Generalized Anxiety Disorder & Panic Disorder

A client says they've felt "on edge" every day for months, then another client arrives convinced they're having a heart attack with a normal ECG. Same anxiety family, completely different nursing responses.

Generalized Anxiety Disorder (GAD) is characterized by excessive, uncontrollable worry about multiple life domains occurring more days than not for at least 6 months. The client presents with muscle tension, restlessness, fatigue, difficulty concentrating, irritability, and sleep disturbance — a chronic, low-to-moderate baseline of anxiety without dramatic spikes. Panic disorder is episodic and acute: recurrent unexpected panic attacks peaking within minutes (often cited as ~10 minutes), featuring palpitations, diaphoresis, chest pain, dyspnea, dizziness, paresthesias, and an overwhelming sense of impending doom or fear of dying. Clients often present to the ED believing they are having a cardiac event. Between attacks, clients develop anticipatory anxiety — persistent worry about the next attack — which can lead to agoraphobia. Nursing priorities differ: for GAD, teach long-term coping strategies like relaxation techniques and cognitive restructuring; for panic attacks, stay with the client, maintain a calm presence, use short simple statements, and guide slow diaphragmatic breathing in a low-stimulus environment. SSRIs (e.g., sertraline) are first-line pharmacotherapy for both. Benzodiazepines may be used short-term for acute panic but carry dependence risk.

Key Distinctions

Don't confuse GAD's chronic diffuse worry with panic disorder's discrete intense episodes — GAD is the slow burn, panic is the explosion. Students mistake panic attack symptoms (chest pain, dyspnea) for cardiac emergencies; the normal cardiac workup is key context. Anticipatory anxiety belongs to panic disorder, not GAD — it's the fear of the next attack that drives avoidance behavior.

Clinical Pearl

GAD worries about everything all the time; panic disorder fears the attack itself. If the client can't name one specific trigger and it's been months — think GAD.