Generalized Anxiety Disorder: Diagnosis, Neurobiology, and Treatment

LJ is a 47-year-old divorced male who presented with a chief complaint of anxiety. He described anxiety as being nervous and not being able to turn his mind off. He was worrying uncontrollably about his upcoming marriage, having to sell his house, the impact of a move on his children, and how his children would get along with his stepchildren. He was irritable with his fiancée. He was also worried about being unproductive at work and an upcoming review with implications for his finances over the next several years. He reported difficulty falling asleep and disturbed sleep, and not feeling rested in the morning. He had considerable difficulty paying attention and staying focused on even simple tasks. As a result he had difficulty functioning at work and did not go to work for a few days because he felt so overwhelmed. He was isolating himself socially. He described wanting to stay at home and crawl into a safe place. Physically, he felt he had little energy. He had nonexertional, nonradiating chest pains, increased perspiration, and facial flushing. He also described gastrointestinal distress, a feeling of tightness in his stomach, which was reduced with food. These symptoms had become an issue during the previous year as he struggled with his decision to remarry.