IS IT REALLY GAD (GENERALIZED ANXIETY DISORDER) OR SOMETHING ELSE?
Although Bruce’s symptoms were typical of a generalized anxiety disorder, sometimes another psychiatric disorder or medical illness may be causing the symptom cluster or syndrome. Many patients who have major depression also experience anxiety symptoms. They too suffer from irritability, insomnia, anxiety, and fatigue, and this may be why Bruce’s internist thought it was depression. Also, many GAD symptoms overlap with other anxiety disorders, such as social anxiety and panic disorder.
Bruce did not appear depressed to me, and he didn’t have other features typical of major depression like appetite loss or feelings of guilt. Also, his insomnia was more representative of an anxiety disorder than depression—he had trouble falling asleep at bedtime, whereas depressed people complain of awakening in the middle of the night or too early in the morning and being unable to fall back to sleep.
When I questioned Bruce about panic attacks, it didn’t seem like a big issue for him. Social anxiety didn’t appear to be the problem either—Bruce felt comfortable with friends and family and even meeting new people occasionally, despite his natural distrust of strangers.
Physical symptoms, including intermittent shortness of breath, fatigue, dizziness, and upset stomach, are common in generalized anxiety disorder, and Bruce had several physical complaints. Sometimes physical illnesses can trigger anxiety symptoms and can be the underlying cause of many anxiety disorder symptoms. I conferred with Bruce’s internist, and we made sure that his laboratory tests were up to date. In older or middle-aged individuals like Bruce, I am particularly concerned about physical or mental symptoms being a clue to an underlying medical condition because age increases a person’s risk of medical illnesses such as cancer, diabetes, and heart disease. We ran some blood tests, checked his cardiogram, and determined that no physical illnesses could explain Bruce’s symptoms.