Generalized Anxiety Disorder: A Case Study

March 16, 2017

Jane, 34 years old, mother of three children, found herself irritable and losing confidence in managing routine day to day issues.  She started worrying on trivial matters. For example, if the school bus was late, she imagined that there was an accident. If her husband did not pick up the phone, she considered the most inappropriate or dreadful reasons. She also saw images of these dreadful scenarios - of her children being pulled out of the mangled bus or of her loving husband in the arms of his attractive secretary.


Once, her feeling was so intense that she "lost control of her tongue" and told her husband that his ''body language with the secretary" was inappropriate. Later she felt ashamed of herself and was apologetic.


She fully knew that these thoughts and images were excessive, out of proportion to reality, and unwarranted, but she spent a lot of time hounded by these thoughts, images and emotions of a negative nature. She sometimes found them intense, uncontrollable and persistent. She repeatedly told herself that the chances for any such fears to be true were extremely remote, but this did not prevent these unlikely sinister possibilities from repeatedly surfacing.


Occasionally she ended up acting on these thoughts. She once advised the school bus driver to be careful while driving and he replied with irritation that he had been doing this job without any complaint for the last 16 years. On another occasion she secretly checked her husband's mobile, an act that she felt ashamed of doing and promised herself never to repeat again.


Several other questions crossed her mind - Am I not attractive as I used to be? Am I becoming mad? Was the milk and other foods adulterated?  Was the meat full of hormones? Did the neighbor overhear the argument she had with her husband last night? Does her dry mouth mean that I have diabetes? She would go online and check for answers, only to end up with more questions. While shopping, she carefully checked groceries, bottles and containers for signs of contamination or if they were past their expiry date.


She found it difficult to concentrate when she read news paper articles or while cooking or stitching. She found herself forgetful - she couldn't recollect where she had kept things. She found her thinking to be "broken up" - "I think of something and before that thought is complete, I start thinking of something else".


Stitching was her hobby, her accomplishment - she was admired for designing beautiful dresses for herself, her family and friends and occasionally sold her creations. Now she got a feeling that stitching was risky - if there was some mistake, she would be criticized and she started avoiding stitching for others. Similarly, she decided to shop only with her husband "to avoid mistakes". She started avoiding people who could be critical - the question on her mind was "what will people say?", "what negative comment is coming?".


After this had gone on for several months, she found herself tense, on the edge, often losing her temper on trivial things. She went to her husband for reassurance - and initially he was supportive, but after sometime he responded that her questions were repetitive and that she was wasting a lot of energy on trivial issues and that he was not going to answer these questions. This led to arguments and she became irritable and felt that her husband was not supportive.


As she looked back, she realized she was not like this before - that all this anxiety had started about a year back during a rather difficult phase in their life when her husband had lost his job. They were in a severe financial crisis and as she told her psychiatrist later "we all had lived on bread and jam for months". Later, her husband had found an even better job and their problems were solved, but the anxiety persisted and actually increased. She felt she worried so as to "prevent problems before they emerged".


As the worries increased, Jane developed a feeling of insecurity - "anything could potentially go wrong anytime". She frequently saw people's intentions or events around her in negative terms - as intimidating and critical. This also led to a feeling of loss of self confidence and loss of self esteem. Jane also developed a host of physical symptoms - difficulty to fall asleep ("her mind keeps running as I try to sleep"), restlessness ("I can't sit in one place peacefully"), muscles tensing up, body pains (especially around the upper back, shoulder and neck), repeated headaches ("tension headaches"), palpitations, breathlessness, repeated loose stools when she worried, and dry mouth that led her to suspect she had diabetes. All these symptoms got worse prior to her periods. She read about these symptoms online and considered all the sinister possibilities and rushed in turn from doctor to doctor - physician, cardiologist, pulmonologist and gastroenterologist. Several investigations, all of which were normal, finally led to a psychiatry referral.


After taking a detailed history and mental state examination, the psychiatrist made a diagnosis of Generalized Anxiety Disorder (GAD). She investigated Jane for some medical conditions that can cause anxiety (for example hyperthyroidism). She educated her about anxiety and started her on appropriate medication. The doctor also referred her to a clinical psychologist for a psychological assessment and Cognitive Behavior Therapy (CBT).


3% to 8% of people in the general population have GAD. Women have the problem twice as often as men. The illness can occur at any age - but most consultations happen between 20 and 40. GAD is also seen in young children, teenagers and elderly people. It is the most common anxiety disorder in the elderly.


Jane improved well on treatment, and in three months was back to her usual self.

Please note that the information in this case study should not be considered as medical advice for an individual’s condition. If anyone shows or feel symptoms of a possible medical condition, we strongly encourage you to seek advice from your primary physician or a mental health professional for an evaluation as soon as possible.


The names been changed to protect the privacy of individuals.

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