Generalized Anxiety Disorder

Persistent anxiety and uncontrollable worry for at least 6 months characterize generalized anxiety disorder. First-line treatments are cognitive behavioral therapy or pharmacotherapy with a selective serotonin-reuptake or serotonin–norepinephrine reuptake inhibitor. Foreword This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors’ clinical recommendations. Stage A 46-year-old married woman presents with insomnia, headaches, muscle tension, and back pain. She describes a long-term pattern of worrying about several life situations, including health, finances, and her job, and she notes increased anxiety associated with her teenager’s leaving home to attend college. She drinks alcohol daily to reduce the tension and help her sleep. In reviewing her history, you note that she has visited your office many times over the past year because of physical symptoms. What do you advise? The Clinical Problem Generalized anxiety disorder is characterized by chronic and persistent worry. This worry, which is . . .