In adults with new anxiety symptoms, which feature most strongly suggests a primary medical cause requiring medical evaluation?

• A. Gradual onset over several years
• B. Predominant worry about many social situations
• C. No accompanying physical symptoms
• D. Sudden onset after age 50

Answer: (D)

The key idea is recognizing red flags for a medical or physiological cause when anxiety appears suddenly in an older adult. A sudden onset of anxiety symptoms after age 50 is especially concerning because new anxiety at this age is not typical of primary anxiety disorders, which usually begin earlier and unfold gradually. This pattern prompts a medical evaluation to rule out contributors such as thyroid problems, cardiovascular issues, metabolic disturbances, medication or substance effects, withdrawal states, or neurological conditions.

The other features described fit more with primary anxiety presentations: anxiety that has developed gradually over years is common for disorders like generalized anxiety; worry focused on many social situations points toward social or generalized anxiety; and the absence of accompanying physical symptoms does not reliably point to a non-medical cause. But none of these as strongly as a sudden onset after 50 in signaling a potential medical issue requiring evaluation.