When Screening Uncovers Hidden GAD

Matthew Macaluso, DO, highlights that routine screening and measurement-based care can uncover generalized anxiety disorder (GAD) in patients who would not otherwise identify anxiety as the primary issue. He describes patients presenting with nonspecific symptoms such as fatigue, headache, insomnia, or stress or depression, where anxiety is not initially recognized. In one case, a patient referred for exhaustion and job-related stress was found, through completion of the GAD-7 questionnaire, to have significant anxiety symptoms, shifting the clinical focus. This underscores how patient-reported descriptors may obscure the underlying diagnosis and reinforces the importance of structured screening tools in routine practice.Dr Macaluso emphasizes that anxiety often presents with both psychic and somatic features, including persistent worry, rumination, and physical symptoms such as fatigue, restlessness, and sleep disturbance, making it a master of disguise. Measurement-based care, particularly the use of standardized rating scales, provides precise symptom identification and can reveal clinically meaningful anxiety that might otherwise be missed in time-limited encounters. The clinical implication is that systematic screening enhances diagnostic accuracy and ensures appropriate identification and management of GAD, particularly in patients presenting with predominantly physical symptoms.