Sometimes It Isn't the Job. It's an Old Wound.

You could line up five people with generalized anxiety disorder, and they would describe nearly the same thing. Racing heart. Trouble sleeping. A mind that won't stop circling.

Same symptoms. Five completely different reasons underneath.

I'm Christopher Schuman, a board-certified psychiatric nurse practitioner serving patients in Texas and Washington. The diagnostic manual sorts people by symptom, which is useful for a lot of things and useless for the question that matters most: what is this coming from?

A Conversation That Comes Up Often

Someone tells me they feel constant anxiety at work. They feel like they're going to be written up, or fired, or found out.

So I ask whether there's objective evidence that they're not performing well. Any feedback, any documentation, anything concrete.

Often the answer is no. Nothing. Their performance is fine.

So then I ask a different question. Have you ever felt good enough in your life?

And more than occasionally, the answer is no. Not really. Not ever.

That's not a workplace problem. That's a wound, and it's been there a long time. The job didn't create it. The job is just where it's currently showing up.

Why This Distinction Changes Everything

If someone's anxiety comes from a genuine culture mismatch with a supervisor, the work is about navigating that relationship. If it comes from a workload that isn't sustainable, the work is about the workload.

But if it comes from a self-esteem wound that predates the job by decades, then changing the job changes nothing. The person will bring the same feeling to the next one.

And there's a loop that forms. Someone who never feels good enough starts second-guessing their own work. They hesitate. A supervisor notices the hesitation and reads it as uncertainty, maybe asks where their confidence went. Now the person has external evidence for the thing they already believed.

The performance was fine. The perception of the performance was the problem, and then the perception started affecting the performance.

What This Means for Treatment

This is a large part of why I don't reach for a prescription pad first.

If someone's anxiety is rooted in an old wound about worth, an SSRI is not the answer to that question. It might take the edge off the physical symptoms, and sometimes that's genuinely worth doing. But it doesn't touch the thing generating them.

That work usually belongs with a good therapist, and part of my job is knowing which one to send you to. I have a network of people who specialize in different things, and matching the person to the right kind of work matters more than most people realize.

The Question Worth Sitting With

If you've been anxious at work for a long time, it's worth asking yourself honestly whether the feeling is new.

Did it start with this job, this supervisor, this stretch? Or is it a familiar feeling that found a new place to live?

There's no wrong answer. But the answer determines what would actually help, and it's the first thing I want to understand before suggesting anything.