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Difficulty: EasyAnxiety, OCD, and Trauma-Related Disorders

A 35-year-old teacher visits her primary care physician due to chronic fatigue and neck pain. During the interview, she reveals that she feels constantly 'on edge' and struggles to control her worries. Over the last 7 months, she has experienced relentless anxiety concerning her family's health, financial stability, and school responsibilities, despite no recent changes in her life circumstances. She notes that these thoughts frequently prevent her from falling asleep. Physical examination is unremarkable, and recent laboratory studies, including thyroid-stimulating hormone levels, are within normal limits. Which of the following is the most likely diagnosis?

  1. Generalized anxiety disorderAnswer
  2. B
    Adjustment disorder with anxiety
  3. C
    Panic disorder
  4. D
    Acute stress disorder
  5. E
    Obsessive-compulsive disorder

Answer

Generalized anxiety disorder
The patient's presentation of excessive, uncontrollable worry about multiple issues (health, finances, work) lasting for at least 6 months, along with somatic symptoms (muscle tension, fatigue, sleep disturbance), perfectly aligns with the DSM-5 criteria for generalized anxiety disorder (GAD). The normal TSH levels appropriately rule out hyperthyroidism, a common medical mimic.

Step-by-Step Solution

1
Analyze the primary symptoms and their duration.
The patient has excessive, uncontrollable worry about multiple everyday domains (family, finances, work) lasting for 7 months.
Duration is a critical diagnostic criterion for psychiatric disorders; greater than 6 months of excessive worry points toward generalized anxiety disorder.
2
Identify accompanying somatic symptoms.
The patient experiences chronic fatigue, neck pain (muscle tension), feeling 'on edge', and sleep disturbance.
Generalized anxiety disorder requires the presence of at least three associated somatic or cognitive symptoms, such as restlessness, fatigue, difficulty concentrating, irritability, muscle tension, or sleep disturbance.
3
Rule out other potential causes.
Normal physical exam and TSH levels rule out hyperthyroidism. The absence of a specific stressor, panic attacks, or trauma rules out adjustment disorder, panic disorder, and acute stress disorder.
Psychiatric diagnoses are made after ensuring symptoms are not better explained by another medical condition, substance, or mental disorder.

Key Concept

Generalized anxiety disorder is characterized by excessive, difficult-to-control worry about multiple everyday issues lasting for at least 6 months, accompanied by somatic symptoms like muscle tension, fatigue, and sleep disturbance.
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Topics

Anxiety, OCD, and Trauma-Related Disorders

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