The Case of Carol
Reason for Referral
Carol has come to the clinic seeking treatment after her boss gave her a demotion and was likely going to change her work location to an office that was out of range of public transportation, which would mean she would have to drive. The patient has struggled with anxiety over driving previously and these changes have increased the intensity of that anxiety and caused her to seek treatment on her own volition. She also did not feel she could leave her current job because of the anxiety around the hiring process at a new company would be too much to handle.
Presenting Complaints, Symptoms and Possible Diagnosis
Carol self-reported the following symptoms:
• Waking up feeling nauseous and stressed both related to driving and
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The anxiety, panic attacks or phobic avoidance associated with the specific object or situation are not better accounted for by another mental disorder… True Carol, while nervous, was still able to leave her house, especially if she was able to not have to drive. She does not seem to fit the criteria of any of the other disorders listed.
Generalized Anxiety Disorder
A. Excessive anxiety and worry, occurring more days than not for at least 6 months, about a number of events or activities Yes The patient seems to have general worry about many things, mostly tied to driving, but it has become multifaceted now to all aspects of her life. She has been suffering with this for at least 6 months.
B. The person finds it difficult to control the worry. Yes Currently, the patient doesn’t seem to be able to break out of the cycle of worry/fear that she is in. It becomes more intense in some situations, but doesn’t seem to let up or she’s able to let it go
C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months)
a. Restlessness or feeling keyed up or on edge
b. Being easily
Agoraphobia is a psychological disorder characterised by panic and anxiety. This particular anxiety disorder involves the fear of experiencing a panic attack in a public place where safety may be unavailable, which causes discomfort (Lilienfeld, 2017). This disorder is commonly recognized in women and often arises during adolescent years. Often times, people develop agoraphobia after a previous panic attacks, which than causes them to worry about having another in the future (Agoraphobia, 2017). This results in avoidant behaviours, such as evading places where an attack may occur. There are many causes, symptoms, effects on both the individual with the disorder and their loved ones, as well as a variety of treatments available.
Mary has suffered with her illness for over 10 years. She has previously been diagnosis with a Cluster B type Personality Disorder. Mary comes across as narcissistic, self-engrossed and can be very demanding at times. Mary suffers from anxiety and is prone to panic attacks in relation to her PD diagnosis. At times Mary has been known to make ...
living in such a manner. I did not know the exact cause of her anxiety
About three percent of men and women in the U.S. suffer from Generalized anxiety disorder (APAA). It is one of the most common forms of anxiety and seems to be the most left untreated because people don’t know that it can be treated (McGradles). GAD, although it affects many, is a disorder that can be detrimental to the quality of life of an individual. With the regard to the quality of life, the level of severity that a person experiences is a great factor in determining more information. The accumulated information is a defining feature in figuring the dissimilarity of the normal fight or flight response and the diagnoses of GAD. The disorder itself is that of excessive worry (AnxietyBC) about everyday things like, financial situations, school, family, or health (APAA). Having three or more symptoms such as nausea, shaking, sweating, hot flashes, headaches, and many others, is what contributes to the diagnosis (Patel). By understanding what the disorder is and how it can be treated, Generalized Anxiety Disorder is a serious, yet gradually treatable issue.
The onset of Generalized anxiety disorder begins in childhood or adolescents, and It can have a lifetime prevalence of 3-5% with a higher risk in women. One major effect of Generalized Anxiety Disorder is excessive worry or anxiety lasting up to 6 months at a time, although individuals that have Generalized Anxiety Disorder don’t identify their worrying as excessive all of the time, but they will recount subjective distress because of a constant worry, or may have difficulty with control over the worrying, or even experience social impairment. Anxiety can be associated up to 6 symptoms which include inability to sleep, fatigued, lack of concentration, easily agitated, muscle tension, and sleep disturbances. Most of which can affect everyday lifestyle and greatly effect physical health, not only can they cause personal distress but may also cause distress in those around.
Bearing in mind that an anxiety response is a result of various factors, there are different types of anxiety disorders. The most common type of anxiety disorders as described as specific phobias, social anxiety disorder (SAD), panic disorder (PD), generalized anxiety disorder (GAD), obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). According to Anxiety and Depression Association of America (ADAA) (2016), specific phobias affect about 19 million adults in the U.S, while SAD affects 15 million, PD affects 6 million, GAD affects about 6.8 million, OCD affects about 2.2 million and PTSD affects 7.7 million adults respectively. Considering that anxiety disorders are the most common mental illness in the U.S, yet only about one-third of those suffering receive treatment (ADAA, 2016).
Excessive or ongoing anxiety and worry, for at least three months, about two or more activates or events (Table 5-1).
When questioned she closes up and will go into a dissociated and hostile state. She has issues when forming close bonds with others but once formed she will stay with them. To gather a better feel for her personality she would be an INTJ so she keeps trying to process these conflicting feelings with performing surgeries and working for days without sleep. Has gone without sleep for 4 days. Reaction to trauma: She just stares and breathes.
