MEDizzy - A 22-year-old college student presents to the clinic

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Anxiety Disorders

A 22-year-old college student presents to the clinic reporting worry regarding an exam she must take in a week. She has had low energy, poor concentration, insomnia, and ‘always feels under pressure for over 2 years. She recently saw a neurologist because she was worried that her frequent headaches and muscle tension meant that she had a neurological illness. The neurologist assured her that she didn’t have a neurological disease, which reassured her. What is the most probable diagnosis?

ExplanationGeneralized anxiety disorder is relatively common, with a lifetime prevalence of about 5–8%. It is hallmarked by what is described as ‘free-floating’ anxiety, meaning that an individual will worry about many different things without a specific focus or theme to their concerns. The patient with a generalized anxiety disorder will also have a wide range of symptoms relating to the degree of anxiety, including low energy, poor concentration, insomnia, irritability, muscle tension, and feeling unable to relax, and will generally experience significant functional impairment. There is a substantial level of psychiatric comorbidity (e.g. high prevalence of comorbid depression). ICD-10 diagnostic criteria require that symptoms have persisted for 6 months or more for a diagnosis of generalized anxiety disorder to be made. See Hoge et al (2012).