Anxiety Disorder: Core Preoccupation
Patients with anxiety disorders are most typically preoccupied with negative things that may happen in the future (Answer C). This future-oriented worry is the pathognomonic feature of generalized anxiety disorder, the most prevalent anxiety disorder, and represents the hallmark symptom across anxiety disorders more broadly.
Core Clinical Features
The defining characteristic of anxiety disorders is excessive worry about future events and outcomes. 1 This manifests as:
- Prolonged, excessive worry about future possibilities - This is the hallmark of generalized anxiety disorder (GAD), which is the most common anxiety disorder seen in clinical practice 1
- Apprehensive expectation - Patients describe "expecting the worst" or feeling that "something bad is going to happen" 1
- Multiple excessive worries that may be disproportionate to actual risk (e.g., excessive fear of recurrence, worry about multiple symptoms) 1
Why Other Options Are Incorrect
Guilt about past mistakes (Option A) is characteristic of major depressive disorder, not anxiety disorders. 1 The DSM-5 explicitly distinguishes GAD from depression by noting that "guilty ruminations" are a feature of major depressive disorder rather than anxiety. 1
Preoccupation with being unsafe due to others' bad motives (Option B) describes paranoid personality disorder or paranoid ideation, not anxiety disorders. 2 While anxiety patients may have concerns about safety, these are future-oriented worries rather than beliefs about others' malicious intent.
Specific irrational mental images (Option D) describes obsessions in obsessive-compulsive disorder (OCD), which is classified separately from anxiety disorders in DSM-5. 1 OCD involves recurrent intrusive thoughts, urges, or images that are unwanted and cause distress, but this is distinct from the worry-based preoccupation of anxiety disorders.
Clinical Recognition Challenges
Patients with anxiety may not present with overt "anxiety" symptoms. 1, 3 Instead, they often describe their preoccupations as:
- "Concerns" or "fears" rather than anxiety per se 1, 3
- Worries that are persistent and interfere with daily functioning 1
- Apprehensive expectations about future events that feel uncontrollable 1
The excessiveness of worry is a key diagnostic feature - the worry in GAD is disproportionate to the actual likelihood or impact of feared events. 1