Anxiety Disorders

Anxiety becomes a disorder when fear or worry is disproportionate, persistent, difficult to control, and associated with distress or impaired functioning. Start by identifying the time course and trigger pattern rather than anchoring on a single symptom such as tachycardia or shortness of breath. Generalized anxiety disorder (GAD) is characterized by excessive worry about several areas of life occurring more days than not for at least 6 months. The worry is accompanied by at least three of restlessness, fatigue, difficulty concentrating, irritability, muscle tension, or sleep disturbance. Abrupt surges of intense fear suggest a panic pattern; anxiety tied to a specific object, situation, trauma reminder, or social scrutiny points toward a different anxiety disorder and changes the psychotherapy approach. An experienced clinician also asks whether the presentation could be medical, substance-related, or medication-induced. Tremor and palpitations may reflect anxiety, but new hypoxemia, syncope, chest pain, fever, delirium, stimulant exposure, or alcohol withdrawal requires medical assessment rather than reassurance that the symptoms are “just panic.” Suicidal thinking, mania, psychosis, severe functional decline, and inability to maintain basic self-care change the priority...