Does Generalized Anxiety Disorder (GAD) cause hypersensitivity to stimuli?

From the Guidelines

Generalized Anxiety Disorder (GAD) can cause hypersensitivity to stimuli, as the brain's threat detection system becomes overactive, leading to an intense response to environmental stimuli. This hypersensitivity occurs because the constant state of worry and hypervigilance characteristic of GAD keeps the nervous system in a heightened state of arousal, making it difficult to filter out unimportant sensory information. Although the study by 1 focuses on atopic dermatitis, it mentions that heightened sensitivity to sensory stimulation is not uncommon in patients with the condition, possibly reflecting nerve fiber sensitivity, which can be related to the hypersensitivity experienced by GAD patients.

Key Points to Consider

• People with GAD often experience heightened reactions to sensory input like loud noises, bright lights, strong smells, or physical sensations
• The constant state of worry and hypervigilance characteristic of GAD keeps the nervous system in a heightened state of arousal
• Management strategies include mindfulness techniques, gradual exposure therapy, and sometimes medications like SSRIs or benzodiazepines for short-term relief
• Cognitive behavioral therapy can help patients develop coping mechanisms to better process sensory information and reduce their reactivity to everyday stimuli

Relevant Factors

• The brain's threat detection system becomes overactive in GAD patients, causing the amygdala to respond more intensely to environmental stimuli
• This can manifest as being easily startled, feeling overwhelmed in busy environments, or experiencing physical discomfort from stimuli that others might not notice
• While the study by 1 does not directly address GAD, its findings on sensitivity to sensory stimulation can be applied to the condition, highlighting the importance of considering the nervous system's response to environmental stimuli in GAD patients.

From the Research

Generalized Anxiety Disorder (GAD) and Hypersensitivity to Stimuli

• GAD is characterized by excessive and uncontrollable worry, accompanied by physical symptoms such as headaches, tension, restlessness, gastrointestinal distress, and heart palpitations 2.
• Studies have shown that individuals with GAD exhibit autonomic hypersensitivity, elevated heart rate, heightened interoceptive awareness, and increased anxiety in response to adrenergic stimulation 3.
• This hypersensitivity may be associated with regulatory dysfunctions in the ventromedial prefrontal cortex (vmPFC), which could serve as a treatment target to help patients with GAD more appropriately appraise and regulate signals of sympathetic arousal 3.
• Restlessness, a core physiological symptom of GAD, can be measured physiologically with actigraphy sensors and subjectively with self-report ratings, providing initial validation for actigraphy as a novel measure of motor restlessness in GAD 4.

Physiological Responses in GAD

• Patients with GAD show diminished autonomic flexibility, accompanied by less precise perception of bodily states, and are more sensitive to bodily changes than nonanxious individuals 5.
• GAD patients exhibit a trend toward heightened basal arousal, manifesting itself in a faster heart rate throughout the day, although their physiologic responses are comparable in intensity to those with panic disorder (PD) 5.
• The perception of anxiety-related symptoms in GAD may reflect central rather than peripheral responses, suggesting that the disorder is characterized by a chronic state of arousal rather than a heightened physiological reaction to threat 4, 5.

Comparison with Other Anxiety Disorders

• Patients with PD experience more frequent distress than those with GAD and controls, but their physiologic responses are comparable in intensity 5.
• The main differences between patients with PD and GAD are a heightened sensitivity to body sensations and more frequent button presses in PD patients 5.
• Both GAD and PD patients exhibit diminished autonomic flexibility, although the underlying mechanisms and physiological responses may differ between the two disorders 5.