Weston is social anxiety disorder. Criterion A and B list that the individual has marked fear or anxiety about one or more social situations where the person is exposed to possible scrutiny by others, and in return, he/she will act in a way or show anxiety symptoms that may be negatively evaluated. For both of these criteria, I listed him as not meeting them due to there not being significant evidence in his vignette that implies he is particularly fearful of what others think of him. Criterion C and D list that the social situations almost always provoke fear or anxiety and are avoided or endured with intense fear or anxiety. He stated many times that he experiences fear and anxiety in certain social situations. Criterion E and F state that the fear/anxiety is out of proportion to the actual threat posed, and it is persistent, lasting for six months or longer. These criterion are listed in both generalized anxiety disorder and agoraphobia, both of which I also listed as convergent evidence. Criterion G and H are also convergent evidence, and they state that the fear/anxiety causes clinically significant distress or impairment in social, occupational, and other important areas of functioning. Also, none of this is attributable to substance abuse or another medical condition. This is also stated in the criterion of the previously discussed mental illnesses, both of which were proven accurate by the symptoms listed in his vignette. The last two criterion are convergent evidence; criterion I states that the fear, anxiety, or avoidance isn’t better explained by the symptoms of another mental disorder, and criterion J states that if another medical condition is present, the symptoms are exacerbated. I believe that agoraphobia provides a better explanation for his symptoms, and there is not another medical condition interacting with his symptoms to make his fear/anxiety more
Anxiety disorder is a type of abnormal behavior characterized by unrealistic, irrational fear. These types of disorders are diagnosed two as often in women as in men. Although these disorders can be very chronic and serious, they are easily treatable. Generalized anxiety disorder is when people experience fear and worry that is not focused on one specific aspect; nevertheless, they suffer greatly with headaches, dizziness, heart palpitations, and insomnia. Obsessive-compulsive disorder, better known as OCD, involves persistent, unwanted, obsessions and irresistible urges to perform compulsions in order to relieve anxiety. Unlike other anxiety disorders, OCD consists more of anxiety and worry rather than fear itself. Many people who experience OCD are aware that there is no motive behind their actions, however their anxiety is heightened when they try to ignore the compulsions. People with such anxiety disorders often experience sensitivity to other people’s views as well as worry over their surroundings.
The Beck Anxiety Inventory was designed by Aaron T. Beck and is self report scale that consists of 21 items. The items are short and straightforward, making it easy to read and comprehend. All items are related to anxiety and describe a symptom of anxiety that is rate on a four point likert scale according to severity. The answers range from 0-3 and the responses range from “not at all” to “severely; I could barely stand it” and all items are added for a total score. The instructions on the test ask for the respondent to “indicate how much you have been bothered by each symptom during the past week, including today, by placing an X in the corresponding space in the column next to each symptom” (Dowd, 2008). The assessment is intended for adolescents and adults and can be administered individually or in a group setting. An additional copy of the inventory test is also available in Spanish. It was originally created from a sample of 810 outpatients of that were predominately affected by mood and anxiety disorders and research on the original development is described as informative and thorough.
It has been claimed that attentional bias causes anxiety. Attentional bias is when attention is automatically captured by certain stimuli. In terms of anxiety, this can be for example, the fear of spiders. Individuals who suffer from the phobia could, for example be reading a newspaper and related stimuli such as the word ‘web’ would capture their attention. Attentional bias has been found among many anxiety disorders including social phobia, OCD, trait anxiety, social phobia and generalised anxiety disorder (GAD). I will review evidence for the presence of attentional bias among anxiety disorders and try to determine whether attentional bias causes anxiety. I will review evidence from Macleod and Mathews (2002), Koster, Crombez, Verschuere, Damme and Wiersema (2006), and Bradley and Mogg (1999).
A 39 years old male adult attended for a regular 6 monthly dental check up and routine scaling. The patient reports to suffer from anxiety, he is a teacher, a non-smoker, non-drinker and a regular dental attender.
National Institute of Mental Health. (2009). Studying anxiety disorders. NIH Medline plus, 5, 13-15. Retrieved from http://www.nimh.nih.gov/health/publications/anxiety-disorders/complete-index.shtml
In general, anxiety has an effect on emotions. People of all ages with anxiety have common symptoms because anxiety affects the same parts of the brain. Although “moodiness” is a popular emotion that people have frequently, when it repetitively comes up it can be defined as a symptom of anxiety. Hand in hand with “moodiness,” a routine of irritability is another symptom that has been recorded for anxiety. Anxiety is also seen when one is unable to relax, feels overwhelmed, have a sense of loneliness and depression. Even though depression is a symptom of anxiety, it can also be an end result to a critical case of anxiety. Along with emotional, physical symptoms also come to the attention of those who diagnose anxiety.