AssessmentsGeneralized anxiety disorder
Generalized anxiety disorder
USMLE® Step 1 style questions USMLE
A 35-year-old woman presents to the physician for evaluation of fatigue. The patient tells the physician she finds it difficult to sleep at night because she feels she needs to check on her 12-year-old son multiple times throughout the night to ensure he is safe. She adds that she feels worried about her family most of the time, and she calls them multiple times during the day, although she knows this may be “too much.” She says that lately, she has been “irritable” and “feeling on edge.” Additionally, the patient changed her work recently, and she feels worried she may lose her job because she finds it difficult to concentrate while at work and keeps thinking about her family. She says that this has been going on for more than 8 months. Past medical history is noncontributory. Which of the following is the most likely diagnosis in this patient?
Content Reviewers:Rishi Desai, MD, MPH
Contributors:Tanner Marshall, MS
Say you’ve got a huge presentation in front of all your colleagues—you’re feeling a bit nervous, and you get even more stress in the final days leading up to the presentation.
That stress is completely normal, and really, probably useful in certain situations since it can make you more alert and careful.
After the presentation’s over you feel the stress start to fade away, right?
At this point it’s considered to be anxiety.
That anxiety might even get worse over time, and might even cause further problems like chest pains or nightmares.
Sometimes the anxiety is so severe that it causes someone to be anxious about leaving the house or doing everyday things like going to work or school.
This anxiety may be a sign of Generalized Anxiety Disorder, sometimes shortened to GAD.
GAD’s characterized by excessive, persistent, and unreasonable anxiety about everyday things, like money, family, work, and relationships; even sometimes the thought of getting through the day causes anxiety.
There are three general categories for anxiety.
If the anxiety doesn’t seem to go away, it’s called persistent anxiety.
If someone feels greater levels of anxiety than the average person, it’s called excessive anxiety.
If the anxiety is about something that shouldn’t really be causing much stress at all, it’s called unreasonable anxiety.
People who have GAD might understand that their anxieties are excessive and unreasonable, but they feel it’s out of their control and don’t quite know how to stop it.
People with severe GAD might be completely debilitated and have trouble with the simplest daily activities, or they might be only mildly affected and be able to function socially and hold down a job.
Sometimes the feelings might worsen or improve over time.
In addition to having feelings of worries and anxiety, other symptoms of generalized anxiety disorder include edginess and restlessness, difficulty concentrating or feeling like the mind just goes blank, and irritability.
These psychological symptoms can also lead to physical manifestations of symptoms like digestive problems from eating more or eating less.
People with generalized anxiety disorder might have muscle aches and soreness from carrying tension in their muscles.