Anne initially states she has entered counseling because she has been struggling with insomnia but then acknowledges that she is _____.
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Ann, a 32-year-old medical secretary in Dublin, Ireland, is referred to a clinic for treatment of depression. She confides that the reason she is depressed is that for the last 5 months, she has been afraid that she will urinate in public. She has never actually done this, and in the safety of her own home, she considers the idea that it will actually happen to her to be nonsensical. When Ann is away from home, the fear dominates her thinking and she takes precautions to prevent this from happening. She always wears sanitary napkins, never travels far from home, limits her intake of fluids, has stopped drinking alcohol, and has had her desk at work relocated near a toilet. For the 2 weeks before the consultation, she was unable to go to work because the fear had become so intense. Ann vaguely recalls that her deceased father also had a fear of urinating in public. Before leaving for work each day, he urinated several times and avoided taking any fluids. Her younger sister has been successfully treated for a cleansing ritual. Ann had psychiatric treatment 10 years ago when she began to fear that she had contracted syphilis, even though there were no clinical or laboratory evidence of infection. Up until 5 months ago, she had never feared that she would urinate in public. In addition to these specific fears, she has always been an anxious, insecure person, considered by her family to be overly cautious and perfectionistic. For the past year, she has been upset about her boyfriend's impending return to his home country after completing his medical studies in Ireland. She was divorced 5 years previously and is now living with her 7-year-old son and mother. Her mother disapproves of her boyfriend, and Ann has felt increasing pressure to end the relationship. She believes that the onset of her current difficulties coincided with the stress of her relationship with her mother and the threat of her boyfriend's departure from the country. When interviewed, Ann is visibly anxious. She remarks that she has been feeling despondent about her problems. She has trouble sleeping and has no energy during the day. Although her appetite is poor, she has not lost any weight.
Supreeta N.
Ann, a 32-year-old medical secretary in Dublin, is referred to a clinic for treatment of depression. She confides that the reason she is depressed is that for the last six months she has been afraid that she will urinate in public. She has never actually done this, and in the safety of her own home she considers the idea that it will actually happen to her to be nonsensical. When Ann is away from home, the fear dominates her thinking, and she takes precautions to prevent its happening. She always wears sanitary napkins, never travels far from home, limits her intake of fluids, has stopped drinking alcohol, and has had her desk at work relocated near a toilet. For the two weeks before the consultation, she has been unable to go to work because the fear has become more intense. She vaguely recalls that her deceased father also had a fear of urinating in public. Before leaving for work each day, he urinated several times and avoided taking any fluids. Her younger sister has been successfully treated for a cleansing ritual. Ann had psychiatric treatment ten years ago when she began to fear that she had contracted syphilis, even though there was no clinical or laboratory evidence of infection. Prior to six months ago, she never feared that she would urinate in public. Apart from these specific fears, she has always been an anxious, insecure person, considered by her family to be overly cautious and perfectionistic. For the past year she has been upset about her boyfriend's impending return to his home country, after completing his medical studies in Ireland. She was divorced five years previously, and is now living with her seven-year-old-son and mother. Her mother disapproves of her boyfriend, and Ann has felt increasing pressure to end the relationship. She believes that the onset of her current difficulties coincided with the stress of her relationship with her mother and the threat of her boyfriend's departure from the country. When interviewed, Ann is anxious and agitated. She remarks that she has been feeling despondent about her problems. She has trouble sleeping and has no energy during the day. Although her appetite is poor, she has not lost any weight.
Crystal W.
Helen Bates was a 27-year-old single administrative assistant who presented for counseling for mood problems. She had recently begun an intensive outpatient program after a first lifetime hospitalization for an impulsive overdose following the breakup of a 2-year relationship. She said she had become increasingly sad and hopeless for 1-2 months in anticipation of the breakup. A month prior to her admission, she started seeing a new psychotherapist who told her that she had "borderline traits" and "situational mood swings." During these 4-8 weeks, Ms. Bates' mood has been moderately depressed throughout the day on most days with no diurnal variation and intact mood reactivity. She had recently gained about 10 pounds from "overeating comfort food and junk." She denied prominent irritability or argumentativeness. She described her self-esteem as "none" and had found it hard to feel motivation or to concentrate on routine tasks. By contrast, sometimes she would have "bursts" of nonstop thinking about her estranged boyfriend and devising ways to "get him back," alternating with "grieving his loss." She described times of being flooded with strategies to regain his interest (including purchasing a full-page newspaper "open letter" to him) and recently found herself awake until 5:00 or 6:00 am journaling or calling friends in the middle of the night, "for support." She would then "trudge through the day" without fatigue after only 2-3 hours of sleep. These symptoms began prior to her hospitalization. She denied drug or alcohol misuse and self-injurious behavior. Until this break-up, she denied a history of particularly intense or chaotic relationships as well as a history of suicidal behavior. Ms. Bates saw a counselor in high school for "moodiness" and poor grades. She became "depressed" in college. At that time, she began antidepressants and psychotherapy but improved quickly, stopping both after a few weeks. While in the hospital following her suicide attempt, she started medications at bedtime for "sleep." Ms. Bates was the youngest of three children who grew up in a middle-class suburban home. She attended public school and a state college as "mostly a B student" and hoped someday to go to law school. She described herself as having been a "quiet, anxious" child and "not a troublemaker." Her older brother abused multiple substances, although Ms. Bates said she herself had never used illicit substances. Her young sister was treated for "panic attacks and depression," and Ms. Bates knew of several aunts and cousins who she thought were "depressed." Based on the above case, what diagnosis would you provide (with appropriate specifiers)? How did you arrive at the above diagnosis? Use the below outline to help organize some of your diagnostic process- Diagnostic Process Establish all symptoms the patient is exhibiting Are the symptoms better explained by typical behavior? Are the symptoms better explained by a general medical condition? Are the symptoms better explained by substance use? Create a list of disorders that are likely diagnoses Evaluate each item on the list for reasons it may or may not be the disorder Establish the primary diagnosis.
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