Case 33: A woman who has been tense and worried for nine months

Case 33: A woman who has been tense and worried for nine months

A 27-year-old woman who arrives an hour early for her appointment and asks to be admitted at once, after nine months of constant tension and worry.

  • 2 min read
  • Checked 01 Nov 2026

The case

A 27-year-old woman arrives an hour before her appointment and insists on being admitted straight away. She describes severe tension, being unable to relax, and worry about small matters, with a vague sense that something bad is coming. She also has sweating, palpitations, a dry mouth, shortness of breath, faintness and dizziness. She has had them without a break for nine months; because of them she has stopped working and rarely travels.

Summary

Diagnosis

Generalised anxiety disorder, one of the anxiety disorders.

What points to it

  • Anxiety that is present all the time, not in attacks, and not tied to a particular situation or object.
  • Worry about minor matters and vague apprehension.
  • Motor tension: she cannot relax.
  • Autonomic symptoms: sweating, palpitations, dry mouth, breathlessness, dizziness.
  • Nine months, well beyond the several months the diagnosis needs, with loss of her job.

What else it could be

Physical causes: hyperthyroidism, arrhythmias, caffeine, drugs, alcohol withdrawal. Depression, which often comes with it. Panic disorder, where the anxiety comes in discrete attacks, and other anxiety disorders, where it has a focus.

Management

  • Explain the diagnosis and reassure her that admission is not needed; offer education and guided self-help first.
  • CBT or applied relaxation, which includes progressive muscle relaxation.
  • An SSRI, an antidepressant such as sertraline, first; if it fails, another SSRI or an SNRI; pregabalin if these are not tolerated.
  • Benzodiazepines only briefly, in a crisis.
  • Ask about alcohol and low mood.

Outlook

Often chronic and fluctuating. Many improve with treatment, but full remission is less common, and symptoms lasting more than a year make chronicity likely: only about a third are in remission three years on.