi.org/10.1176/appi.books.9780890425787
***This is an abbreviated version of the full diagnostic criteria for GAD in the DSM 5, meant to focus on the purposes of our discussion.
****We can also hypothesize that the sleeplessness which can occur with GAD is caused by an overly active mind, one that is constantly scanning for safety in a generalized way.