A 25-year-old female presents to her primary care physician with complaints of muscle tension, especially in her shoulders and neck, contributing to tension headaches. She describes decreased sleep, chronic fatigue and constant restlessness in addition to poor concentration at work, with repeated run-ins with her coworkers. She has been a worrier since childhood, with worsening bouts when under stress; currently she reports having a hard time controlling her worry, which extends into several topics. Physical exam reveals a healthy, tense female with normal vital signs and generalized muscular tension. She does not abuse substances, and medical history is unremarkable.
Patients may try to reduce anxiety by drinking alcohol or taking CNS depressants, thereby increasing the risk of substance abuse and dependence. Depression or panic attacks may co-occur, with symptoms including shortness of breath, palpitations, hot and cold flashes, or fear of dying or going crazy.