What is a major imbalance associated with the pathophysiology of generalized anxiety disorder?

The major imbalance associated with the pathophysiology of generalized anxiety disorder (GAD) is the imbalance of neurotransmitters such as dopamine, norepinephrine (NE), and serotonin. In GAD, evidence suggests that these neurotransmitters do not function optimally, which can lead to the symptoms of anxiety.

Serotonin is crucial in regulating mood and anxiety levels, while norepinephrine is associated with the body's stress response. Dopamine also plays a role in mood regulation and reward pathways. Imbalances in these neurotransmitters can disrupt the normal emotional regulation mechanisms, contributing to the heightened anxiety experienced by individuals with GAD.

The other options do not specifically address the core neurotransmitter imbalances involved in anxiety disorders. High cortisol levels may be associated with stress and anxiety but are not the defining factor in the pathophysiology of GAD. Low insulin levels are more related to metabolic disorders and do not play a direct role in anxiety disorders. Excessive endorphin release typically relates to pain modulation and could lead to opposite effects in mood and anxiety rather than an imbalance relevant to GAD.